AKs most often develop on sun-exposed skin including most often, the scalp, face and backs of the hands.

Things to look for on your skin include the following:

• Red or pink dry scaly spots
• Scaly or rough patches or growths that feel painful or sensitive when rubbed
• Constantly dry scaly lips
• Horn-like growth

If you have any of these signs or symptoms on your skin, you should see a dermatologist. Left untreated,  AKs may turn into a type of skin cancer called squamous cell carcinoma. People who have AKs also have a higher risk of getting other types of skin cancer including basal cell carcinoma and melanoma. When found early, most skin cancers can be cured.

This man does not have AKs, but his hand and wrist show signs of sun damage (wrinkling and blotchiness with obvious tan line) due to working outdoors most of his life. He has a higher risk of developing AKs on his hand and wrist.

You may feel an AK before you see it. This man felt a sandpaper-like patch on his sun-damaged neck; this was an AK.

AKs can look like red, raised, scaly bumps on sun-exposed skin. This 57-year-old woman has several AKs on her face.

Skin that soaks up years of sun, such as the scalp, face, and arms can have many AKs. This man has thick growths on his hand and forearm which are AKs.

Some AKs grow quickly and look like an animal’s horn. Horns are more likely to progress to skin cancer.

Whitish scale on bottom lip: When an AK forms on the lip, the AK is called actinic cheilitis. If you have a rough scaly lip, splitting lips or your lips always feel dry, you should see a dermatologist.

Without treatment, some AKs progress to squamous cell carcinoma, a type of skin cancer.

Ultraviolet (UV) rays cause AKs. Most people get exposed to UV rays from being outside during the day or using tanning beds.

When UV rays hit our skin, the rays damage the skin. When we are young, the body can repair some of this damage. Over time, the damage accumulates, and the body is less able to repair itself and UV-damaged skin results. If UV rays continue to hit the skin, people get AKs.

People who live in places that get more intense sunlight throughout the year, such as Florida, Arizona, and Southern California may get AKs earlier. AKs often appear much earlier in people who use tanning beds and sun lamps.

People who are more likely to get AKs have one or more of the following traits:

• Fair skin
• Naturally blond or red hair
• Blue, green, hazel or gray eye color
• Skin that easily freckles or burns in the sun
• People over 40 years of age
• People with a weakened immune system
• People with a medical condition that makes the skin very sensitive to UV rays

Dermatologists diagnose AKs by closely examining the skin. If your dermatologist finds a growth that looks like an AK, he/she will discuss a variety of treatments for AKs and choose the best one for you.  Some treatments can be performed in the office and some you will use at home. Some patients may  require more than one type of treatment. No one treatment works on all AKs.  The goal of treatment is to destroy the AKs.

Treatments for AKs-

In-office procedures:

• Cryotherapy: Destroys visible AKs by freezing them with liquid nitrogen. The treated skin often blisters and peels off within days to a few weeks. Once the skin heals, a small white mark may be left.  This is the most common treatment.
• Curettage:  Removes a visible AK with a sharp instrument called a curette. This may be followed by electrosurgery to cauterize the skin. New healthy skin will appear once the area heals.
• Photodynamic therapy (PDT):  A solution is applied to make the skin more sensitive to light. After a few hours, the treated skin is exposed to blue light. The light activates the solution and destroys the AKs. New healthy skin will appear once the areas heal.

Prescription medicines for use at home:

• 5-Fluorouracil (5-FU) cream:  This chemotherapy cream is applied to AKs usually twice daily for 2-4 weeks.  5-FU causes AKs to become red, raw and crusty. After treatment, the areas will heal with healthy skin.
• Imiquimod cream: This cream boosts the body’s immune system so your body can rid itself of the precancerous skin cells. Most patients apply this for several weeks to a few months but your dermatologist will instruct you on its use. This cream will also cause the skin to redden, swell and crust over. Some patients may even develop flu-like symptoms.  After treatment, the areas will heal with healthy skin.
• Ingenol mebutate gel:  This gel not only boosts the body’s immune system but also is a type of chemotherapy. Treatment is used for 2 or 3 days depending on body location. This gel will cause rapid redness, swelling and even blistering of the areas being treated. After treatment, the areas heal in 1-2 weeks with healthy skin.

Photographs used with permission of the Journal of the American Academy of Dermatology.

• Bhatia ND. “Medical Management of Actinic Keratoses.” Focus session presented at the 2011 American Academy of Dermatology Summer Academy Meeting: New York City. Aug 2011.
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• Rigel DS, Cockerell CJ, Carucci J et al.“Actinic Keratosis, Basal Cell Carcinoma, and Squamous Cell Carcinoma.” In: Bolognia JL, Jorizzo JL, Rapini RP, et al. editors. Dermatology, 2nd ed. Spain, Mosby Elsevier; 2008. p. 1645-6.
• Sander CA, Pfeiffer C, Kligman AM et al. “Chemotherapy for disseminated actinic keratoses with 5-fluorouracil and isotretinoin.” J Am Acad Dermatol 1997 Feb;36:236-8.