What are the aims of this leaflet?
This leaflet has been written to help you understand more about actinic keratoses. It describes what they are, what causes them to develop, how they can be treated and where you can find out more information.
What are actinic keratoses?
Actinic keratoses are areas of sun-damaged skin. They usually occur on parts of the body that are exposed to the sun. This includes the forearms, back of the hands, face, ears, and any scalp areas without hair (e.g., as a result of balding). They may also occur on the lips. The terms actinic and solar are from Greek and Latin respectively, meaning ‘caused by sunlight’. The term keratosis refers to thickened skin.
What causes actinic keratoses to develop?
Actinic keratoses are caused by sun exposure over many years. This includes sunbathing, sunbed use, outdoor work, or recreational activities, and living in a country with a sunny climate. Phototherapy or ionising radiation may also contribute to their development. They occur more commonly in older people and fair skinned, blue eyed, red, or blonde-haired individuals, who burn easily in the sun. Actinic keratoses are not contagious.
What do actinic keratoses look and feel like?
Actinic keratoses can be variable in appearance. They may simply feel rough or scaly, looking like dry skin. They are often pink but can be skin- coloured or red. A change in texture of the skin may be noticed before a colour change. They can grow to 1-2 cm in diameter and occasionally develop a thicker lumpy layer. The surrounding skin often looks sun-damaged (blotchy, freckled and wrinkled). There are usually several actinic keratoses in the same area of sun-exposed skin; they rarely occur alone.
Actinic keratoses often do not cause any trouble but can be itchy or sore. If left untreated for many years, there is a very small risk that an actinic keratosis can progress into a form of skin cancer called a squamous cell carcinoma. People affected by many actinic keratoses are also at a higher risk of developing other types of skin cancer, compared to someone of the same age who does not have any actinic keratoses.
If an actinic keratosis develops into a lump or horn, grows very quickly, becomes tender, forms an ulcer, or starts to bleed, it is important to seek medical advice. These changes could indicate the early onset of skin cancer. People at a higher risk include those with multiple actinic keratoses, and those on immunosuppressive drugs, for example organ transplant patients.
Are actinic keratoses hereditary?
No, but some of the risk factors for developing actinic keratoses do run in families – for example, those who tend to burn easily in the sun rather than tan, have red or fair hair, blue eyes, and freckles. People with albinism or xeroderma pigmentosum are also at increased risk.
How are actinic keratoses diagnosed?
Usually, the appearance of actinic keratosis is sufficient to enable the diagnosis to be made by a doctor who manages skin problems, for example a GP or dermatologist. In cases of uncertainty, a sample (biopsy) or the whole affected area may be removed surgically under local anaesthetic for examination under a microscope in the laboratory.
Can actinic keratoses be cured?
Actinic keratoses can be treated but tend to recur over time. Their presence indicates there is sun damage to the skin and so, whilst an individual actinic keratosis can be cured, the affected individual is at risk of developing more in the future.
How can actinic keratoses be treated?
Some actinic keratoses may go away without treatment, especially if they are small and if the skin is protected from the sun. Moisturisers can be used for scaly patches. There are several treatments available and the options can be discussed with your healthcare professional. Treatment will depend on the number and location of the actinic keratoses, and other factors which will differ between people. Some individuals may choose not to treat actinic keratoses and just self-monitor their skin.
Treatments that your doctor can provide for actinic keratoses:
PDT and laser therapy are only available in certain clinics.
How can I protect my skin?
Protecting your skin from the sun will help reduce the number of new actinic keratoses and will reduce the risk of developing skin cancer. Practice good sun protection by following these recommendations:
People who actively avoid sun exposure should have their vitamin D levels checked and monitored. Your GP may advise you to take a vitamin D supplement.
Where can I find out more about actinic keratoses?
British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis
https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.15107
Web links to other relevant sources:
https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-symptoms
https://www.dermnetnz.org/topics/actinic-keratosis
https://www.skinhealthinfo.org.uk/support-resources/patient-support-groups/
Jargon Buster: https://www.skinhealthinfo.org.uk/support-resources/jargon-buster/
Please note that the British Association of Dermatologists (BAD) provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET
PRODUCED | MAY 2007
UPDATED | MAY 2010, SEPTEMBER 2013, NOVEMBER 2016, DECEBER 2020, JANUARY 2024
NEXT REVIEW DATE | JANUARY 2027