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Actinic Keratosis- Causes And Treatment

Actinic Keratosis

Actinic Keratosis, also known as Solar Keratosis, caused by prolonged exposure to the harmful ultraviolet radiation of the sun. It characterized by dry or patchy areas, which may or may not be discolored. These areas can further harden into warts or growths with a ‘horn-like’ structure.

Causes

This kind of Keratosis directly caused by sun exposure and, thus, most often seen in the areas exposed to the sun more. This includes the face, forearms, back of hands, ears, and even bald spots in the scalp. In other instances, it might occur on the chest or even the back.

It is also a condition that affects fair-skinned people; its occurrence in people of darker complexion is very rare. Fair-skinned people do not tan easily and are prone to sunburn. Lesions or hardened patches of skin start appearing on the sun-damaged skin and can be localized or increase in number and extent.

Actinic Keratosis also has seen more in the countries nearer to the equator with sunny weather. People who have outdoor jobs are vulnerable, as are sports enthusiasts. It also exhibited in men more than women, a fact that can attribute to outdoor professions for men.

Age is also a variable that features an increased occurrence of this skin condition. Cumulative ultraviolet damage over the years increases the chances of Actinic Keratosis a lot. It thus seen more in patients who have reached their middle ages or more. This, however, does not cut risk factors for younger people, as sun damage can be harmful to the young as for the old.

Actinic Keratosis is not a life-threatening disease in itself, but it also considered as pre-cancerous. This is to say that the condition can cause complications that present themselves as skin cancer or Cancer or Squamous cell carcinoma. Medical advice as soon as the first signs of the disease present themselves can be the preventive measure.

Actinic Keratosis

Actinic Keratosis

Actinic Keratosis is curable – through medication as well as surgical procedures. The best route of treatment chose to take into account the extent of lesions as well as various other variables like age, history of skin cancer( if any), and allergy to a specific medication.

Sometimes a mix of both medicine and surgery is advised as the course of treatment. Disfiguring of skin as a result of treatment may worry about some patients. They can opt for cosmetic reconstruction, but this is a treatment that should always give after all the symptoms of the disease cease to present.

Medication is a chosen method of therapy when the extent of the disease is seen over a large or localized area with multiple patches or lesions. From several options available, Imiquimod, 5-Fluorouracil, and Solaraze gel may prescribe for topical use.

Though the effectiveness of these medications is established, they are not often devoid of painful side effects. They act upon the skin, which becomes inflamed and flaky. These ‘flakes’ fall off over time, leaving skin quite unblemished.

But the inflammatory stage can be harrowing. Also, this mode of therapy advised for a period of between1 week to 4 months. It can, therefore, be time-consuming.

Advise

Surgery often advised for single warts or patches which have hardened and therefore take time for application of local medication to work.

Surgical procedures include electrical cauterization, freezing or cryotherapy, or conventional surgical removal of the affected area. Lasers and other light sources have also used to remove Keratosis in recent times.

After treatment, the patients need to be careful about the recurrence of the condition or changes in existing areas of Keratosis. Regular screening is thus necessary as a precautionary measure.

Medical practitioners also routinely advise biopsy of the affected area to rule out cancer. Precautions against sun damage even imperative, and the doctor’s advice on this should stringently follow.

Prevention

There are simple but effective measures to avoid sun damage leading to Actinic Keratosis.

  • Minimize sun exposure without protection and use good quality sunscreen with SPF of 15 or more.
  • Chosen Sunscreen should be one that provides protection again UVA and UBA.
  • Avoid sun exposure completely around noon as ultraviolet rays are most harmful around this time.
  • Apply sunscreen carefully to cover every bit of exposed skin, about 30 minutes before going out.
  • Reapply frequently especially if out swimming.
  • Apply sunscreen all year through, even in winters.
  • Wear clothes which provide additional sun protection like wide-brim hats, long-sleeved shirts/blouses, and long skirts/trousers.

These measures can ensure protection against sun damage and can prevent Actinic Keratosis. Even if the condition has cured, it becomes even more critical that these steps followed to avoid recurrence. It is best to never take chances with a deadly disease like cancer.

Treatment

Actinic Keratosis or Solar Keratosis has seen as skin lesions or patchy areas of skin that may have wart-like growths. This disease is directly linked to prolonged exposure to the ultraviolet radiation of the sun. Occurring as single or a localized patch, it may also occur as multiple lesions across the area of sun-exposed skin like the face, forearms, or even the chest or back.

Though these warts or lesions are benign in nature, it is also a condition that considered to be pre-cancerous. Approximately 10% of patients exhibiting symptoms of this disease progress to more serious conditions like skin cancer or squamous cell carcinoma.

It also observed that this condition might remain unchanged in some patients, not adversely affecting the body in any way. They can also be painless and may not cause any skin irritation. In some cases, they may also self-heal.

But the moot point is that it is not wise to take chances with a disease which can spell Cancer in later stages. Single warts may remain unchanged, but multiple warts increase the chances of anyone developing cancerous cells. Sometimes the affected area assumes skin color and becomes difficult to spot. A seemingly healed wart may reappear and then understand complications.

Treatment is relatively simple and, in most cases, well received. Thus it is best to adhere to medical advice.

Management of this Disease

Management of this disease starts with advising the patient of limiting sun exposure and often, avoiding exposure ultimately between 10 am and 3 pm. Skincare, with the help of a sunscreen with appropriate SPF (15 or more), also advised.

  • Frequency and number of lesions
  • A most efficient method of treating the identified lesion/s
  • Age of the patient
  • The previous onset of skin cancer, if any
  • Tolerance to the chosen method of treatment

Treatment can broadly be differentiated into two types:

  • Medicinal therapy.
  • Surgical removal of the affected area.

Medicinal therapy most opts when multiple lesions are formed over a large area of skin like on the face or the forearms.

While it is of advantage in the condition stated above, its disadvantage is that it may take time to have its effects felt and can also cause discomfort during its course. 5-fluorouracil, topical diclofenac gel, imiquimod cream.

PDT with topical aminolevulinic is some medication that is commonly used.

  • 5-fluorouracil follows a course of 60-90 days of treatment. It can be painful as the lesions tend to become red and inflamed. It can also be disfiguring as ulcerations followed by the formation of a crust over the affected area. This is, however, a temporary phase, and within 2 weeks of stopping treatment, a marked difference in the complexion noticed and Keratosis is improved.
  • Topical diclofenac sodium gel is a non-steroid drug and usually prescribed for a period of 3 months. It is quite preferred as a follow-up treatment after a certain kind of surgical removal – called Cryotherapy or freezing the area and its removal. The best thing about this treatment is that it has shown to have the minimal inflammatory symptoms associated with topical treatment.
  • Imiquimod cream is useful in the course of a week to 4 months, though an average of a month treatment found to be effective. Side effects vary from patient to patient, and doses regulated accordingly. It also found to be safe for patients who have undergone organ transplants and are showing symptoms of Keratosis.
  • PDT uses a chemical which when introduced into the bloodstream, accumulates in the actinic cells and produces a strong photosensitizer. When these cells further exposed to the light of a particular wavelength, they destroyed. Thus Keratosis is treated. But topical pain is reported in this type of therapy. The advantage, however, is counted high as cosmetically it is the best option available

Actinic Keratosis vs. Seborrheic Keratosis

Seborrheic keratosis is a non-cancerous bump or growth on the skin, whereas actinic keratosis is a very common skin disorder. It is referred to as a ‘pre-cancerous condition,’ mostly faced by people who reside in hot climates. Usually, it affects the uncovered areas of the skin.

Keratosis pilaris, on the other hand, is a skin disorder, which occurs due to ‘plugged hair follicles.’ Hence, it becomes imperative for people to identify symptoms of keratosis to avoid major problems such as skin cancer or brutal skin damage.

Seborrheic Keratosis

A benign and non-cancerous skin problem is Seborrheic Keratosis. In general, experts believe that an individual does develop seborrheic keratosis once in his lifetime. It is seen in people who grow older.

A seborrheic keratosis typically shows as a black, brown, or pale growth either on the face, shoulders, chest, or back. It appears as high growth, which is scaly and waxy in nature. Sometimes, there are several growths together, however.

Generally, it noticed a single. According to experts, seborrheic keratoses usually do not turn cancerous. Nevertheless, it looks like skin cancer. Seborrheic Keratosis is painless, yet it is troublesome.

Symptoms of Seborrheic Keratosis

Usually, a seborrheic keratosis has wart-like growth. It can notice on the neck, head, or trunk of the body. A seborrheic keratosis:

  • Varies in color. It can be of light tan color, brown, yellow, or black
  • Is oval or round-shaped
  • It has a typical feature i.e. it looks as if ‘pasted on’ skin
  • The size of seborrheic keratosis may range between small and 1 inch or sometimes even more than 1 inch.
  • Sometimes, you may feel an itch on the skin around seborrheic keratosis

You should immediately see a doctor if:

  • You find multiple growths over a short span of time on your skin. In general, a person has a single or two seborrheic keratoses over many years.
  • Bleeding from the growths or suddenly feel aggravated.
  • Changes in skin, which can include sores, discoloration, or the problem persists for a longer time and does not heal there could be chances of skin cancer. Hence, they should take medical help. A skin biopsy will help to detect skin cancer.

Treatment of Seborrheic Keratosis

Removing the skin growth is the only way to treat seborrheic keratosis. You can remove it by 3 methods. These are:

  • Cryosurgery: You can freeze a small keratosis with liquid nitrogen, which destroys the cell. It is an effective way of removal. However, it does not work on thick and large keratosis.
  • Curettage: This method involves rubbing the skin with a specialized surgical device. Sometimes, it used along with electrocautery.
  • Electrocautery: It is a method where seborrheic keratosis burnt with an electric current. This process is longer than other processes and may leave scars on the skin, if not performed by an expert.
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