Skin Lesions (Actinic Keratosis)

Actinic keratoses (AKs) are common skin lesions.  Caused by years of sun exposure, AKs also are called “solar keratoses” or “sun spots,” Fair-skinned people are more susceptible, and AKs tend to appear on skin that receives the most sun.  The forehead, ears, neck, arms, hands, lower lip, a bald scalp, and lower legs of women are common sites.  No matter where AKs develop, they are considered the earliest stage in the development of skin cancer.

Like skin cancer, AKs develop when ultraviolet (UV) light from the sun damages cells in the skin.  When AKs form, the affected skin cells are the keratinocytes. These tough-walled cells make up 90 percent of the epidermis (the outermost layer of skin) and give the skin its texture. Changes to these cells cause the skin to become rough and scaly.  Bumps or small horn-like growths form.  If the cells continue to change, AKs can progress to squamous cell carcinoma, a type of skin cancer. 

What Actinic Keratoses Look Like

The typical actinic keratosis (AK) is a dry, scaly, rough bump that is skin-colored to reddish brown. The lesion may range from the size of a pinhead to larger than a quarter. Some skin colored AKs may be easier to feel than see.  When touched, these often feel like sandpaper.

Sometimes an AK grows rapidly upward, causing it to resemble the horn of an animal.  When this happens, the AK is called a “cutaneous horn.”  Horns vary in size from that of a pinhead to a pencil eraser.  Some horns grow straight; others curve.  Cutaneous horns often form on the ears, which tend to receive years of sun exposure.

AKs also commonly form on the lower lip.  An AK on the lower lip is known as “actinic cheilitis” and looks like a diffuse, scaly patch on a dry, often cracked lip.

No matter where an AK forms, it can seem to disappear for weeks or months and then return.  This also can happen when an AK is scraped off.  The damaged cells continue to grow, and the AK returns.  A dermatologist can determine when to treat AKs and how.

Treating Actinic Keratoses

When treating AKs, dermatologists may use one therapy or combine therapies.  Some available treatments for actinic keratoses are:

  • CRYOSURGERY — The most common treatment for AKs, cryosurgery involves applying a cryogenic (extremely cold) substance, usually liquid nitrogen, to the lesion.  This freezes the surface skin, causing the skin to flake off.  New skin forms.  The main side effect is skin redness; blistering may occur.
  • TOPICAL CHEMOTHERAPY — To destroy AKs, patients apply a cancer fighting cream or lotion (e.g., 5-fluoruracil,) to their skin.  Red spots may remain on the treated skin for a while.  Another treatment option such as cryosurgery may be necessary to treat thicker lesions that a cream or lotion cannot fully penetrate.
  •  TOPICAL IMMUNOTHERAPY — When applied to the skin, this medication (e.g., imiquimod) stimulates the patient’s own immune system to destroy the AKs and accompanying damaged skin cells.  Patients apply this medication at home as directed by their dermatologist.
  • TOPICAL NSAID (NON-STEROIDAL ANTI-INFLAMMATORY DRUG) — Patients apply this medication (e.g., sodium diclofenac gel) to the lesions as directed. During treatment, patients should avoid the sun.  The medication works to destroy the AKs and accompanying solar damage.
  • PHOTODYNAMIC THERAPY — A solution that makes the skin more sensitive to light is applied and left on the skin.  After a few hours, the treated skin is exposed to “blue” or “red” light, which activates the solution and destroys the AKs.  Areas of redness may develop in treated regions. These will fade after several days.
  • CHEMICAL PEELING — A chemical solution is applied to the skin in order to peel away the AKs and damaged skin.  As the treated skin peels off, new healthy skin replaces it.  It is common to experience discomfort, redness, and crusting in the treated areas.
  • LASER SKIN RESURFACING — A laser may be used to remove AKs and damaged skin.  A common side effect is redness immediately afterward.  It may take a week or two for the skin to heal.

Research and development of other treatments for AKs is ongoing. No one therapy works on all AKs or in all individuals.

Preventing Actinic Keratoses

This should start early in life.  Sun damage begins in childhood and puts the child at risk for AKs and skin cancer later in life. However, it is never too late to prevent new AKs – even in adults who have AKs.

The Basics of Actinic Keratoses Prevention:

  • Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m.  If your shadow is shorter than you are, seek shade.
  • Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
  • Generously apply sunscreen daily.  Sunscreen should have a sun protection factor (SPF) of 15 or higher and offer broad-spectrum protection (both UVA and UVB protection). Sunscreen should be applied at least 20 minutes before going outdoors to all skin that will be exposed such as the face, ears, and hands.
  • Reapply sunscreen every 2 hours, after swimming or sweating, even on cloudy days

Dermatologic Conditions

Acne

Acne is a skin condition which has plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules).  Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms.  Although most teenagers get some...

Allergic Contact Dermatitis

Allergic contact dermatitis is caused by a reaction to substances called allergens that come into contact with your skin. In susceptible people, these contact allergens can cause itching, redness, and blisters that is known as allergic contact dermatitis. What...

Alopecia Areata

Alopecia areata (AA) causes hair loss in small, round patches that may go away on their own, or may last for many years. Nearly 2% of the U.S. population (about four million people) will develop AA in their lifetime. Some people with AA (about 5%) may lose all scalp...

Dry Skin

Dry Skin and Keratosis Pilaris Dry skin and keratosis pilaris are common. Dry skin can occur at any age and for many reasons. Keratosis pilaris is an inherited skin condition that develops in up to 40% of the population. Sometimes a dermatologist's help is necessary...

Eczema (Atopic Dermatitis)

A common skin condition, atopic dermatitis is frequently described as "the Itch that rashes”.  Intensely itchy patches form.  These patches can be widespread or limited to a few areas.  Scratching often leads to redness, swelling, cracking, "weeping" of...

Excessive Sweating (Hyperhidrosis)

Hyperhidrosis is excessive sweating. Sweating is necessary to keep the body cool; however, it should not interfere with a person's ability to interact and function. Hyperhidrosis affects quality of life. It may cause embarrassment and frustration. It can impact one's...

Genital Warts

Genital warts, also known as venereal warts, or condylomata acuminata, are caused by the human papilloma virus (HPV). More than 100 types of HPV are known to exist. Low risk types (HPV 1, 2, and 3) cause warts on the hands, feet, and other parts of the body. Types (6...

Granuloma Annulare

Granuloma annulare is a raised, bumpy, or ring-shaped lesion, which can occur singly or in groups on the skin. It is more common in children and young adults, although it may affect people of all ages. Women are twice as likely as are men to develop granuloma...

Hand Eczema

What causes a hand rash? A hand rash, also called hand dermatitis or hand eczema, may be caused by many things. Hand rashes are extremely common.  Many people start with dry, chapped hands that later become patchy, red, scaly, and inflamed. Numerous items can...

Hives (Urticaria)

Hives, or "wheals", are pale red swellings of skin that occur in groups on any part of the skin.  Urticaria is the medical word for hives.  Each hive lasts a few hours before fading without a trace.  New areas may develop as old areas fade.  They...

HSV (Herpes Simplex)

The herpes simplex virus (HSV) can cause blisters and sores almost anywhere on the skin. These sores usually occur either around the mouth and nose, or on the genitals and buttocks. HSV infections can be very annoying because they can periodically reappear.  The...

Lichen Planus

Lichen Planus (pronounced LY -kin-PLAN-us) is a rather common disease that affects the skin, the mouth, or both. It affects about one percent of the general population. What is lichen planus? How do you get the disease? Can it be cured? This information will help...

Moles

Everyone has moles, sometimes 40 or more.  Most people think of a mole as a dark brown spot, but moles have a wide range of appearances. At one time, a mole in a certain spot on the cheek of a woman was considered fashionable.  These were called "beauty...

Perioral Dermatitis

What is perioral dermatitis? Perioral dermatitis is a common skin problem that mostly affects young women. Occasionally men or children are affected. Perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. In addition to redness,...

Pityriasis Rosea

Pityriasis rosea is a rash that occurs most commonly in people between the ages of 10 and 35, but may occur' at any age. The rash can last from several weeks to several months. Usually there are no permanent marks as a result of this condition, although some...

Poison Plants

Poison Plants: Ivy, Oak, and Sumac Those nasty weeds!  Poison ivy, poison oak, and poison sumac are the most common cause of allergic reactions in the United States.  Each year 10 to 50 million Americans develop an allergic rash after contact with these...

Psoriasis

Psoriasis is a persistent, inflammatory skin condition.  Some cases of psoriasis are so mild that people don't know they have it.  Alternatively, severe psoriasis may cover large areas of the body.  Dermatologists can help even the most severe...

Rosacea

Rosacea is a common skin disease that causes redness, pustules, papules, and swelling on the face.  Often referred to as "adult acne," rosacea frequently begins as a tendency to flush or blush easily.  It may progress to persistent redness in the center of...

Sclerotherapy

Spider Vein Varicose Vein Therapy Spider veins are small superficial blood vessels that appear red or blue in the skin. They commonly occur on the legs, but are also found on the face or other areas of the body. These dilated blood vessels may be short, unconnected...

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin disorder that can be easily treated.  Causing a red, scaly, itchy rash, this condition most commonly develops on the scalp, sides of the nose, eyebrows, ears, eyelids, and middle of the chest. Other areas, such as the navel...

Seborrheic Keratoses

Seborrheic keratoses (SKs) are common skin growths.  These benign (non-cancerous) growths can occur almost anywhere on the skin.  Some people get just one; others develop many.  Having many SKs is more common. Usually beginning as small, rough bumps,...

Shingles (Herpes Zoster)

Anyone who has had chicken pox can develop herpes zoster.  Also known as shingles or zoster, herpes zoster is caused by the same virus as chicken pox.  After the chicken pox clear, the virus remains dormant (inactive) within certain nerve cells of the...

Skin Cancer

Of all the cancers that humans can get, skin cancer is the most common.  In the United States, skin cancer is increasing in all races. Who gets skin cancer? People of all colors and races get skin cancer.  Those with light skin who sunburn easily have a higher...

Tinea Versicolor

Tinea versicolor is a common skin condition caused by an overgrowth of yeast on the skin's surface.  The yeast normally live in the pores of the skin and thrive in oily areas such as the neck, upper chest, and back.  An overgrowth results in a fungal...

Vitiligo

Vitiligo is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few too many milky-white patches. Common areas of involvement are: face lips hands arms legs...

Warts

What are warts? Warts are non-cancerous skin growths caused by a viral infection in the top layers of skin. The virus that causes warts is called the human papilloma virus, or HPV:  Warts are usually skin colored and feel rough to the touch, but they can be dark,...