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Actinic Keratosis

What is actinic keratosis?

Actinic keratosis (AK) is a rough, scaly patch or bump (lesion) on sun-exposed skin. Most people have more than one AK.

AK is the most common precancer of the skin. Over time, it can develop into squamous cell skin cancer. Because of this, AKs are often treated. If they’re found and treated early, they don’t have the chance to develop into skin cancer.

What causes actinic keratosis?

Ultraviolet (UV) rays from the sun and from tanning beds cause almost all actinic keratoses. Damage to the skin from UV rays builds up over time. This means that even short-term exposure to sun on a regular basis can build up over a lifetime and raise the risk for actinic keratoses.

Who is at risk for actinic keratosis?

A risk factor is anything that may increase your chance of having a disease. Some risk factors may not be in your control. But others may be things you can change.

You are more at risk for actinic keratoses if you:

  • Have pale skin, blonde or red hair, and eyes that are blue, green, or gray

  • Have skin that burns or gets freckles when you’re in the sun

  • Have darker skin, hair, and eyes and have been exposed to UV rays without protection

  • Are over age 40

  • Are younger than age 40 and live in a place that gets intense sunlight all year

  • Are younger than age 40 and use tanning beds or lamps

  • Have a weakened immune system from chemotherapy, AIDS, or an organ transplant

  • Have a rare condition that makes your skin very sensitive to UV rays, such as albinism or xeroderma pigmentosum (XP)

  • Work outdoors or spend a lot of time in direct sunlight

What are the symptoms of actinic keratosis?

Actinic keratoses (AKs) develop slowly in the top layer of skin. It mostly starts on skin that’s often exposed to and damaged by the sun. This includes the face, ears, bald scalp, neck, backs of hands and forearms, and lips. The lesions tend to be flat patches on the skin of the head and neck. But they appear as bumps on the arms and hands.

The base of an AK may be light or dark, tan, pink, red, or a combination of these. Or it may be the same color as the skin and a change you feel rather than see. The scale or crust may be horny, dry, and rough. In some cases, the lesion may itch or have a prickly or sore feeling.

Sometimes the lesions come and go, often coming back after sun exposure. Often you will have more than one actinic keratosis lesion.

Actinic keratoses that develop on the lip are called actinic cheilitis. They can cause the lips to crack and feel scaly, dry, and rough.

How is actinic keratosis diagnosed?

AKs are often diagnosed when a person sees a doctor about a skin change they’ve noticed. The doctor will look at and feel the changed skin. The doctor will ask about your health history and do a physical exam. All of your skin may be checked, too. 

You may be sent to a dermatologist. This is a doctor with special training to treat skin problems. A special light, magnifying lens, or camera may be used to get a very close look at the changed skin or lump. 

A healthcare provider can often diagnose actinic keratosis by looking at and feeling the area on your skin. But sometimes actinic keratosis can be hard to tell apart from skin cancer. You will likely need a biopsy. This is when small pieces of tissue are taken from the lesion. These samples can be removed with a needle or scalpel and checked under a microscope to rule out cancer. 

How is actinic keratosis treated? 

Treatment for AK aims to remove or destroy the lesion and limit scarring as much as possible. It may include:

  • Cryotherapy. This treatment freezes lesions that can be seen on the skin. This is the treatment most often used.

  • Topical chemotherapy. These medicines are put right onto the skin to destroy the affected cells.

  • Chemical peels. Strong chemicals are used to destroy the top layers of the skin where the lesion started.

  • Laser surgery. Intense light is used to vaporize thin layers of the lesion until it’s all removed. This can be used to remove lesions from the face and scalp, and actinic cheilitis from the lips.

  • Curettage and electrodessication. The lesion is scraped away and heat is used to kill any damaged cells that may remain and stop bleeding.

  • Photodynamic therapy. Special chemicals are put on the lesion and absorbed by the damaged cells. A few hours later, laser light is used to turn on the chemical and kill the cells.

Most AKs can be treated and cured. But they may come back. And if you have one, you likely will develop others. It’s important to have regular skin exams after treatment. These exams will help spot new actinic keratoses and skin cancer.

What are possible complications of actinic keratosis?

After treatment the skin will be red and sore. With time it will heal and new healthy skin will appear.

Some of the treatments increase sun sensitivity. Talk with your doctor about this and be very careful to protect your skin from the sun.

It’s important that actinic keratosis be checked by a doctor and treated, because over time it may turn into squamous cell skin cancer.

What can I do to prevent actinic keratosis?

You can help prevent actinic keratoses by taking these steps:

  • Apply sunscreen with at least SPF 30 every day.

  • Don’t use tanning beds or sun lamps.

  • Do regular skin self-exams to check for changes on your skin. If you notice anything, talk with your healthcare provider right away.

Key points about actinic keratosis

  • Actinic keratosis is a rough, scaly patch or bump on sun-exposed skin.

  • They are caused by UV damage to the skin.

  • People are more at risk for this if they have pale skin, blonde or eyes that are blue, green, or gray.

  • A skin exam and sometimes a biopsy are needed to diagnose this skin problem.

  • Actinic keratoses are often treated, because over time they might turn into skin cancer.

  • Treatments include creams, cryotherapy, and laser surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Louise Cunningham, RN
Online Medical Reviewer: Richard LoCicero, MD
Date Last Reviewed: 11/1/2018
© 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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