Actinic Keratosis

An actinic keratosis is a rough, scaly patch of skin that develops after long-term exposure to ultraviolet rays from the sun or tanning beds. It most often appears on areas of the body that receive frequent sun exposure, such as the face, lips, ears, scalp, neck, forearms, and the backs of the hands. The condition is also known as solar keratosis.

Actinic keratoses form in the top layer of the skin and usually grow slowly over time. They are most commonly seen in people over the age of 40, although younger people with significant sun exposure can also develop them. These lesions may begin as flat, barely noticeable spots and gradually become thicker or more scaly.

While actinic keratoses are not skin cancer, they are considered precancerous. If left untreated, a small percentage can progress into squamous cell carcinoma, a type of skin cancer. Early recognition and treatment greatly reduce the risk of cancerous change.

Symptoms

Actinic keratoses can vary in appearance and texture. Some may be more easily felt than seen, especially in the early stages. Symptoms commonly include:

• Rough, dry, or scaly patches of skin, usually smaller than 1 inch in diameter

• Flat or slightly raised spots on the surface of the skin

• Hardened areas with a wart-like texture in some cases

• Color changes such as pink, red, brown, or skin-toned patches

• Itching, burning, bleeding, or crusting

• New patches developing on sun-exposed areas such as the head, neck, hands, and forearms

The affected skin may feel tender or sensitive, particularly when rubbed or scratched. Some actinic keratoses may come and go, while others persist or gradually grow thicker over time.

Causes

Actinic keratosis is caused by repeated or intense exposure to ultraviolet radiation. UV rays damage the DNA of skin cells, leading to abnormal growth in the outer layer of the skin. This damage accumulates over time, which is why actinic keratoses often appear later in life.

Both natural sunlight and artificial sources, such as tanning beds, can contribute to the development of these lesions. People who spend long hours outdoors or who have had frequent sunburns are especially vulnerable. The skin’s ability to repair UV damage decreases with age, further increasing risk.

Risk factors

Anyone can develop actinic keratoses, but certain factors raise the likelihood. These include:

• Light-colored skin, red or blond hair, and blue or light-colored eyes

• A history of frequent sun exposure or severe sunburns

• Skin that freckles or burns easily

• Age over 40

• Living in sunny or high-altitude regions

• Working outdoors for long periods

• A weakened immune system due to illness or medications

The more risk factors a person has, the greater the chance of developing actinic keratoses over time.

Complications

When treated early, actinic keratoses can often be removed or cleared without long-term effects. However, if they are left untreated, some lesions may progress to squamous cell carcinoma.

This type of skin cancer usually grows slowly and is often not life-threatening when detected and treated early. However, it can become more serious if ignored. Monitoring skin changes and addressing persistent or changing lesions helps reduce the risk of complications and supports early detection of skin cancer.