Actinic Keratosis

Introduction to Actinic Keratosis

Actinic keratosis (AK) are common skin growths caused by prolonged exposure to ultraviolet (UV) rays from the sun or indoor tanning beds. These growths typically appear on areas of the body most exposed to the sun, such as the forehead, neck, chest, ears, scalp (especially in individuals with baldness), arms, hands, and lower legs. When AKs develop on the lips, they are referred to as actinic cheilitis, presenting as a white or grayish, scaly patch on a dry, cracked lip.

Characteristics of Actinic Keratoses

Actinic keratoses vary in appearance but often share these features:

Texture: Dry, scaly, and rough, with some feeling like sandpaper.
Color: Can be skin-colored, red, or crusted.
Size: Ranges from the size of a pinhead to larger than a quarter.

These variations make AKs a key indicator of cumulative sun damage to the skin.

Risk Factors for Actinic Keratosis

Certain individuals are more prone to developing AKs. Those with fair skin, light-colored hair, and eyes are particularly susceptible, especially after the age of 40. Frequent sun exposure, living in sunny climates like Florida or California, and using tanning beds increase the risk. Additionally, individuals with weakened immune systems or conditions that heighten sensitivity to UV rays are at higher risk.

Diagnosis and Treatment Options

Dermatologists typically diagnose AKs through a physical examination, though a biopsy may be necessary in some cases. Treatment options include:

Cryosurgery: Freezing AKs with liquid nitrogen to destroy abnormal cells.
Photodynamic Therapy: A light-sensitive solution is applied to the skin, followed by exposure to a special light to destroy the AK.
Curettage: Involves scraping or cutting off AKs, often paired with electrosurgery.
Chemical Peel: A chemical solution is used to penetrate and destroy AKs.
Laser Skin Resurfacing: A laser removes AKs, with the specific type chosen based on skin type.
Topical Medications: Prescription creams or gels, such as those containing 5-fluorouracil (chemotherapy cream) or diclofenac (NSAID gel), are applied to treat the AKs over time.
Immunotherapy: Medications that work with the immune system, like imiquimod cream, help destroy AKs.

Preventing Actinic Keratosis

Preventing AKs involves protecting your skin from UV exposure. Seek shade, especially during peak sun hours, and wear protective clothing, such as long-sleeved shirts, pants, wide-brimmed hats, and sunglasses. Sunscreen should be a daily habit, using a broad-spectrum SPF 30 or higher, applied 15 minutes before sun exposure and reapplying every two hours or after swimming.

Avoid tanning beds, as their UV rays can be stronger than natural sunlight. Regular skin checks are essential for early detection and management of AKs. If you notice any growths that itch, bleed, become thicker, or change in size, shape, or color, it’s important to contact your dermatologist immediately.

Dr. Jane Yoo Board-Certified Dermatologist and Mohs Surgeon

Jane Yoo, MD, MPP, is a Korean American board-certified dermatologist and fellowship-trained Mohs surgeon based in Midtown Manhattan. She is a Clinical Assistant Professor at the Icahn School of Medicine at Mount Sinai and the founder of Jane Yoo MD, PLLC and the Clinical Research Center of New York. Dr. Yoo holds an undergraduate degree from MIT and a Masters of Public Policy from Harvard's Kennedy School of Government. She completed her Mohs micrographic surgery fellowship at Yale. Her clinical and research focus spans aesthetic clinical trials including injectables and laser technology, skincare formulation and sunscreen science, K-Beauty and skin of color, ultrasound guided filler dissolution, artificial intelligence and beauty tech. Dr. Yoo's research is indexed under ORCID 0000-0002-7112-8963.

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