Actinic keratosis has been known to show signs of Bowen disease or carcinoma in situ. The patients present with the following clinical features [2].

• Areas of skin that are usually exposed, like head, face, neck, forearms and hands etc. show minuscule lesions.
• The lesions are small, have indurated margins, 1 cm in diameter, tan brown or red in color and grow close together in patches.
• The lesions appear as elevated skin areas, resembling warts, and may even bleed.
• The skin becomes rough, with a sand-paper like texture.
• The lesions gradually enlarge and become scaly.
• The skin is itchy and tender.
• In immunocompromised patients, the lesions become erythematous, due to flare formation.
• • The lesions persist over years. They may either regress with care or get transformed into malignant lesions on further exposure to ultraviolet (UV) light.

• Inflammation

  Cabrera PV, Blanco G, Alaniz L et al (2004) CD44 and hyaluronic acid regulate in vivo iNOS expression and metalloproteinase activity in murine air-pouch inflammation. Inflamm Res 53:556–566 CrossRef PubMed Google Scholar 9. [doi.org]

  […] keratinocytes at upper spinous and granular layers with coarse keratohyalin granules Hyperkeratotic: with cutaneous horn Pagetoid: Pigmented: resembles solar lentigo, which lacks atypia and has downward projections Case reports 54 year old man with inflammation [pathologyoutlines.com]

  Once the inflammation subsides, which will take several weeks, her skin will be smoother, less blotchy and, most importantly, healthier, Karen said. Follow A. Pawlowski on Facebook, Instagram and Twitter . [today.com]

  Both treatments reduced the number of visible AK by 75% and produced equivalent reductions in keratinocyte atypia, hyperkeratosis, parakeratosis, and inflammation, with no significant alteration of preexisting solar elastosis and telangiectasia. [ncbi.nlm.nih.gov]

• Swelling

  There may be redness, itching, swelling, and crusting. [webmd.com]

  Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling clear. Researchers continue to look for new treatments for AKs. No one treatment works on all AKs. Outcome Some people get only a few AKs. [aad.org]

  During this procedure a topical solution is applied to the lesions, causing each to become red and swell. Lesions may scab and take up to 7 days to resolve. [goldenbergdermatology.com]

  Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling clear. [cahabaderm.com]

• Weakness

  The risk of actinic keratosis increases with age and is more common for people with lighter skin and hair, weak immune systems, or a history of intense sunburns are more susceptible to the condition. [firstderm.com]

  From the point of view of the GD Task Force "Licht.Hautkrebs.Prävention," an interdisciplinary expert panel of the Society for Dermopharmacy for the prevention and treatment of skin cancer, this guideline reveals strengths and weaknesses but, in summary [ncbi.nlm.nih.gov]

  The strengths and weaknesses of the relevant evidence are critically reviewed within this summary to provide useful information for those working on the managed entry of new medicines for the NHS, but this summary is not NICE guidance. [nice.org.uk]

  […] a sunny place Have a history of frequent or intense sun exposure or sunburn Have red or blond hair, and blue or light-colored eyes Tend to freckle or burn when exposed to sunlight Have a personal history of an actinic keratosis or skin cancer Have a weak [mayoclinic.org]

  Those with a weak immune system due to chemotherapy, HIV, or an organ transplant are at higher risk. Spots usually appear in those who are older (over 50), but they can start appearing in younger adults who have had a lot of sun exposure. [skinsight.com]

• Pathologist

  After a suspicious lesion has been identified, it should be biopsied and examined by a pathologist to confirm the diagnosis. Laboratory test Histopathology may be performed on skin biopsies. [eyewiki.aao.org]

  The authors who have contributed to this volume are researchers and clinicians discussing actinic keratosis across the whole spectrum – from epidemiology to immunology, from molecular biology to behavioral psychology – and of course pathologists and clinicians [karger.com]

  Skin biopsy Next you may have a skin biopsy, which involves taking a sample of suspicious tissue so a pathologist can examine the cells under a microscope to look for cancer. [seattlecca.org]

  The CCA/ACN was the only guideline to score above 60% for the stakeholder involvement domain; it was developed by a multidisciplinary “working party” that included dermatologists, pathologists, plastic surgeons, general practitioners, health economists [hindawi.com]

• Surgical Procedure

  Often, all that is needed is a simple surgical procedure or application of a topical chemotherapeutic agent. Treatment Treated early, almost all actinic keratoses (AKs) can be eliminated before becoming skin cancer. [brevardskin.com]

  There are a number of ways to treat actinic keratosis, including with prescription creams and gels, minor surgical procedures like freezing and scraping, and photodynamic therapy. [sunsaferx.com]

• Cheilitis

  Symptoms of actinic cheilitis, a variant of AK that appears on the lower lip, may include chapping, cracks and whitish discoloration. [skincancer.org]

  Actinic cheilitis - Actinic cheilitis is a type of actinic keratosis or leukoplakia occurring on the lips. It causes them to become dry, cracked, scaly and pale or white. [brevardskin.com]

  Actinic keratoses that develop on the lip are called actinic cheilitis. How is actinic keratosis diagnosed? Healthcare providers can often diagnose an actinic keratosis by looking at and feeling the area on your skin. [hopkinsmedicine.org]

  Different diagnostic RCM features have been described for AK, actinic cheilitis (AC), erythroplasia of Queyrat, Bowen disease, invasive SCC, and keratoacanthoma (KA). [ncbi.nlm.nih.gov]

  Definition / general Also called solar keratosis, senile keratosis Buildup of excessive keratin due to chronic exposure to sunlight On sun-exposed sites (face, arms, dorsum of hands) Called actinic cheilitis in lips May become invasive with only a single [pathologyoutlines.com]

• Skin Lesion

  This patient illustrates the importance of careful observation and photo-documentation of suspicious skin lesions. A review of the treatment options for these lesions is included in this report. [ncbi.nlm.nih.gov]

  Neuhaus, Neoplastic Skin Lesions in the Elderly Patient, Textbook of Aging Skin, 10.1007/978-3-642-27814-3_55-2, (1-31), (2015). [doi.org]

• Ulcer

  Clinical parameters found were: induration (3 studies), bleeding (3 studies), enlargement in diameter (3 studies), erythema (2 studies) and ulceration (2 studies). [ncbi.nlm.nih.gov]

  A tender, thickened, ulcerated or enlarging actinic keratosis is suspicious of SCC. Cutaneous horn may arise from an underlying actinic keratosis or SCC. [dermnetnz.org]

  Important risk factors for the development and progression of cSCC include ultraviolet radiation, chronic skin ulcers and immunosuppression. [doi.org]

  In rare instances, they may bleed or develop a persistent sore, also known as an ulceration. In other cases, they come and go in the same spot. Scattered thick, scaly, red patches on the back of the hand. [skincancer.org]

• Blister

  Usually the skin turns red and blisters before new skin appears. Photodynamic therapy. A chemical is applied to the skin. Then the skin is exposed to a light that activates the chemical to destroy the abnormal skin cells. [webmd.com]

  Treatment options pose unique risks in these patients as surgical wounds can have delayed wound healing and photodynamic therapy (PDT) may exacerbate their blistering disease. [ncbi.nlm.nih.gov]

  The area becomes irritated and may blister for a few days, but then normal skin regrows. Topical therapy involves applying a cream or gel to the visible lesions. We might use this approach if you have several AKs in one area. [mountsinai.org]

  The treated area will start to blister and peel within a few days, revealing new, healthy skin underneath. [vivida.com]

• Dermatitis

  Procedures were less likely to be performed at visits for warts, psoriasis, acne, or dermatitis, which indicates that reimbursable procedures are performed not simply because they are available. [ncbi.nlm.nih.gov]

  [berloque dermatitis] L56.3 Solar urticaria L56.4 Polymorphous light eruption L56.5 Disseminated superficial actinic porokeratosis (DSAP) L56.8 Other specified acute skin changes due to ultraviolet radiation L56.9 Acute skin change due to ultraviolet [icd10data.com]

  […] compared with placebo in patients with moderate-to-severe atopic dermatitis (AD). [gwdocs.com]

  The most likely diagnosis is Seborrheic keratosis Actinic keratosis Seborrheic dermatitis Basal cell carcinoma Poikiloderma Answer on page 699 Copyright© the College of Family Physicians of Canada In this issue Related Articles Cited By... [cfp.ca]

• Freckles

  Examine your skin regularly, looking for the development of new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp. [mayoclinic.org]

  People with fair skin, freckles, blonde or red hair and blue, green or gray eyes are most vulnerable to sun damage. They have a high likelihood of developing AKs if they spend time in the sun and live long enough. [skincancer.org]

  Sunlight exposure was positively associated with localized hypomelanism, localized hypermelanism, seborrheic keratoses, senile lentigines, freckles, acne rosacea, spider nevi, varicose veins, venus star, dry skin, wrinkled skin, pterygia, arcus senilis [doi.org]

  Moisturizing creams temporarily plump up wrinkles, and makeup helps hide imperfections in skin color (such as freckles, sun spots, and lentigines) and some fine wrinkles. [merckmanuals.com]

• Burning Sensation

  Skin may feel dry and rough to the touch, or raw, sensitive and painful, or even itchy with a pricking or burning sensation. Some AKs look and feel inflamed. [skincancer.org]

  Most people affected by actinic keratosis are asymptomatic and feel nothing from the lesions, but on occasion the lesions can sting, bleed, itch,or produce a burning sensation. [sunsaferx.com]

  5 to 7 days and may also cause stinging, a burning sensation, redness, crusting, changes in skin coloration, infections, and scarring (rarely).2 Since this procedure is often considered cosmetic in nature, it may not be covered by medical insurance.2 [uspharmacist.com]

  Most lesions are asymptomatic, but some cause pruritus or a burning sensation. 1 View/Print Table SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Evidence rating References Actinic keratoses should be treated because of their potential [aafp.org]

  The lesions are usually asymptomatic, but can be tender, itch, bleed, or produce a stinging or burning sensation.[18] AKs are typically graded in accordance with their clinical presentation: Grade I (easily visible, slightly palpable), Grade II (easily [en.wikipedia.org]

Not much investigation is needed to diagnose a patient suffering from actinic keratosis. Thorough skin examination is usually enough to recognize actinic keratosis clinically. In some patients, skin biopsy is useful in ruling out the suspicion of malignancy.

Conservative treatment can be done with the following:

• Topical chemotherapeutic agents like 5-fluorouracil gel [3] [4]
• Anti-inflammatory drugs
• Imiquimod [5]

The surgical techniques that can be employed include the following:

• Cryosurgery (most effective)
• Chemical peeling
• Laser surgery [6]
• Laser resurfacing [7]
• Photodynamic therapy (PDT) in which the skin is exposed to blue light [8]
• Curettage and excision
• Electrosurgery and cauterization

Combination therapy with 5-FU followed by cryotherapy with liquid nitrogen is an effective mode of treatment.

In about 10% of the people, actinic keratosis progresses to squamous cell carcinoma. Early treatment prevents the development of carcinoma [1]. Although metastasis is rare, the lesions have a high tendency for malignancy. 2 to 10% of the malignant cases can invade the internal organs, proving to be life threatening. The earlier the diagnosis; more are the chances of cure.

Excessive exposure to UV radiation, even from indoor sources like lamps etc. can trigger the development of these lesions. Excessive exposure to X-rays or industrial chemicals can also be the reason. A large number of cases of actinic keratosis have been related with the mutations in TP53 gene, the tumor suppressor gene.

Actinic keratosis has been further classified into:

• Hyperkeratotic actinic keratosis (associated with high risk of malignancy)
• Pigmented actinic keratosis (lesions with rough, scaly surface)
• Lichenoid actinic keratosis (soft, shiny lesions, occurring in areas prone to friction)
• Atrophic actinic keratosis

The highest prevalence is in countries like South Africa and Australia where sunlight exposure and fair skinned population are relatively higher. In the northern hemisphere, it is found in 11 to 25% of the people at the age of 40 and above.

Fair skinned people are mostly commonly affected by the sunlight. Freckled individuals are at a higher risk too. Population living in areas with long-term sunlight exposure like Australia is, therefore, at higher risk of developing the disease as compared to those with low exposure to sunlight.

Older population is implicated with a high risk of actinic keratosis as damage caused by sunlight builds up over the years, hence called senile keratosis. Men are affected more than women owing to the fact that they spend relatively more time outdoors as compared to women. Caucasians are most susceptible as compared to Hispanics and Asians with darker skins.

Individuals with immunosuppression, like those undergoing cancer chemotherapy or organ transplantation, or those with immunocompromised states like diabetes or HIV are at a relatively higher risk for developing the disease. Individuals with skin disorders like xerdoderma pigmentosum and albinism are prone to develop actinic keratosis too.

The mutations in the suppressor gene cause disinhibition of tumor suppression, thereby inducing tumorigenesis. The basal cell layer of the skin is the first to get affected; it shows hyperplasia of basal cells. Pleomorphic keratinocytes start accumulating in the stratum basalis. Uninhibited growth ensues, sometimes extending into the superficial as well as the deeper layers of skin. The cellular architecture is lost as a result of rapid proliferation of cell. The nuclear-cytoplasmic ratio is high and mitotic figures are seen; a sign of malignancy.

A dense infiltration of inflammatory cells occurs. Hyperkeratosis, with occasional areas of parakeratosis is seen. Granular layer is lost. As the disease progresses, it can invade the surrounding areas, giving rise to squamous cell carcinoma. Therefore, actinic keratosis is considered a precancerous state.

The following measures are effective in preventing the development of actinic keratosis.

• Sunlight should be avoided as much as possible by standing indoors [9] [10].
• Broad spectrum sunscreens should be used for protection from harmful radiations in the sunlight.
• When going out, full clothing should be worn that covers the arms and the legs.
• Basking in the sun has to be avoided.
• The use of tanning beds or indoor tanning devices should also be avoided.
• Frequent head to toe self-examination should be done to look for any sort of skin changes.

Actinic keratosis, also known solar keratosis or senile keratosis due to its association with old age, is one of the most common pre-malignant lesions of skin. The condition is associated with chronic exposure to sunlight. The ultraviolet radiations in sunlight induce these scaly growths and if left untreated, they can progress into squamous cell carcinoma, although there have been reports of regression or stability of these lesions.

Actinic keratosis is a skin disorder that can turn into skin cancer, if not immediately tended to. The main reason is long term exposure to sunlight. Fair skinned people who spend long hours in the sun are especially at risk.

It shows up as small red skin eruptions. The skin becomes itchy and painful. The eruptions on the skin may harden and can also bleed. Avoiding sunlight as much as possible and using sunscreen lotions is the best possible preventive measure.

1. Bogal CB. Actinic keratosis: treat lesions to reduce cancer risk. Advance for nurse practitioners. Jan 2010;18(1):18.
2. Werner RN, Sammain A, Erdmann R, Hartmann V, Stockfleth E, Nast A. The natural history of actinic keratosis: a systematic review. The British journal of dermatology. Sep 2013;169(3):502-518.
3. Gupta AK, Davey V, McPhail H. Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: Critical review and meta-analysis of efficacy studies. Journal of cutaneous medicine and surgery. Oct 2005;9(5):209-214.
4. Gupta AK, Paquet M. Network meta-analysis of the outcome 'participant complete clearance' in nonimmunosuppressed participants of eight interventions for actinic keratosis: a follow-up on a Cochrane review. The British journal of dermatology. Aug 2013;169(2):250-259.
5. Hadley G, Derry S, Moore RA. Imiquimod for actinic keratosis: systematic review and meta-analysis. The Journal of investigative dermatology. Jun 2006;126(6):1251-1255.
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7. Sherry SD, Miles BA, Finn RA. Long-term efficacy of carbon dioxide laser resurfacing for facial actinic keratosis. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. Jun 2007;65(6):1135-1139.
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9. Cohn BA. From sunlight to actinic keratosis to squamous cell carcinoma. Journal of the American Academy of Dermatology. Jan 2000;42(1 Pt 1):143-144.
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