Learn about Actinic Keratoses

answerWhat are Actinic Keratoses (AKs)?

Often called “sun spots,” AKs are rough-textured, dry, scaly patches on the skin that are caused by excessive exposure to ultraviolet light (UV) such as sunlight and have the potential to progress to squamous cell carcinoma (SCC) - the second most common skin cancer. They occur most often on the face, scalp and ears. They can range in color from skin toned to reddish brown. They can be as small as a pinhead or larger than a quarter. While most AKs remain benign, approximately 10 percent develop into SCC within an average of two years. Since there is no way to know ahead of time which ones will become cancerous, it is very important to seek a dermatologist’s care. Frequent skin examinations are the key to early detection and prevention.


Up to 58 million people in the United States have AKs. If you are wondering whether you are one of the individuals at risk of developing AKs, continue to read the actinic keratoses FAQs below.


answerHow common are AKs?

It is estimated that up to 58 million individuals in the US have AKs. Slightly more men than women have AKs.


answerWhat do AKs look like?

AKs generally begin as rough spots of skin that may be easier felt than seen. Common complaints include a lesion that has increased in size or one that is raised, bleeding, poor in healing, discolored or associated with discomfort such as pain or itching.


While a lesion may initially appear skin-colored to pink, red, or brown, lesions on darker skin may be more pigmented. AKs may feel soft, rough or “gritty,” but in any case, they feel different from the surrounding healthy skin.


Since there are many clinical variants of AKs, it is best to consult a dermatologist if you suspect a lesion.


photo: actinic keratosis
photo: actinic keratosis
photo: actinic keratosis


answerWhat causes AKs?

AKs develop as the result of years of sun exposure. Because the effect of sun exposure is cumulative, it is your lifetime exposure that increases your risk. Even if you didn’t sunbathe much, years of simple outdoor activities can add up to a significant amount of sun exposure. Examples of some of these activities are:


  • Walking the dog
  • Participating in an outdoor sport (e.g. golf, tennis)
  • Gardening
  • Going out to the mailbox


answerWho is at risk for developing AKs?

Individuals with a higher likelihood of developing one or more AKs are those with:


  • Fair skin
  • Blond or red hair
  • Blue, green or grey eyes
  • History of kidney disease or weakened immune system
  • Daily, long-term exposure to the sun
  • Multiple severe sunburns early in life
  • Older age


answerWhy treat AKs?

AKs have the potential to progress into squamous cell carcinoma (SCC). While most AKs remain benign, a study has shown that approximately 10 percent develop into SCC within an average of two years. Since there is no way to know ahead of time which AKs will develop into SCC, it is very important for individuals with AKs to be under a dermatologist’s care. Frequent skin examinations are the key to early detection and prevention.


answerWhat treatments are available?

There is a range of treatment options available for AKs. Among the choices  are the following:


  • Photodynamic Therapy
    This treatment involves the application of a photosensitizing agent to the AKs. The treated area is exposed to a light that activates the agent. The period between application and exposure will vary and depend on the photosensitizing agent that is used. This treatment targets just the AKs and causes little damage to the surrounding normal tissue. Some redness, swelling and a burning sensation during therapy often occurs.
  • Cryotherapy (freezing)
    This treatment involves freezing the AKs with an extremely cold substance such as liquid nitrogen. There is no cutting or anesthesia required. This method causes the lesion(s) to shrink or become crusted and then fall off. After treatment there may be temporary redness and swelling. In some patients this treatment can cause permanent white spots on the skin.
  • Topical Medication
    This treatment involves the application of a topical medication to the affected skin. The course of treatment can range from days to weeks, depending on the topical medication that is used. Redness, swelling and ulceration may occur during treatment.
  • Curettage (scraping)
    This procedure involves the use of a curette to scrape off cells that are damaged. A local anesthetic is required for this procedure. Scarring and skin discoloration may occur at the site of the treatment.
  • Chemical Peel
    Chemicals are applied directly to the AKs. The chemical causes the top layer of skin to slough off. This layer of skin is usually replaced within seven days. Anesthesia is necessary for this procedure and temporary discoloration and irritation can occur.
  • Dermabrasion
    This procedure involves using a rapidly moving brush to remove the affected skin. Local anesthesia is used. Following the procedure, the skin appears red and raw-looking. It can take as long as several months for the treated area to heal.
  • Surgical Excision
    With surgical excision, the entire lesion with some healthy tissue is removed. Scarring is possible with this procedure.
  • Lasers
    This treatment involves focusing a laser on the lesion. The laser cuts through the skin tissue without causing bleeding. Local anesthesia may be required. This treatment can cause pigment loss in the skin.


answerHow do I know which treatment is right for me?

Download the dermatologist discussion guide.

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