Actinic (Solar) Keratosis

An actinic keratosis (also called solar keratosis) is a dry scaly patch of skin that has been damaged by the sun. The patches are not usually serious but there’s a small chance they could become skin cancer, so it’s important to avoid further damage to your skin.

The patches usually appear on areas of your body that are often exposed to the sun, such as your face, hands and arms, ears, scalp and legs.

The patches:

  • Can feel dry, rough and scaly, or like sandpaper
  • Seldom exceed more than 1 cm in diameter
  • Can be the same colour as your skin or range from pink to red to brown
  • May feel itchy

NICE estimates that over 23% of the UK population aged 60 and above have AK. Although the risk of an AK transforming into skin cancer is very low, this risk increases over time, in the immunocompromised, those with previous skin cancer and with larger numbers of lesions. The presence of ten AK is associated with a 14% risk of developing a skin cancer within five years.

AK are a consequence of cumulative long-term sun-exposure:

  • Lesions are very uncommon under the age of 45 years
  • The incidence increases with age
  • The exceptions are patients with xeroderma pigmentosum and albinism who can develop AK at a very young age

Genetic factors play a role and individuals with fair skin, blue eyes and blonde hair are at higher risk of developing AK.

Artificial ultraviolet radiation such as UVB and PUVA, used to treat psoriasis and several other skin conditions, as well as the use of sun beds, increase the risk of developing AK.

Men are more affected than women (2:1)

Selfcare and more information

If you have actinic keratoses it’s important to avoid any further sun damage. This will stop you getting more skin patches and will lower your chance of getting skin cancer.

All year-round regular sun protection (which may include sunblock) will reduce the frequency of new visible lesions developing and may help mild lesions regress.

Do:

  • use sunscreen with a sun protection factor (SPF) of at least 30 before going out into the sun and reapply regularly
  • wear a hat and clothing that fully covers your legs and arms when you’re out in the sunlight

Don’t:

  • do not use sunlamps or sunbeds as these can also cause skin damage
  • do not go into the sun between 11am and 3pm – this is when the sun is at its strongest

You should consult your GP if:

  • this is the first time you have noticed patches on your skin
  • the patches begin to bleed, get bigger, change colour, feel tender or develop into a lump

It’s important to get these skin changes checked, in case they could be caused by something more serious, such as skin cancer.

Treatments for actinic keratoses

If you only have 1 skin patch, a GP might suggest waiting to see if the patch goes away by itself.

If you have more than 1 patch, or a patch is causing you problems such as pain and itchiness, treatment is usually recommended.

The vast majority of AKs can be managed by your GP. However, your GP may refer you to a skin specialist (dermatologist) if there is any concern about diagnosis, if there is extensive skin involvement or if your skin lesion(s) have not responded to standard topical treatments.

Treatments for actinic keratoses include:

  • prescription creams and gels
  • freezing the patches (cryotherapy), this makes the patches turn into blisters and fall off after a few weeks
  • surgery to cut out or scrape away the patches – you will be given a local anaesthetic first, so it does not hurt
  • photodynamic therapy (PDT), where special cream is applied to the patches and a light is shone onto them to kill abnormal skin cells

Useful information about Actinic Keratosis

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.