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   Image      = Actinic keratosis 1.jpg|
   Image      = Actinic keratosis 1.jpg|
   Caption    = Actinic keratosis. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> |
   Caption    = Actinic keratosis. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> |
  ICD10      = {{ICD10|L|57|0|l|55}} |
  ICD9        = {{ICD9|702.0}} |
}}
}}
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{{CMG}}
{{CMG}}; {{AE}} {{KS}}


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{{SK}} Solar keratosis; AK


'''Actinic keratosis''' (also called '''solar keratosis''', or '''AK''') is a [[premalignant condition]] of thick, scaly, or crusty patches of skin. It is  most common in fair-skinned people who are frequently exposed to the sun, because their pigment isn't very protective. It usually is accompanied by solar damage. Since some of these pre-cancers progress to [[squamous cell carcinoma]], they should be treated.
==Overview==
'''Actinic keratosis''' is a [[premalignant condition]] of thick, scaly, or crusty patches of [[skin]]. It is  most common in fair-skinned people who are frequently exposed to the sun, because their pigment isn't very protective. It usually is accompanied by solar damage. Since some of these pre-cancers progress to [[squamous cell carcinoma]], they should be treated.


==Pathophysiology==
When skin is exposed to the sun constantly, thick, scaly, or crusty bumps appear. The scaly or crusty part of the bump is dry and rough. The growths start out as flat scaly areas, and later grow into a tough, wart-like area.
When skin is exposed to the sun constantly, thick, scaly, or crusty bumps appear. The scaly or crusty part of the bump is dry and rough. The growths start out as flat scaly areas, and later grow into a tough, wart-like area.
==Diagnosis==
===Physical Examination===
An actinic [[keratosis]] site commonly ranges in between 2 to 6 millimeters, and can be dark or light, tan, pink, red, a combination of all these, or the same pigment of one's [[skin]]. It may appear on any sun-exposed area, such as the [[face]], [[ear]]s, [[neck]], [[scalp]], [[chest]], back of hands, [[forearm]]s, [[lip]]s etc.
====Skin====
=====Face=====
<gallery>
File:Keratosis solar01.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar05.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar08.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar09.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar10.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar11.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar01.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar13.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar14.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar15.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar17.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar20.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar21.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar23.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar24.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>


An actinic [[keratosis]] site commonly ranges in between 2 to 6 millimeters, and can be dark or light, tan, pink, red, a combination of all these, or the same pigment of one's skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, back of hands, forearms, lips etc.
=====Extremities=====
<gallery>
File:Keratosis solar02.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar03.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar04.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar04.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar07.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar12.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar18.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Keratosis solar19.jpg|Keratosis solar. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>


==Prevention==
===Other Diagnostic Studies===
Preventative measures recommended for AK are similar to those for skin cancer:
Doctors can usually identify AK by doing a thorough examination. A [[biopsy]] may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer. [[Seborrheic keratosis|Seborrheic keratoses]] are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. [[Seborrheic keratoses]] may be mistaken for an actinic keratosis.
* Not staying in the sun for long periods of time without protection (e.g.:[[sunscreen]], clothing, hats).  
 
* Frequently applying powerful sunscreens with [[Sunscreen|SPF]] ratings greater than 15 and that also block both [[Ultraviolet|UVA]] and [[Ultraviolet|UVB]] light.
==Treatment ==
* Using sunscreen even in winter [[Sunburn|sun exposure]].
{| class="wikitable"
* Wearing sun protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
|+Modalities employed in the treatment of actinic keratosis
* Avoiding sun exposure during noon hours is very helpful because [[ultraviolet]] light is the most powerful at that time.
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Medical Therapy}}
! style="background: #4479BA; width: 500px;" |{{fontcolor|#FFF|Characteristics}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Fluorouracil_(topical)|5-Fluorouracil]] (a chemotherapy agent)
|
A cream that contains this medication causes AKs to become red and [[inflamed]] before they fall off. The application of [[Fluorouracil_(topical)|5-FU]] prevents production of DNA on the cells. Treatment products containing 5FU are Efudix, Carac, [[Fluorouracil_(topical)|Fluorocacil]], among others.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Cauterization|Electrocautery]]
|
Consists of burning off AKs with electricity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Immunotherapy]]
|
[[imiquimod|Imiquimod]] uses your body's immune system to kill cancer cells. Improvement of the immune system works its way out up to the cancerous cells and treat the [[Skin_cancer|skin cancer]]. Treatment products containing [[imiquimod|Imiquimod]] include Aldara™, Zyclara, [[Interferon]], among others.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Natural direct therapy
|
Active compound BEC (based on eggplant) works its way to the endo-lectins of the cancerous cells and causes their [[Apoptosis|apoptosis]] (death). Treatment products containing BEC for [[Skin_cancer|skin cancer]] and AKs are [https://www.curadermbcc.eu/treatments-for-skin-cancers/ Curaderm BCC], among others.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Photodynamic therapy
|
This therapy involves application of a chemical on the skin. It destroys cancerous cells with a combination of laser light and drugs, that makes them sensitive to light.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Freezing
|
Medical professional applies [[liquid nitrogen]] ([[Cryosurgery]]) to freeze and destroy actinic keratosis and some small, early skin cancers. The dead tissue sloughs off later on.
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Different forms of [[surgery]]
|}


==Diagnosis==
Regular follow-up after treatment is advised by many doctors. The regular checks are to make sure new bumps have not developed and that old ones haven't become thicker and/or have skin disease.
Doctors can usually identify AK by doing a thorough examination. A [[biopsy]] may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a [[skin cancer]]. [[Seborrheic keratosis|Seborrheic keratoses]] are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. [[Seborrheic keratoses]] may be mistaken for an actinic keratosis.


== Treatment ==
===Primary Prevention===
Various modalities are employed in the treatment of actinic keratosis:
Preventative measures recommended for AK are similar to those for skin cancer:
* [[Cryosurgery]], e.g. with [[liquid nitrogen]], by "freezing off" the AKs.
* [[5-fluorouracil]] (a [[chemotherapy]] agent): a cream that contains this medication causes AKs to become red and [[inflamed]] before they fall off.
* [[Photodynamic therapy]]: this new therapy involves application of a chemical on the skin, which makes AKs sensitive to specific wavelengths of light
* [[Cauterization|Electrocautery]]: burning off AKs with electricity.
* [[Immunotherapy]]: topical treatment with [[imiquimod]] (Aldara™), an immune enhancing agent
* Different forms of [[surgery]].


Regular follow-up after treatment is advised by many doctors. The regular checks are to make sure new bumps have not developed and that old ones haven't become thicker and/or have skin disease.
*Not staying in the sun for long periods of time without protection (e.g.[[sunscreen]], clothing, hats).
*Frequently applying powerful sunscreens with [[Sunscreen|SPF]] ratings greater than 15 and that also block both [[Ultraviolet|UVA]] and[[Ultraviolet|UVB]] light.
*Using sunscreen even in winter [[Sunburn|sun exposure]].
*Wearing sun protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
*Avoiding sun exposure during noon hours is very helpful because [[ultraviolet]] light is the most powerful at that time.


==Experimental treatments==
==Future or Investigational Therapies==
As of 2008 a company in Australia named Clinuvel Pharmaceuticals Limited is performing [[clinical trial]]s with a [[melanocyte-stimulating hormone]] named [[melanotan]] (which they refer to as CUV1647) for actinic keratosis in organ transplant patients.<ref name="Clinuvel">[http://www.clinuvel.com/en/faqs/ Clinuvel » Investors » FAQs<!-- Bot generated title -->]</ref>
As of 2008 a company in Australia named Clinuvel Pharmaceuticals Limited is performing [[clinical trial]]s with a [[melanocyte-stimulating hormone]] named [[melanotan]] (which they refer to as CUV1647) for actinic keratosis in organ transplant patients.<ref name="Clinuvel">[http://www.clinuvel.com/en/faqs/ Clinuvel » Investors » FAQs<!-- Bot generated title -->]</ref>
==External links==
* [http://www.skincarephysicians.com/actinickeratosesnet/index.html American Academy of Dermatology]
* [http://www.aocd.org/skin/dermatologic_diseases/actinic_keratosis.html American Osteopathic College of Dermatology]
* [http://www.nlm.nih.gov/medlineplus/ency/article/000827.htm National Library of Medicine and the National Institute of Health]
* [http://www.dermnet.com/moduleSearch.cfm?searchterm=actinic%20keratosis%20 Actinic Keratosis photo library at Dermnet]
* [http://www.medicinenet.com/actinic_keratosis/article.htm Medicinenet's article on Actinic Keratosis]
* [http://www.skincancer.org/ak/index.php Information on Actinic Keratosis from The Skin Cancer Foundation]


==References==
==References==
{{reflist}}
{{reflist|2}}


==Additional Resources==
[[Category:Dermatology]]
{{refbegin|2}}
[[Category:Disease]]
* {{cite journal | author=Abel EA | title=Cutaneous manifestations of immunosuppression in organ transplant recipients | journal=J Am Acad Dermatol | year=1989 | pages=167-79 | volume=21 | issue=2 Pt 1  | id=PMID 2671063}}
* {{cite journal | author=Fitzpatrick TB | title=The validity and practicality of sun-reactive skin types I through VI | journal=Arch Dermatol | year=1988 | pages=869-71 | volume=124 | issue=6  | id=PMID 3377516}}
* {{cite journal | author=Glogau RG | title=The risk of progression to invasive disease | journal=J Am Acad Dermatol | year=2000 | pages=23-4 | volume=42 | issue=1 Pt 2  | id=PMID 10607353}}
* {{cite book
| author = Gordon D, Silverstone H.
| chapter =  The biologic effects of ultraviolet radiation
| editor = Ubach F, editor
| title = The Biologic Effects of Ultraviolet Radiation
| location = Oxford (UK)
| publisher = Pergamon Press
| year = 1969
| pages = p. 625
}}
* {{cite journal | author=Lookingbill DP, Lookingbill GL, Leppard B | title=Actinic damage and skin cancer in albinos in northern Tanzania: findings in 164 patients enrolled in an outreach skin care program | journal=J Am Acad Dermatol | year=1995 | pages=653-8 | volume=32 | issue=4  | id=PMID 7896957}}
* {{cite journal | author=Marshall V | title=Premalignant and malignant skin tumours in immunosuppressed patients | journal=Transplantation | year=1974 | pages=272-5 | volume=17 | issue=3  | id=PMID 4592184}}
* Scotto J, Fears TR, Fraumeni JF. ''Incidence of nonmelanoma skin cancer in the United States''. Publication No (NIH) 82-2433. Washington, DC: US Dept Health and Human Services; 1983.
{{refend}}


{{Diseases of the skin and subcutaneous tissue}}
[[Category:Dermatology]]
<br>
[[de:Aktinische Keratose]]
[[nl:Actinische keratose]]
[[ja:日光角化症]]
{{SIB}}
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Latest revision as of 09:28, 2 August 2021

Template:DiseaseDisorder infobox Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Solar keratosis; AK

Overview

Actinic keratosis is a premalignant condition of thick, scaly, or crusty patches of skin. It is most common in fair-skinned people who are frequently exposed to the sun, because their pigment isn't very protective. It usually is accompanied by solar damage. Since some of these pre-cancers progress to squamous cell carcinoma, they should be treated.

Pathophysiology

When skin is exposed to the sun constantly, thick, scaly, or crusty bumps appear. The scaly or crusty part of the bump is dry and rough. The growths start out as flat scaly areas, and later grow into a tough, wart-like area.

Diagnosis

Physical Examination

An actinic keratosis site commonly ranges in between 2 to 6 millimeters, and can be dark or light, tan, pink, red, a combination of all these, or the same pigment of one's skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, back of hands, forearms, lips etc.

Skin

Face
Extremities

Other Diagnostic Studies

Doctors can usually identify AK by doing a thorough examination. A biopsy may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer. Seborrheic keratoses are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. Seborrheic keratoses may be mistaken for an actinic keratosis.

Treatment

Modalities employed in the treatment of actinic keratosis
Medical Therapy Characteristics
5-Fluorouracil (a chemotherapy agent)

A cream that contains this medication causes AKs to become red and inflamed before they fall off. The application of 5-FU prevents production of DNA on the cells. Treatment products containing 5FU are Efudix, Carac, Fluorocacil, among others.

Electrocautery

Consists of burning off AKs with electricity.

Immunotherapy

Imiquimod uses your body's immune system to kill cancer cells. Improvement of the immune system works its way out up to the cancerous cells and treat the skin cancer. Treatment products containing Imiquimod include Aldara™, Zyclara, Interferon, among others.

Natural direct therapy

Active compound BEC (based on eggplant) works its way to the endo-lectins of the cancerous cells and causes their apoptosis (death). Treatment products containing BEC for skin cancer and AKs are Curaderm BCC, among others.

Photodynamic therapy

This therapy involves application of a chemical on the skin. It destroys cancerous cells with a combination of laser light and drugs, that makes them sensitive to light.

Freezing

Medical professional applies liquid nitrogen (Cryosurgery) to freeze and destroy actinic keratosis and some small, early skin cancers. The dead tissue sloughs off later on.

Different forms of surgery

Regular follow-up after treatment is advised by many doctors. The regular checks are to make sure new bumps have not developed and that old ones haven't become thicker and/or have skin disease.

Primary Prevention

Preventative measures recommended for AK are similar to those for skin cancer:

  • Not staying in the sun for long periods of time without protection (e.g.sunscreen, clothing, hats).
  • Frequently applying powerful sunscreens with SPF ratings greater than 15 and that also block both UVA andUVB light.
  • Using sunscreen even in winter sun exposure.
  • Wearing sun protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
  • Avoiding sun exposure during noon hours is very helpful because ultraviolet light is the most powerful at that time.

Future or Investigational Therapies

As of 2008 a company in Australia named Clinuvel Pharmaceuticals Limited is performing clinical trials with a melanocyte-stimulating hormone named melanotan (which they refer to as CUV1647) for actinic keratosis in organ transplant patients.[2]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 "Dermatology Atlas".
  2. ↑ Clinuvel » Investors » FAQs


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