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Актиничний кератоз (МКХ-10: L57) ⚠️

Actinic Keratosis (AK, Solar Keratosis)

Actinic keratosis — also called solar keratosis — is a skin condition that’s considered precancerous. It shows up as rough, red patches with a scaly surface. This usually affects people over 40, especially on parts of the skin that get a lot of sun exposure. Because it can develop into squamous cell skin cancer, it’s important to keep an eye on it. Actinic keratosis tends to appear as multiple spots that can grow in number over time. It affects men and women equally.

What Increases the Risk?

While the exact cause of actinic keratosis isn’t fully clear, several factors can raise the chance of developing it. These mostly relate to environmental and genetic influences that make the skin more vulnerable to damage and the formation of these lesions:

  • Ageing Skin: As we get older, our skin cells change and don’t work as well, which can lead to these patches.
  • Too Much UV Exposure: Spending a lot of time in the sun or using tanning beds is the main cause. The damage from UV rays builds up over time, increasing the risk.
  • Genetics: Some people may be more prone to actinic keratosis because of their skin type or family history.
  • Exposure to Ionising Radiation: This can come from certain jobs or medical treatments and may trigger these skin changes.
  • Chemicals and Repeated Skin Injuries: Constant contact with certain chemicals or ongoing skin damage can also lead to actinic keratosis.

How Is It Diagnosed?

Doctors usually diagnose actinic keratosis by looking closely at the skin and using a dermatoscope — a special magnifying tool — to examine the spots. If there’s any doubt that a patch might be cancerous or unusual, a small skin sample (biopsy) may be taken for further testing.

What Does It Look and Feel Like?

Actinic keratosis can appear as one or several flat or slightly raised patches with a rough, dry surface. These spots often have crusts and may sometimes bleed or look eroded. They usually have uneven, poorly defined edges and can be flesh-coloured, grey, brownish-grey, or pink. Sometimes, redness around the patch is noticeable.

The size varies from about 5 mm up to 20 mm, and groups of spots can cover areas of 3-4 cm or more. The patches usually don’t rise more than 5-7 mm above the skin. They don’t typically affect hair growth, but some people might find them itchy or uncomfortable, though this is usually mild.

These patches mostly show up on skin that’s often in the sun — like the face, ears, scalp, neck, upper arms (especially shoulders and wrists), and chest. They’re less common on the palms or soles.

What Shows Up Under the Dermatoscope?

When examined with a dermatoscope, actinic keratosis has some typical features that help with diagnosis:

  • Redness: A flushed or red area around the patch is common.
  • Red Pseudo-Network: A network-like pattern made by blood vessels just under the skin’s surface.
  • Dry, Flaky Skin: You’ll often see dry flakes on the patch.
  • White Halo Around Hair Follicles: A white ring around hair follicles within the patch.
  • Yellowish Keratin Plugs: Hardened keratin plugs in the enlarged hair follicles.
  • Blood Vessel Patterns: The patch usually has twisted or linear blood vessels visible.
  • Dark Brown Spots and Veins: In pigmented forms, you might see dark brown dots, veins, or globules.

What Else Could It Be?

Actinic keratosis can look like other skin conditions, so it’s important to tell them apart. These include:

  • Psoriasis, eczema, and dermatitis
  • Seborrhoeic keratosis
  • Lentigo (age spots)
  • Post-inflammatory darkening of the skin
  • Melanosis
  • Dysplastic nevus (atypical mole)
  • Bowen’s disease (a form of early skin cancer)
  • Lentigo maligna melanoma
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

What Are the Risks?

Because actinic keratosis is a precancerous condition, there’s a real risk it could turn into squamous cell carcinoma (SCC) — a type of skin cancer. This risk is estimated to be between 1 and 10%. It can develop into invasive SCC over time. Bowen’s disease is a related condition that’s an early form of SCC but remains in the top skin layer. Since UV damage builds up over the years, these patches can grow in number and size, increasing the chance of cancer.

People with lots of actinic keratoses have significant sun damage and should have regular skin checks, as other sun-related skin cancers like basal cell carcinoma or SCC might also develop on the same areas.

What Should You Do?

If the patches don’t change and you don’t have symptoms like pain or swelling, it’s usually enough to keep an eye on them yourself. Check your skin at least once a year, especially in places that are hard to see. If a patch gets injured, is exposed to the sun, or changes in any way, it’s important to see a dermatologist or skin cancer specialist.

Your doctor will decide if the patches need closer monitoring or removal. If the spots are regularly irritated by clothes, jewellery, or work activities, they should be checked by a specialist. Taking photos can help track any changes over time.

If you have many actinic keratoses, it’s best to see a dermatologist or oncologist twice a year — in spring and autumn, before and after the sunny months. Mapping your skin spots can help keep track of new or changing lesions.

Treatment Options

Treatment is important because of the risk of these patches turning cancerous. Actinic keratoses usually need to be treated directly, as they can persist or come back if left alone. Treatment options include:

  • Protecting Your Skin from the Sun: This is the most important step. Wearing protective clothing, hats, avoiding too much sun, and using sunscreen can slow down the condition and lower the risk of cancer.
  • Removing the Patches Locally: This can be done with laser therapy, freezing (cryotherapy with liquid nitrogen), or heat treatment (diathermocoagulation).
  • Surgical Removal: In rare cases, surgery might be needed to take out larger or troublesome patches. This is less common because there are often many spots and surgery can affect appearance.

Topical treatments may also be prescribed, such as:

  • 5-fluorouracil combined with salicylic acid
  • Imiquimod

These should always be used under medical supervision, as side effects and recurrence are possible.

How to Prevent Actinic Keratosis

Preventing actinic keratosis and its possible progression to cancer involves careful sun care and skin protection:

  • Limit UV exposure by avoiding tanning beds and excessive time in the sun.
  • Use protective creams during times when you’re in the sun.
  • Avoid repeated skin injuries that can irritate or damage the skin.
  • Minimise or avoid exposure to ionising radiation and workplace hazards.
  • Follow safety guidelines when handling chemicals that can harm the skin.
  • Maintain good personal hygiene and regularly check your skin for changes.

Regular skin checks, prompt medical advice if you notice changes, and removing any suspicious patches are key to keeping your skin healthy and avoiding complications.