Actinic keratosis or solar keratosis is considered premalignant and may develop into squamous cell carcinoma if left untreated. It was first described in 1806 by Sir Thomas Browne as "squamous cell papilloma." However, it was not until 1963 that the term actinic keratosis was proposed and named because it resembles solar keratosis, a lesion caused by prolonged exposure to sunlight.
Actinic keratosis (AK) is a skin lesion commonly found in areas of the body chronically exposed to sunlight, such as the back of hands and face. AKs are ubiquitous and represent about 90% of pre-cancerous lesions in fair skin types. However, they are rare in dark-skinned individuals because most lesions occur on the face and hands, where there is less pigment than in other areas.
The most common solar keratosis type is senile keratosis (SK), representing about 50% of all actinic keratosis.
Among actinic keratosis risk factors, there are:
People at increased risk for actinic keratoses are those with lighter skin types, particularly if they are older than 60 years of age. This means it is more frequent in Caucasians, particularly those with red hair and green eyes. This suggests that the risk of actinic keratosis is increased fourfold for those with skin type 1 compared to skin type 7.
Also, it is more common in men, most likely due to outdoor occupations or recreational activities.
Finally, it is more prevalent in people who are older than 60 years of age, probably due to decreased protective melanin production with aging.
Severe actinic damage occurs when the skin does not receive the daily doses of sun that are required to suppress actinic keratosis formation.
There are three main types of keratosis:
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Actinic Keratosis Symptoms are typically non-specific and include the gradual development of red, scaly patches. As an actinic keratosis evolves, it may erode into a “rodent ulcer” due to constant irritation from rubbing against clothing or other surfaces. Other symptoms include:
Keratosis can be detected clinically by a dermatoscopy or by using a Wood's lamp. A Wood's lamp is used to illuminate the lesion with ultraviolet light, which causes it to fluoresce bright green if it contains high levels of porphyrins from neutrophils.
Dermatoscopy is a non-invasive method of detecting the lesion by taking digital pictures, which are examined more closely on a computer screen by a dermatologist or other specialist. It is considered to be the best method for detecting actinic keratoses.
In order to better identify the location, a dermatologist may perform a skin biopsy on visible lesions to obtain a more accurate diagnosis.
The treatment will depend on the severity of the condition. For most cases of actinic keratoses, topical treatments are sufficient in treating single lesions that don't cause discomfort or pain.