Written by: Deen Kurrimbux

Actinic keratoses (AK) are dry scaly patches of skin caused by long-term exposure to the sun. Also known as solar keratoses the patches can vary in colour (red, pink or brown) and diameter (from millimetres to centimetres) and the skin can become very thick often forming small hooks and spikes.

Actinic keratoses are found where there is sun exposure on the body, namely the head, face (ears, forehead and nose), lower arms and legs (in women below the knee). The patches, while unsightly, itchy and sore, will usually fade away however this is a small risk that the patches can develop into squamous cell carcinoma (SCC) if left untreated.

AK affects mainly males of fair complexion (blue eyes, blond hair, red hair) over the age of 40 especially those who have an outdoor lifestyle (career or leisure). Diagnosis is done by the local GP who usually takes a sample for study. Further investigation is warranted only if the initial diagnosis is inconclusive or there is a strong possibility of the patch(es) becoming cancerous. If they are cancerous then several treatments are available.

Topical applicants such as imiquimod cream, diclophenac gel and fluororacil cream are applied daily over the course of several weeks causing the abnormal skin cells to die. After the patch has cleared up the remaining skin will feel sore.

Cryotherapy (freeze treatment) is also recommended. This process involves liquid nitrogen applied to the affected areas; the cells die off and the skin flakes away. While not overly painful there is some initial discomfort.

Excision is necessary when the AK patch is suspected to be cancerous. The surgery is done under local anaesthetic and completed with suturing the wound. This will leave scarring.

Other treatments shown to be effective are, photodynamic therapy – there light is shone onto a pre-applied cream that then chemically destroys the cells. Dermabrasion and chemical peels work by physically eroding the affected area.

Reducing the exposure to the sun by covering with clothing and head protection along with sun protection factor 15 sunscreen is thoroughly recommended to avoid the possibility of further developing additional AKs or developing them in the first instance.

Treated AKs will usually clear up completely, however, its presence in the first place strongly indicates skin damage by sun over exposure which leads to a stronger risk of developing skin cancer.

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