Alternative names: solar keratosis, sunspots, sun damage
Actinic keratoses are, small scaly plaques of thickened skin that usually develop after the age of 40, in response to many years of sun exposure. As such, they are found predominantly on skin sites that experience the most sun exposure such as faces/scalps, ears, hands and lower legs. They are very common with 1 in 5 people in the UK having them. People with fair skin who burn easily in the sun are most likely to be affected.
Very rarely actinic keratoses can transform into a type of skin cancer called squamous cell carcinoma.
Actinic keratoses are ill-defined rough patches, ranging in colour from pink to brown and measuring from 0.5 to 3cm in width (see figure). Some can resemble crusty outgrowths when they are particularly thick and raised.
If an AK starts to bleed or rapidly change in appearance or size this may indicate that it is progressing toward squamous cell carcinoma and medical advice must be sought immediately.
Actinic keratoses are usually harmless, though they can be itchy and feel rough to the touch. Some people also find their appearance unsightly, particularly when they are on the face.
Actinic keratoses are usually little cause for concern, and small patches may regress by themselves. However, it is important to adopt good sun-protection habits such as using sunscreens and wearing protective clothing on hot days, in order to prevent further skin damage.
Due to the small risk of progression to skin cancer it is generally advisable to treat actinic keratoses. They can also be removed to improve the cosmetic appearance of the skin as a matter of personal choice. A variety of treatments are available and include:
Creams and ointments (5-fluorouracil, imiquimod or diclofenac sodium): these can be used when there are a large number of actinic keratoses, for example on the scalp.
Photodynamic therapy: employs the use of a special cream, which is applied to affected areas and is activated by light of a specific wavelength.
Cryotherapy: involves freezing an affected site with liquid nitrogen.
Curettage or excision: this is performed under local anaesthetic and normally reserved for thicker patches and suspected skin cancers.
Though these options are highly effective, due to prior sun-damage it is likely that more actinic keratoses will develop in the surrounding skin, requiring future treatment.
Our Dermatologists at the Harley Street Dermatology Clinic can offer effective treatment for all types of sun damage including actinic keratoses.
For further information please visit the NHS website and read the British Association of Dermatology Patient leaflet.