Actinic Keratoses (AK)
Actinic Keratoses (AK): Causes, Symptoms, Diagnosis, and Management
Actinic keratoses (AK), also known as solar keratoses, are premalignant skin lesions resulting from chronic exposure to ultraviolet (UV) radiation. They appear as rough, scaly patches on sun-exposed areas and carry a risk of progressing to squamous cell carcinoma. Below is a detailed overview of AK, supported by current evidence.
Causes and Risk Factors
Primary Cause:
- UV radiation: Prolonged exposure to UVB from sun or tanning beds damages skin cells, leading to AK formation[1][3].
- Fair skin: Individuals with pale skin, blonde/red hair, and blue/green eyes are more susceptible[3].
- Age: Older adults due to cumulative UV exposure[3].
- Immune suppression: Conditions like organ transplants or HIV/AIDS increase risk[4].
- Genetic disorders: Albinism or xeroderma pigmentosum enhance UV sensitivity[3].
Symptoms
AK lesions are characterized by:
- Rough, scaly patches that may be pink, red, gray, or brown[2][5].
- Dry, gritty texture often felt more than seen[5].
- Itching, burning, or stinging sensations[1].
- Bleeding or tenderness if irritated[1].
- Actinic cheilitis: Diffuse involvement of the lip[3].
Diagnosis
Clinical Examination:
- Visual inspection: Lesions are typically identified on sun-exposed areas (e.g., face, hands)[3].
- Palpation: Rough texture helps differentiate from other skin lesions[2].
Biopsy:
- Skin biopsy: May be performed if lesions are suspicious for cancer or if diagnosis is unclear[3].
Treatment
Cryotherapy:
- Freezing: Causes lesions to blister and fall off[5].
Topical Treatments:
- Chemotherapy creams (e.g., fluorouracil) or diclofenac gel[5].
- Imiquimod cream: Stimulates immune response against lesions[6].
Surgical Options:
- Excision: For large or resistant lesions[5].
- Photodynamic therapy (PDT): Uses light-sensitive medication to target lesions[5].
Prevention
- Sun protection: Use SPF 30 sunscreen, hats, and protective clothing[5].
- Avoid tanning beds: Reduce UV exposure from artificial sources[5].
- Regular skin exams: Monitor for new or changing lesions[5].
Conclusion
Actinic keratoses are treatable but require early intervention to prevent progression to squamous cell carcinoma. Regular skin checks and sun protection are crucial for managing and preventing AK.
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