Actinic, or solar, keratoses (AK) is a rough, scaly patch on the skin and is a common premalignant lesion that develops as a consequence of chronic sun exposure. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck.
Clinical Features:
- small, crusty or scaly, lesions
- may be pink, red, brown or the same color as the skin
- typically on sun exposed areas e.g. temples of head
- multiple lesions may be present
Risk Factors: include:
- Age older than 40
- Living in a sunny climate
- A history of frequent or intense sun exposure or sunburn
- Red or blond hair, and blue or light-colored eyes
- People who tend to freckle or burn when exposed to sunlight
- Have a personal history of an actinic keratosis or skin cancer
- Have a weak immune system as a result of chemotherapy, leukemia, AIDS or organ transplant medication
Diagnosis is clinical on the basis of history and examination. If there is any doubt a skin biopsy can be done.
Management: options include
- prevention of further risk: e.g. sun avoidance, sun cream
- fluorouracil cream: typically a 2 to 3 week course. The skin can become red and inflamed sometimes
- topical hydrocortisone is given following fluorouracil to help settle the inflammation
- topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side effects
- topical imiquimod: trials have shown good efficacy
- cryotherapy
- curettage and cautery
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