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Actinic Keratoses

Actinic keratoses, also known as solar keratoses, are common precancerous skin lesions caused by chronic exposure to ultraviolet (UV) radiation. Actinic keratoses are more frequent in people with fair skin, light-coloured eyes, and a history of significant sun exposure, particularly in middle-aged and older adults.

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Overview

What are actinic keratoses?

Actinic keratoses are rough, scaly patches that can appear skin-coloured, pink, red, or brown. They are usually small, ranging from a few millimetres up to 3 cm in diameter, but they may enlarge or merge over time. The lesions often feel like sandpaper and can be slightly raised or flat.

Unlike benign moles or warts, actinic keratoses are precancerous, reflecting UV-induced DNA damage in skin cells. Early identification is important to prevent malignant transformation.

Where do actinic keratoses commonly appear?

These lesions typically develop on areas of skin most exposed to the sun:

  • Face, ears, and scalp – chronic sun exposure and minimal natural protection make these areas highly susceptible.
  • Neck and décolletage – frequently exposed during daily activities or outdoor work.
  • Back of the hands, forearms, and shoulders – common in outdoor workers or those who spend extended periods in sunlight.
  • Lips and lip borders (actinic cheilitis) – less common but higher risk for progression to cancer.

Individuals with fair skin, older age, a history of sunburn, or a weakened immune system are at increased risk.

Symptoms and Causes

Recognising the signs of actinic keratoses

  • Rough, scaly patches on sun-exposed skin
  • Flat or slightly raised lesions with a sandpaper-like texture
  • Pink, red, brown, or skin-toned discolouration
  • Itching, tenderness, or burning in some lesions
  • Occasional bleeding or crusting, especially if irritated

Most actinic keratoses are painless and asymptomatic, and they may go unnoticed unless closely examined. However, multiple lesions or those in visible areas can cause cosmetic concern or discomfort.

What causes actinic keratoses?

Actinic keratoses develop as a result of long-term UV exposure, which damages the DNA of skin cells and causes abnormal growth. Several factors increase the likelihood of developing these lesions:

  • Fair skin, light eyes, and light hair – lower natural melanin protection.
  • Chronic sun exposure – outdoor work, recreational activities, or repeated sunburn.
  • Age over 40 – cumulative sun damage over time.
  • Weakened immune system – e.g., post-organ transplantation or immunosuppressive medications.
  • History of previous skin lesions – presence of other sun-related skin changes increases susceptibility.

Actinic keratoses are not contagious, but multiple lesions may indicate significant sun damage and require careful monitoring.

Diagnosis and Tests

Can actinic keratoses be treated?

Actinic keratoses are usually diagnosed by a GP or dermatologist based on appearance, texture, and location.

  • Dermoscopy – a magnified examination can help distinguish actinic keratoses from other lesions, such as seborrheic keratoses or early skin cancers.
  • Skin biopsy – performed if lesions appear atypical, pigmented, rapidly growing, or symptomatic, to confirm the diagnosis and rule out squamous cell carcinoma.

Most lesions are diagnosed visually, and additional tests are rarely needed for typical actinic keratoses.

Management and Treatment

Treatment aims to remove the lesions and reduce the risk of progression to skin cancer. Options vary based on the number, size, and location of lesions:

  • Cryotherapy – freezing the lesion with liquid nitrogen to destroy abnormal cells.
  • Topical treatments – prescription creams such as 5-fluorouracil (5-FU), imiquimod, or diclofenac applied over several weeks.
  • Photodynamic therapy (PDT) – using a photosensitising agent followed by light exposure to target abnormal cells.
  • Curettage and cautery – scraping the lesion and applying heat to stop bleeding.
  • Laser therapy – precise removal of the lesion with focused light.

Professional treatment is recommended to minimise scarring, infection, or incomplete removal. Home remedies are generally discouraged due to the risk of complications.

Outlook/Prognosis

Actinic keratoses are precancerous but usually not immediately dangerous. Early treatment significantly reduces the risk of progression to squamous cell carcinoma. Untreated lesions may persist, enlarge, or occasionally evolve into invasive cancer over months or years.

Individuals with multiple lesions or ongoing sun exposure should have regular skin checks. Even after removal, new lesions may develop in other sun-exposed areas. With careful monitoring and professional management, the prognosis for actinic keratoses is excellent.

Prevention

While it may not be possible to completely prevent actinic keratoses, these strategies can reduce risk and protect skin health:

  • Limit sun exposure, especially between 10 a.m. and 4 p.m.
  • Apply broad-spectrum sunscreen with SPF 30 or higher daily, even on cloudy days.
  • Wear protective clothing, hats, and sunglasses to shield sun-exposed skin.
  • Avoid tanning beds or artificial UV sources.
  • Regular skin monitoring to detect new or changing lesions early.

Adopting these preventive measures helps protect the skin, reduce the formation of new lesions, and minimise the risk of progression to skin cancer.

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Concerned About Actinic Keratoses?

If you notice rough, scaly, or persistent patches on sun-exposed areas of your skin, contact Aventus Clinic for a thorough assessment. Early evaluation and treatment can help prevent progression to skin cancer and protect your skin’s health.

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