Several white, dry bumps on the back of a (sun-damaged) hand.
Several white, dry bumps on the back of a (sun-damaged) hand.
An actinic keratosis (AK) is a sun-damaged spot that has a low risk for turning into skin cancer, specifically squamous cell carcinoma. In addition, patients with AKs are at higher risk for skin cancer elsewhere, the most common being basal cell carcinoma, but melanoma as well.
The AK is usually fixed in location and rough or scaly to the touch. (See below for pictures.) It is often better felt than seen. The face is the most common site, but the sides of the neck, the arms, the back of the hands and the balding scalp may also be affected. An AK often hurts or stings because the sun has damaged the skin so much that the nerves are less protected and can get inflamed.
The sun!!! And it is usually more recent sun exposure, say in the last 6-12 months. Sun exposure any time in life predisposes to skin cancer. But the presence and number of actinic keratoses correlates best with recent sun exposure.
If you have actinic keratoses, you need to wear sunscreen every day! Don't fall into the trap of thinking, "I'll only wear sunscreen on days that I know I will be spending time outdoors." My experience has been that invariably patients will find themselves outside for 5, 10, or 30 minutes talking with a neighbor, strolling in an outdoor mall, etc. Five minutes here, ten there adds up over time. So put on sunscreen every morning--at least SPF 15. SPF 30 is better. And don't just protect the face. Protect your arms, chest, and legs too!
SPF stands for sun protection factor and is a measure of the strength of the sunscreen. I recommend a daily morning SPF of at least 30. If you know you will be outdoors for 30 minutes or more, then I recommend an SPF 50. Sunscreens of higher SPF are even better and I recommend them for anyone who wants or needs extra protection. Remember that most people don't put enough sunscreen on, so slather that stuff on the skin!!
If I had to choose between a hat and sunscreen, I would pick the sunscreen. The trouble is that most of the UV that hits our skin does not come directly from the sun. Instead, it is scattered by the blue sky or reflected off the ground, sand, or concrete. Thus, even when in the shade, your skin may be getting damaging UV rays. But really, why not use both!
Yes! It turns out that good, scientific studies have shown that taking oral nicotinamide 500 mg twice a day can reduce both the number of current actinic keratoses, the development of new ones, plus the development of basal cell and squamous cell carcinoma. (Don't confuse nicotinamide with niacin or nicotinic acid.) Nicotinamide is an over-the-counter form of Vitamin B3. It has very few side effects (in contrast to niacin) and has very few drug interactions.
The area may be swollen and red for the first day or so. It may even blister. (Large blisters may be popped with a sterile needle.) You may cover the area with a bandage, vaseline, or makeup with no problem. Within several days, the area will scab. In 7-14 days, the scab will fall off leaving smooth, normal, pink skin. If the area is still rough three weeks after freezing, let your doctor know.
Any patient with AKs is at higher risk for various skin cancers. The most serious, of course, is melanoma but basal cell carcinoma and squamous cell carcinoma are more common (see individual files for more information and pictures.)
The actinic keratosis often appears as a rough, keratotic papule (rough bump) here just above and to the right of the tip of the nose. Any chronically sun-exposed area may be affected.
Most AKs are white, but occasionally they contain pigment as shown here. Then the term spreading pigmented actinic keratosis or SPAK is used.
Freezing (cryotherapy) is the classic treatment. This photo was taken seconds after freezing. Within 10 seconds, the white color will be gone.
Freezing (cryotherapy) may cause a blister to form days later. This one is a much larger than typically occurs.
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