Actinic keratosis

An early form of this type of skin cancer is actinic keratosis. The disease is limited to the epidermis and is associated with increased keratinization; the skin areas are rough and slightly thickened as a result. If the actinic keratosis grows into the dermis, a prickle cell carcinoma develops. Actinic keratosis is caused by intense sun exposure over long periods of time. If actinic keratosis is treated early, it has a good chance of being cured. It mainly affects fair skin types and usually develops in people over 50, but younger people are also increasingly suffering from this sun-related skin change.

What is actinic keratosis?

Actinic keratosis is caused by excessive UV exposure, whether from natural sunlight or artificial UV rays in a tanning bed. The damage to the skin accumulates over the years – there is something like a lifetime dose of UV rays. That is one of the reasons why only older people develop actinic keratosis. The damaged skin reacts by developing light-colored or reddish patches that peel slightly and turn whitish. Over time, these areas become calloused and hardened, and slowly spread from small spots to increasingly larger areas. Areas of skin that are anatomically exposed and are usually left unprotected from the sun are particularly prone to actinic keratosis:

• Forehead and Bald Spot
• Bridge of the nose, skin on the cheekbones
• Ear cups, lips
• back of the hand
• Decolletage and Scalp
• Forearms, shins, calves

Normally, the outermost layer of the skin (the epidermis) recovers very well after intense sun exposure or a sunburn. However, if the skin is exposed to too much direct sunlight over extended periods of time, the skin cells will suffer. In the first phase, UV light damages the cells of the epidermis. The damage (lesions) is not visible at first. The nuclei of skin cells undergo changes. The corneal cells begin to multiply in a disorganized manner, and the corneal stroma thickens. The lesions look like skin growths and feel rough and coarse to the touch. The skin lesions usually appear in multiple areas and spread across the skin in small clusters. As a layperson, it’s not easy to recognize and identify skin damage, but you can certainly feel the difference on the skin’s surface: the affected areas are thick and rough, and sometimes slightly raised.

At first, the abnormal (malignant) cells remain confined to the outermost layer of the skin. At this stage, actinic keratosis is easily treatable. At some point, the altered cells begin to penetrate deeper layers of tissue. A spinalioma develops; the actinic keratosis has progressed to squamous cell carcinoma. Even at this stage, the same rule applies: The earlier treatment begins, the better.

Actinic keratosis: causes and risk factors

Anyone who spends a long time in the sun without protection runs the risk of developing actinic keratosis. When certain areas of the skin are repeatedly exposed to extreme sun exposure, the overworked skin cells suffer. They no longer regenerate; instead, they accumulate damage, so to speak, and begin to undergo genetic changes. The epidermal keratinocytes—the cells of the stratum corneum—continue to grow irregularly and uncontrollably. Actinic keratosis can develop into white skin cancer, which is why these corneal deposits are also considered a potentially risky precursor. As a rule, older people are at greater risk of developing actinic keratosis due to their accumulated “sun exposure.” Experts therefore also refer to it as senile keratosis. However, excessive sunbathing without protection or too frequent visits to tanning beds are causing an increasing number of younger people to develop this potential precancerous condition.

Specific risk factors for actinic keratosis include:

• UV-sensitive skin type
• Common Outdoor Activities in the Sun
• Jobs Involving Significant Sun Exposure
• Severe sunburns during childhood
• a compromised immune system due to illness or medication

Actinic keratosis can appear and then disappear again for a certain period of time. However, this condition does not go away on its own.

Symptoms: Actinic keratosis

Actinic keratosis appears on the areas most exposed to the sun, known as “sun-exposed areas.” It can manifest itself in various skin changes and is therefore not always easily recognizable. If you spend a lot of time in the sun, you should check your skin regularly. An early sign is small red spots. Here, the outermost layer of skin has become thinner due to intense sun exposure, and the blood vessels are more visible. Over time, these areas develop into small, calloused patches that feel rough and uneven. Whitish, scaly crusts are another sign that it could be actinic keratosis. These skin changes may also be accompanied by a feeling of tightness, minor bleeding, itching, or pain.

Seek medical advice or go to the hospital if you notice any of the following symptoms:

• Red, scaly patches on the back of the hand
• reddish crusts on the cheek or the outer ears
• rough patches of skin on the forehead or bald spot
• crusted cracks on the lower lip

You should also take skin changes on your forearms, shins, or calves seriously. It doesn’t make sense to pick at the areas of thickened, scaly skin and treat the affected areas with a greasy cream. The damage has already been done; these aids, at best, have only a temporary visual effect. Seeing a dermatologist is the right thing to do, because treatment is effective and successful when the condition is caught early.

Diagnosis of actinic keratosis

If the doctor suspects that you have actinic keratosis or prickle cell carcinoma, a tissue sample will be taken and examined under a microscope. If the suspicion is confirmed, the skin cancer or its precursor must be completely removed. Various treatment options are available, depending on the type, size, depth and location of the skin change, as well as the age and health of the patient. Outpatient treatment is almost always possible.

Actinic keratosis: prevention

The best protection against actinic keratosis is sensible and controlled exposure to natural and artificial UV light. It doesn’t matter whether you spend a lot of time in the sun during your free time or for work-related reasons. An Australian study also found that taking vitamin B3 (nicotinic acid/niacin) can reduce the incidence of actinic keratoses.

Other preventive measures may include:

• Use high-quality sunscreen
• Protect the skin on your arms with lightweight clothing
• Protect your head with a sun hat or a cap
• Protect children from the sun’s rays with hats and sunscreen
• prefer to stay in the shade
• Avoid the blazing midday sun

People who work primarily outdoors are at particular risk and must be provided with adequate protection by their employer. Keep in mind that UV radiation is present even when the sky is overcast. Keep a close eye on your skin, especially in the summer, and it’s better to get it checked one too many times than not enough. Compared to other European countries, the rate of skin cancer in Switzerland is very high. That is why you should take advantage of screening exams for the early detection of skin cancer.

Actinic Keratosis – Course and Prognosis

If actinic keratosis is detected and treated early, it can have a favorable outcome. However, even after successful treatment, regular skin checkups remain important. It’s also important to monitor your “sun exposure,” go out in the sun only when protected, avoid direct sunlight, and take good care of your skin. Because it never forgets the damage it has suffered. However, since actinic keratosis is a lifelong condition, you must continue to protect yourself well from UV rays even after successful treatment.

Actinic keratosis - treatment

Actinic keratoses can usually be removed largely without scarring using a whole range of treatment methods.