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Actinic keratosis

DEFINITION

An actinic keratosis is an abnormal lesion on the skin which is rough and scaly. Like many skin lesions, these are caused by exposure to sunlight. They usually appear on areas which are exposed to sun including the face, ears, neck, lips, hands, forearms, and scalp. Actinic keratoses usually appear in older adults and, if left untreated, can progress to skin cancer. Actinic keratoses come from the top layer of skin, called the epidermis. The top layer of skin usually regenerates in an orderly fashion. In the case of actinic keratoses, the epidermis begins to regenerate in an abnormal way and not be shed in a normal way. This abnormal regeneration is the mechanism by which most cancers begin and, in this case, is caused by exposure to ultraviolet (UV) radiation. Those who are at highest risk of developing actinic keratoses are: male, over 40, exposed to or live in a sunny climate, have a history of bad sunburns, have paler skin and light colored eyes, have freckles or get freckles from the sun, or are immunocompromised (have a weak immune system) due to AIDS, chemotherapy, some type of cancer or certain medications. The most important thing you can do to prevent actinic keratoses and skin cancer is to wear SPF 30 or greater sunscreen every day and decrease your exposure to sunlight by covering your body with clothing or staying indoors.

SYMPTOMS
Rough patches of skin, dry patches, raised patches of skin, pink or brown patches, itching or burning of affected skin

DIAGNOSIS
Actinic keratosis is diagnosed by physical exam. If there is any question about whether a lesion is an actinic keratosis, a biopsy can be done by a dermatologist. A biopsy is a simple procedure performed in the doctor’s office where the doctor takes a small piece of skin for closer examination in a lab. You should see a dermatologist if your skin lesion is painful, bleeds, itches, oozes, or changes (in size, color, texture or shape).

TREATMENT
Treating actinic keratoses is important as they can become skin cancer over time. Several treatment options are available for actinic keratoses. Most commonly, a doctor can freeze off the lesions with liquid nitrogen or a similar substance (cryotherapy) right in the doctor’s office. This therapy kills the top layer of skin, turning it into a blister or reddened area. The actinic keratosis will then fall off, allowing new, healthy cells to grow underneath. Sometimes, your doctor may choose to prescribe an ointment or cream containing fluorouracil, a chemotherapy drug which prevents abnormal cells from regenerating. A different cream, imiquimod, is used to cause your body to reject those abnormal cells on its own. A dermatologist can perform chemical peels, which burn off the top layer of skin, allowing a new layer to form below. A dermatologist can do many other things to get rid of these lesions, including curettage (scraping the abnormal cells off the skin which may be performed with local burning of the skin with a very small electrical current), photodynamic therapy (exposure to laser light after application of a skin sensitizing solution), laser therapy, dermabrasion (removal of the top layer of skin with a brush). Your dermatologist may use local anesthetic prior to these procedures in order to make the procedures more comfortable. You should discuss the risks and benefits of your various treatment options for actinic keratosis with your dermatologist.

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