Medicines for Actinic keratoses

What it is

Actinic keratoses (also called solar keratoses) are rough, scaly patches of skin that develop as a result of long-term exposure to ultraviolet (UV) light from the sun (or, less commonly, sunbeds) over many years. They are very common, particularly in older people with fair skin who have had a lot of sun exposure over their lifetime, and they appear on areas most exposed to the sun — such as the face, scalp (particularly in bald or balding men), ears, backs of the hands, forearms, and lower legs. Actinic keratoses appear as small, rough, dry, or scaly patches, which may be pink, red, brown, or skin-coloured, and can feel rough like sandpaper (sometimes more easily felt than seen); there may be one or several. They are usually harmless in themselves and often cause no symptoms, though they can sometimes be itchy or tender, and some come and go. Their importance is twofold: they are a marker of significant sun damage (indicating skin that has had a lot of UV exposure, and therefore a higher risk of skin cancer generally), and a small proportion of actinic keratoses can, over time, develop into a type of skin cancer (squamous cell carcinoma). Because of this small risk, and because they indicate sun-damaged skin, actinic keratoses are worth having assessed, and are often treated or monitored; and it is important to be alert to any that change — for example becoming thicker, lumpy, tender, growing, bleeding, or turning into a sore or ulcer — which should be checked, as this could indicate a change to skin cancer. Actinic keratoses are managed with treatments to remove or clear them, monitoring, and, importantly, sun protection to prevent further damage. The key messages are that actinic keratoses are common rough, scaly patches from long-term sun damage, that they are usually harmless but a sign of sun damage with a small risk of becoming skin cancer, and that assessment, treatment or monitoring, and sun protection are worthwhile.

How it is treated

Actinic keratoses are managed with treatment or monitoring, alertness to any changes, and sun protection to prevent further damage. Because they indicate sun-damaged skin and carry a small risk of developing into skin cancer, it is worth having them assessed by a GP or dermatologist, who can confirm the diagnosis, advise on treatment or monitoring, and check for any suspicious changes. There are several treatment options, chosen according to the number, size, location, and thickness of the lesions and the individual: for a few lesions, treatments such as freezing (cryotherapy), or creams and gels applied to the skin (which treat the affected areas over a period), may be used; for more widespread areas ("field" changes), creams or other field treatments, or other approaches (such as photodynamic therapy) may be used; and some individual thick or persistent lesions may be removed or treated in other ways. Some actinic keratoses, particularly thin ones, may be monitored rather than actively treated, and some resolve on their own. Sun protection is very important, both to prevent new actinic keratoses and to reduce the overall risk of skin cancer: using a high-factor, broad-spectrum sunscreen, covering up, seeking shade, and avoiding sunbeds all help, and are advised on an ongoing basis for people with sun-damaged skin. It is important to be alert to changes: any actinic keratosis (or other skin lesion) that becomes thicker, lumpy, tender, painful, grows, bleeds, or turns into a non-healing sore or ulcer should be checked promptly, as this could indicate a change into skin cancer (squamous cell carcinoma). People who have had actinic keratoses or skin cancer are at higher risk of further skin cancers, so ongoing skin awareness and checks are worthwhile. The reassuring messages are that actinic keratoses are common and usually harmless in themselves, that effective treatments and monitoring are available, that the risk of any one becoming skin cancer is small (but the reason for treating or monitoring them and protecting the skin), and that sun protection and being alert to changing lesions are the key ongoing measures.