Actinic keratoses


Actinic keratoses

Description, Causes and Risk Factors:

Abbreviation: AK.

Alternative Names: Senile keratoderma, verruca senilis, senile wart, senile keratoma, senile keratosis, solar keratosis, verruca plana senilis

Actinic keratoses (AKs) are rough scaly patches on the skin, caused by excessive exposure to the sun that can sometimes progress into dangerous skin cancers (e.g. squamous cell carcinoma). More than 5 million Americans live with these lesions, and far too many people ignore them, leaving them untreated. This can have serious consequences.

actinic keratoses

There exists number of variants:

    Erythematous (the rough scale is more palpable than visible).

  • Pigmented.

  • Hypertrophic/Bowenoid (thick areas of scale).

  • Cutaneous horn: A horny protuberance, the majority are caused by actinic keratoses or warts but 15% are secondary to an underlying SCC.

  • Lichenoid (smooth and shiny, mainly occurring in areas of friction).

  • Actinic chelitis (lips).

All AKs, including actinic cheilitis, develop in the skin cells called the keratinocytes (A cell of the living epidermis and certain oral epithelium that produces keratin in the process of differentiating into the dead and fully keratinized cells of the stratum corneum) which are the tough-walled cells that make up 90% of the epidermis, the outermost layer of skin, and give the skin its texture. Years of sun exposure cause these cells to change in size, shape, and the way they are organized. Cellular damage can even extend to the dermis, the layer of skin beneath the epidermis. Research shows that p53, a mutant protein found in sun-damaged cells in the body, is present in more than 90% of people who have AKs and squamous cell carcinomas.

Risk Factors May include:

    AKs are a consequence of cumulative long-term sun exposure and so the incidence increases with age.

  • The use of artificial UV (ultraviolet) radiation such as UVB (ultraviolet B) and PUVA (psoralen plus ultraviolet light of A wavelength or Psoralin with Ultra Violet A) used to treatment psoriasis and a number of other skin conditions, as well as sun beds increase the risk.

  • Genetic factors play a role and individuals with fair skin, blue eyes and blond hair are at higher risk.

  • Men are more affected than women.

  • Patients with Xeroderma Pigmentosum (XP) or Albinism can develop lesions at a very young age

  • AKs can occasionally transform into squamous cell carcinoma (SCC) - the presence of ten AKs is associated with a 14% risk of developing an invasive squamous cell carcinoma (SCC) within 5 years.

Symptoms:

    AK may present as a single lesion or multiple lesions on sun-exposed areas of the skin.

  • There may be burning, itching or tenderness at the site.

  • They may feel scaly or crusted onpalpation, and are better examined under intense lighting.

  • Lesions may vary in size from 3-10 mm in diameter and enlargegradually.

  • The lesions are usually poorly demarcated, appearing as slightly erythematous papules or plaques in areassuch as the face, balding scalp, posterior neck, upper chest and dorsal upper extremity.

  • They often appearreddish in color with a white scale on top.

Diagnosis:

The health care provider makes the diagnosis based on the appearance of the skin growth. A skin biopsy may reveal any cancerous changes, if they occur.During a skin biopsy, your doctor takes a small sample of your skin (biopsy) for analysis in a lab. A biopsy can usually be done in a doctor's office using a local anesthetic.

Treatment:

There are a number of effective treatments for eradicating actinic keratoses. Not all keratoses need to be removed. The decision on whether and how to treat is based on the nature of the lesion, age, and health.

General measure may include:

    Sun protection.

  • Patients limiting their recreational sunlight exposure need to have an adequate dietary intake of vitamin D.

  • The use of a moisturiser 2-3 times a day can be helpful in differentiating between areas of normal and abnormal skin.

Treatment Options:

Topical Medications: Topical medications are most often used in cases where multiple superficial AK lesions are present. The most widely used topical treatment is 5-fluorouracil (5-FU), also known as Efudex. Other topical medications currently used in the treatment of multiple AK lesions include Solaraze® Gel (diclofenac sodium gel 3%) and Aldara™ (imiquimod). Side effects may present.

Growths may be removed by:

    Burning (electrical cautery or electrocautery).

  • Curettage and electrodesiccation (scrapes away the lesion and uses electricity to kill any remaining cells).

  • Excision (cutting the tumor out and using stitches to place the skin back together).

  • Freezing (cryotherapy, which freezes and kills the cells).

  • Laser Therapy.

  • Photodynamic Therapy (PDT).

  • Chemical Peels.

  • Dermabrasion.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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