Actinic Keratoses

• Actinic keratoses are pre-cancerous lesions most commonly found in areas of the skin that have been frequently exposed to the sun, such as the face, scalp, tops of ears, neck, upper chest, arms, and hands. They can also occur on the legs in people who frequently wear shorts or skirts.

• Yes, actinic keratoses can form on the lips and are referred to as actinic cheilitis.  They often occur on the lower lip due to sun exposure from above, and can be a precursor to squamous cell carcinoma. Actinic cheilitis can cause dryness, cracking, and scaling of the lips, as well as white or gray discoloration. If you have a persistent dry, scaly, or discolored patch on your lips, it’s important to have it evaluated by a dermatologist to determine if it could be an actinic keratosis or another type of skin lesion.

•  A patient who has been diagnosed with actinic keratoses should be provided with the following information:

  • Explanation of the diagnosis: A dermatologist will explain to the patient what actinic keratoses are and how they are diagnosed. They will explain that an actinic keratosis is a precancerous lesion, and may progress to a type of skin cancer called squamous cell carcinoma if left untreated.
  • Treatment options: Various treatment options available for actinic keratoses include topical medications (immunomodulators), cryotherapy (freezing with liquid nitrogen), curettage (scraping), or photodynamic therapy.
  • Sun protection: It is imperative to protect the skin from further sun damage by wearing protective clothing (UPF fabrics) and using a broad-spectrum sunscreen with an SPF of at least 30.
  • Follow-up: Patients with actinic keratoses should be monitored regularly with a recommended follow-up schedule to ensure that the lesions are adequately treated and do not progress to skin cancer. 
  • Risks and benefits of treatment: Potential risks and benefits of each treatment option will be discussed so that an informed decision can be made about the most appropriate and desirable treatment plan.
  • Importance of self-examination: All patients are encouraged to perform regular self-examinations of their skin and report any new or changing lesions to their dermatologist.
  • Lifestyle modifications: A discussion of relevant lifestyle modifications may be beneficial, such as regular sun protection, quitting smoking and maintaining a healthy diet and exercise routine.

  A dermatologist will provide their patient with all the necessary information so that they can make informed decisions about their care and take an active role in managing their skin health.

• Actinic keratoses (AKs) are most commonly found in people with fair skin, light-colored hair, and eyes, who have had significant sun exposure throughout their lives. However, anyone can develop AKs, regardless of their skin type or color. 

    The five most common risk factors for developing actinic keratoses (AKs) are:

1. Sun exposure: Prolonged exposure to ultraviolet (UV) radiation from the sun is the primary cause of AKs. This includes both natural sunlight and artificial sources of UV radiation, such as tanning beds. People who spend a lot of time outdoors or live in climates with high levels of sunlight and do not protect their skin with clothing or sunscreen, are at higher risk.  
2. Fair skin: People with fair skin, light-colored hair, and eyes are more likely to develop AKs. This is because their skin contains less melanin, which provides some protection against UV radiation.
3. Age: The risk of developing AKs increases with age, as the skin’s ability to repair sun damage decreases over time.
4. Gender: Men are more likely than women to develop AKs, possibly because they are more likely to work outdoors and less likely to use sun protection.
5. Immunosuppression: People with weakened immune systems, such as those who have undergone organ transplantation or who have HIV, are at higher risk of developing AKs.

It is important to note that anyone can develop AKs, regardless of their skin type or color. If you have any of these risk factors, it is important to take steps to protect your skin from the sun and to have regular skin examinations to detect any AKs or other skin lesions early.

• Actinic keratoses (AKs) are not contagious and do not spread from person to person. However, if left untreated, they can gradually grow in size and number on the affected area of skin. In some cases, they can progress to a type of skin cancer called squamous cell carcinoma (SCC).

  While AKs themselves do not spread to other parts of the body, it is possible for skin cancer to develop in other areas of the skin. This is why it is important to have regular skin examinations and to promptly report any new or changing skin lesions to your healthcare provider.

  It is also important to note that if you have been diagnosed with AKs, you may have an increased risk of developing other types of skin cancer in the future. This is why it is important to take steps to protect your skin from the sun, such as wearing protective clothing and using a broad-spectrum sunscreen with an SPF of at least 30, and to have regular skin examinations.

• Yes, actinic keratoses (AKs) can grow in size over time if left untreated. They usually start as small, scaly patches on the skin that may be barely noticeable, but can gradually increase in size and thickness. In some cases, AKs can become raised, rough, or even develop a warty appearance.

  It is important to have AKs examined by a dermatologist and treated promptly, as they can progress to a type of skin cancer called squamous cell carcinoma (SCC), which does have the potential to spread to other parts of the body if not treated early.

  In addition to growing in size, AKs can also increase in number over time, especially in people who continue to have significant sun exposure without protection. This is why it is important to take steps to protect your skin from the sun, such as wearing protective clothing and using a broad-spectrum sunscreen with an SPF of at least 30, and to have regular skin examinations.

• The best way to prevent actinic keratoses (AKs) is to protect your skin from the sun’s harmful ultraviolet (UV) rays. Here are some tips for preventing AKs:

  • Wear protective clothing: Cover your skin as much as possible with long-sleeved shirts, pants, and wide-brimmed hats. Dark colors and tightly woven fabrics provide better protection than light-colored, loosely woven fabrics.
  • Use sunscreen: Apply a broad-spectrum sunscreen with an SPF of at least 30 to all exposed skin, including your face, neck, ears, and hands. Reapply every two hours or more often if you are sweating or swimming.
  • Seek shade: Stay in the shade during peak sunlight hours, usually from 10 a.m. to 4 p.m.
  • Avoid tanning beds: Tanning beds emit harmful UV radiation and should be avoided.
  • Check your medications: Some medications, such as certain antibiotics, retinoids and chemotherapy drugs, can make your skin more sensitive to the sun. If you are taking any medication, ask your healthcare provider if it increases your risk of sunburn and how to protect your skin.
  • Get regular skin exams: Have your skin checked by a dermatologist regularly, especially if you have a history of AKs or skin cancer.

  By taking these steps, you can help protect your skin from the sun’s harmful rays and reduce your risk of developing AKs and other types of skin damage.

• If left untreated, actinic keratoses (AKs) can gradually grow in size and number and are at risk of progressing into a type of skin cancer called squamous cell carcinoma (SCC).  SCC can spread to other parts of the body if not treated early, which can be life-threatening in rare cases.  Over 10 years, the risk of malignant transformation of a single actinic keratosis lesion is about 10% for immunocompetent patients and 20% for immunocompromised patients. The risk of malignant transformation of actinic keratoses is higher in patients with multiple lesions, than those with a single actinic keratosis. 

Actinic keratoses (AKs) can be treated using various methods, depending on the location and severity of the lesions, as well as the patient’s overall health and preferences. Here are some common treatment options:

• Topical medications (immunomodulators and field cancerization): Prescription creams, ointments and gels, such as imiquimod, 5-fluorouracil, tirbanibulin or diclofenac, can be applied directly to the affected skin to help remove AKs. These medications work by stimulating the body’s immune system to attack and remove abnormal cells.
• Cryotherapy: This involves using liquid nitrogen spray to freeze and destroy the AKs. The procedure is quick and does not require any anesthesia.  It is recommended for single or isolated AKs.
• Curettage and electrodesiccation: This involves administration of local anesthetic followed by scraping off the AKs with a curette (a small, sharp tool) and then using heat or electricity to destroy any remaining abnormal cells. This is often performed on thicker, hyperkeratotic AKs.
• Photodynamic therapy: This involves use of a topical medication as a photosensitizing agent, followed by exposure to a light source at a specific wavelength to activate the medication and then destroy abnormal cells and target lesions through a photochemical reaction. 
• Chemical peels: Peeling agents such as Jessner’s peel, modified Jessner’s and TCA can be effective for treating multiple AK’s on the face.
• Laser therapy: This involves using a fractionated or non-fractionated resurfacing laser to destroy the AKs. This may be a good option for patients with multiple or extensive lesions.
• Surgery: In some cases, a surgical shave excision may be necessary to remove AKs that are particularly large, deep, or located in sensitive areas.

Your dermatologist can help determine the best treatment option for your individual needs and preferences. It is important to follow all treatment instructions carefully and to protect your skin from the sun’s harmful ultraviolet (UV) rays to prevent the development of new AKs and reduce the risk of skin cancer.

• The best way to treat acne depends on the severity and type of acne you have, as well as your skin type and other individual factors. Here are some general tips that can be helpful for treating acne: Develop a consistent skincare routine: Use a gentle, non-comedogenic cleanser twice a day, and follow up with a moisturizer that is suitable for your skin type. This can help to remove excess oil, dead skin cells, and other impurities that can contribute to acne. Use topical medications: Topical medications such as benzoyl peroxide, salicylic acid, and retinoids can be effective for treating mild to moderate acne. These medications work by killing acne-causing bacteria, unclogging pores, and reducing inflammation. Consider oral medications: Oral antibiotics and isotretinoin may be prescribed by a dermatologist for moderate to severe acne. These medications work by reducing inflammation, killing bacteria, and regulating oil production. Avoid picking or squeezing pimples: This can worsen acne and increase the risk of scarring. Manage stress: Stress can trigger acne breakouts or make existing acne worse, so it’s important to practice stress-reduction techniques such as exercise, meditation, or yoga. It’s important to note that acne treatment can take time, and it may take several weeks or months before you see improvement. If you are concerned about your acne or are experiencing persistent or severe acne, it is recommended that you consult with a dermatologist for guidance and treatment options.

• Treating acne in skin of color may require some different considerations compared to treating acne in lighter skin tones. Here are a few key factors to keep in mind: Post-inflammatory hyperpigmentation (PIH): Individuals with skin of color are more prone to hyperpigmentation, which is darkening of the skin due to increased melanin production.  PIH refers to the dark spots that can remain on the skin after an acne breakout has healed. Since individuals with skin of color are more prone to PIH, it’s important to choose acne treatments that are less likely to cause skin irritation or inflammation, and to use products that can help to fade the dark spots, such as vitamin C, azelaic acid and niacinamide. Use caution with skin lightening products: Some individuals with skin of color may be tempted to use skin lightening products to address hyperpigmentation or PIH. However, many of these products can be harmful, overly irritating or ineffective, and it’s important to avoid using them without the guidance of a healthcare provider. Scarring: Skin of color is also more prone to scarring from acne. To minimize scarring, it’s important to avoid picking or squeezing pimples, and to seek treatment for acne early on. Seek the advice of a dermatologist: Because treating acne in skin of color can be more challenging, it’s important to seek the advice of a dermatologist who has experience treating skin of color. They can provide individualized guidance on the best treatment options for your skin type and concerns.