DermNet NZ

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Actinic keratoses

Rough scaly spots on sun-damaged skin are called actinic keratoses. They are also known as solar keratoses. They should be distinguished from other kinds of keratosis (scaly spot) such as seborrhoeic keratosis, porokeratosis and keratosis pilaris.

What are actinic keratoses?

Actinic keratoses are a reflection of abnormal skin cell development due to exposure to ultraviolet radiation. They are considered precancerous or an early form of squamous cell carcinoma.

They appear as multiple flat or thickened, scaly or warty, skin coloured or reddened lesions. A keratosis may develop into a cutaneous horn.

Actinic keratoses are very common on sites repeatedly exposed to the sun especially the backs of the hands and the face, most often affecting the nose, cheeks, upper lip, temples and forehead. On the lips they are often called actinic or solar cheilitis. They are especially common in fair-skinned persons or those who have worked outdoors for long periods without skin protection. Sun-damaged skin is also dry, discoloured and wrinkled.

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Actinic keratoses

Many more images of actinic keratoses ...

Are actinic keratoses dangerous?

Actinic keratoses themselves are harmless, but they can be uncomfortable and unsightly.

The main concern is that actinic keratoses can give rise to a type of skin cancer called squamous cell carcinoma. The risk of squamous cell carcinoma occuring in a patient with more than ten actinic keratoses is about 10 to 15%.

Actinic keratoses are usually removed because they are unsightly or uncomfortable, or because of the risk that skin cancer may develop in them. If a actinic keratosis becomes thickened or ulcerated get it checked; it may have become a skin cancer. Squamous cell cancers often look like volcanoes erupting within the skin.

People with keratoses should visit their doctor regularly for examination as they are also at risk of developing basal cell carcinoma and malignant melanoma. Referral to a dermatologist may be necessary.

Treatment of actinic keratoses

Treatment of a actinic keratosis requires removal of the defective skin cells. New skin then forms from deeper cells which have escaped sun damage.

It is not practical to remove all keratoses in those with very extensive sun damage; in such cases it is important to get rid of thickened or tender lesions as these are the ones at greatest risk of progressing to skin cancer.

Treatments may include:

Prevention of actinic keratoses

Actinic keratoses may be prevented by protecting skin from ultraviolet radiation. If already present, keratoses may even improve with regular application of broad spectrum sunscreen to affected areas every day. Sun protection is vital for all fair skinned people working or enjoying themselves outdoors.

The number and severity of actinic keratoses can also be reduced by taking nicotinamide (vitamin B3) 500 mg twice daily.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.