What is actinic keratosis?
Actinic keratosis, also known as solar keratosis, are an early form of squamous cell carcinoma that appear on continuously sun-exposed skin. 1
They manifest as skin color or slightly reddish spots that can be rough to the touch. Sometimes they can also be really thick, simulating a little horn.
They can present as single lesions or multiple lesions. In the latter, the possibility of a field of cancerization (ie. area of sun-damaged skin that can be found surrounding each AK lesion and that displays the same genetic changes found in the lesion itself) must be taken into account
What are the risk factors for developing actinic keratosis?
- The biggest risk factor for the development of actinic keratosis is a long exposure to UV light (sun –exposure or bed tanning). In this sense, people of advanced age that have worked outdoor for a long time, people that like playing outdoor sports, going to the beach or people living in countries closer to the equator, are at higher risk of developing actinic keratosis.3-5
- Other risk factors are male sex and people with fair skin color with red or blond hair.3-5
- Finally, immunosuppressed people are also at a higher risk of developing actinic keratosis.6-8
How can we prevent the appearance of actinic keratosis?The first step towards preventing actinic keratosis is by preventing from UV-light:11-14
- Using the right sun screen whenever you go out in the sun. Your sun screen should protect against UVA- and UVB radiation. The sun protection factor (SPF) indicates by which factor the skin's innate protective ability is multiplied. In other words, it tells you how long your skin can be exposed to the sun without getting a sunburn, it should be at least SPF 30. It is generally recommended to apply them 20-30 minutes before sun exposure.
- It is also important to use a cap or a hat, especially in bald people.
- Consider wearing sun protective textiles.
- Avoid sun exposure between 11am and 3pm.
- Avoid artificial sunlight (sun beds/tanning salons).
- Schedule an annual dermatologic skin exam.
- Werner RN, et al. International League of Dermatological Societies (ILDS) Evidence and consensus based (S3) Guidelines for the Treatment of Actinic Keratosis, European Dermatology Forum, 2015. Accessed online on July 14th, 2015 at http://www.euroderm.org/edf/index.php/edf-guidelines/category/5-guidelines-miscellaneous.
- Ferrándiz C, et al. Prevalence of actinic keratosis among dermatology outpatients in Spain. Actas Dermosifiliogr. 2016.
- Harvey I, Frankel S, Marks R, Shalom D, Nolan-Farrell M. Nonmelanoma skin cancer and solar keratoses. I. Methods and descriptive results of the South Wales Skin Cancer Study. Br J Cancer 1996; 74: 1302–1307.
- Frost CA, Green AC. Epidemiology of solar keratoses. Br J Dermatol 1994; 131: 455–464.
- Frost CA, Green AC, Williams GM. The prevalence and determinants of solar keratoses at a subtropical latitude (Queensland, Australia). Br J Dermatol 1998; 139: 1033–1039.
- Parrish JA. Immunosuppression, skin cancer, and ultraviolet A radiation. N Engl J Med 2005; 353: 2712–2713.
- Stockﬂeth E, Ulrich C, Meyer T, Christophers E. Epithelial malignancies in organ transplant patients: clinical presentation and new methods of treatment. Recent Results Cancer Res 2002; 160: 251–258.
- Tessari G, Girolomoni G. Nonmelanoma skin cancer in solid organ transplant recipients: update on epidemiology, risk factors, and management. Dermatol Surg 2012; 38: 1622–1630.
- Werner RN, Sammain A, Erdmann R, Hartmann V, Stockﬂeth E, Nast A. The natural history of actinic keratosis: a systematic review. Br J Dermatol 2013; 169: 502–518.
- Chen GJ, Feldman SR, Williford PM, Hester EJ, Kiang SH, Gill I, et al. Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer. Dermatol Surg. 2005;31:43-47.
- Ulrich C, Jurgensen JS, Degen A, Hackethal M, Ulrich M, Patel MJ, et al. Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: A 24 months, prospective, case-control study. Br J Dermatol. 2009;161 Suppl 3:78-84.
- Berardesca E, Bertona M, Altabas K, Altabas V, Emanuele E. Reduced ultraviolet-induced DNA damage and apoptosis in human skin with topical application of a photolyase-containing DNA repair enzyme cream: Clues to skin cancer prevention. Mol Med Report. 2012;5:570-574.
- Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329:1147-1151.
- Darlington S, Williams G, Neale R, Frost C, Green A. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses.A rch Dermatol. 2003;139:451-455.
- Stockfleth E., the paradigm shift in treating actinic keratosis: a comprehensive strategy. J Drugs Dermatol 2012;11:1462-1467.