What is Actinic Keratosis
Actinic keratosis is a skin lesion, a pathology that involves the areas affected by excessive sun exposure and ultraviolet rays in general: not surprisingly, actinic keratosis is also called solar keratosis.
See other Photos Actinic Keratosis
Actinic keratoses represent skin lesions of dermatological interest: they can in fact lead to cancerous forms such as squamous cell carcinoma (spinalioma) and basal cell carcinoma (basalioma).
Incidence
Actinic keratosis is a disorder linked in part to the age and in part to the phototype of the subject: it affects 60% of light-skinned individuals over the age of 40, and 80% of the elderly over 60 years of age: it is therefore a a widespread condition that can also affect young people who increasingly undergo exposure to artificial UV rays for an impeccable tan even in winter. Not surprisingly, this type of lesion is considered to be the most common form of skin precancerous.
Actinic keratoses represent a rare condition in the black population and in subjects with high phototype (IV-VI).
Although actinic keratosis can also occur in women, current estimates show that actinic keratosis occurs with a "slightly higher incidence in men. An explanation for this fact could be due to the tendency of many male exponents to expose themselves to the sun for periods of time. prolonged without applying sunscreen.
Causes
Causes and risk factors for actinic keratosis
Both experimentally and epidemiologically, ultraviolet rays represent the cause that causes the actinic manifestation. Radiation accelerates skin photoaging: this hypothesis has been demonstrated by the fact that the skin, in addition to presenting actinic keratosis, is also accompanied by wrinkles, neoplasms, freckles and solar freckles, typical events caused by UV irradiation.
It seems a paradox that elderly people complain of actinic keratosis precisely in the period in which solar exposures are reduced, almost absent.The explanation is simple: solar keratoses represent a cumulative phenomenon, which means that over the years, UV radiation "accumulates" in the skin - which acts as a sponge - and the outbreak of the disease can occur suddenly, even if the subject has not undergone tanning for some years. The sun exposure that contributes to actinic keratosis, however, can also be involuntary, in the sense that even walking, building and agricultural work can be the cause that, even many years after leaving work, it triggers the disorder.
A connection between actinic keratosis and immunosuppression has also been demonstrated: the alteration of the immune conditions of subjects (for example those who have undergone an organ transplant) could favor the progression of solar keratosis in cancer, accelerating the timing of malignant evolution.
Finally, in certain cases, actinic keratosis could be the consequence of prolonged exposure to particular chemicals or X-rays.
Features
Signs and characteristics of actinic keratosis
In general, actinic keratoses occur mainly in the face (especially in the auricles, forehead and lips), legs, arms, back of hands and scalp (in bald subjects), that is, in all those areas more exposed to the sun.
Actinic keratosis occurs in the form of erythematous scales, of normal color, pigmented with yellow or greyish and surrounded by a red halo and by telangiectasias.
The lesions caused by solar keratosis are more evident to the touch, rather than to the eye, since the scales are rough and the area has raised papules. with difficulty through a simple glance.However, the development of the lesions occurs very slowly, but they can increase their size until they reach 3-6 millimeters in size.
It should be remembered that actinic keratoses should not be confused with seborrheic keratoses: the latter represent a benign condition that cannot lead to neoplasia.
Symptoms
For further information: Actinic Keratosis Symptoms
Actinic keratoses are generally asymptomatic; as such, they have no obvious effects, other than an itchy sensation or, in some cases, tension.
In addition to these symptoms, actinic keratoses can become inflamed, giving rise to the skin redness that often surrounds them.
Finally, in very rare cases, skin lesions can bleed.
Evolution
Evolution and complications of actinic keratosis
As mentioned, actinic keratosis can evolve and become complicated into a malignant tumor form.
Fortunately, in the majority of patients, actinic keratosis remains a benign lesion that causes no problems.
In some cases, a natural involution of actinic keratosis has been recorded, while in others it has been noted that the keratosis does not evolve and does not disappear, but remains in the same form in which it occurred.
However, despite this, it is estimated that about 10% of patients with actinic keratosis have undergone the malignant evolution of the disease.
In addition to this, it has been estimated that about 50% of squamous cell carcinoma cases started with untreated actinic keratoses. It is therefore immediately clear how important an early diagnosis and timely treatment of lesions is.
Differential diagnosis
The diagnosis of actinic keratosis is absolutely important, because it is possible that the skin disorder evolves into a malignant form: in this regard, actinic keratosis was evaluated as keratinocytic intraepithelial neoplasia. However, as already mentioned, actinic keratosis is not considered a tumor, but a precancerous form: not necessarily, therefore, it will turn into a neoplasm, although there is a certain probability in this regard. For this reason, the specialist will have to correctly diagnose the dermatological disorder before it turns into a malignant form.
Care
For further information: Drugs to treat Actinic Keratosis
Following the diagnosis, carried out by the dermatologist or a specialist, the patient must undergo a resolutive therapy.
Therapeutic approaches to eliminate actinic keratosis are different. The choice of one method of treatment rather than another, of course, is up to the specialist who will prescribe on an individual basis the therapy that best suits each patient.
The pharmacological treatment of actinic keratosis involves the administration of drugs topically, to be applied directly on the area affected by the lesions. Among the active ingredients most used in this field, we remember:
- 3% diclofenac gel in combination with hyaluronic acid;
- 5-fluorouracil (5-FU) in ointment in concentrations ranging from 0.5% to 5%;
- L "imiquimod in cream at 5%.
Among the possible resolutive treatments - more or less invasive - we remember:
- Surgical excision;
- Photodynamic therapy;
- Cryotherapy (liquid nitrogen treatment);
- Laser therapy.
Furthermore, in cases where he deems it appropriate, the specialist doctor may decide to subject the patient to a combination of the aforementioned therapies (for example, taking 5-FU followed by cryotherapy interventions), in order to both increase the chances of healing, both to decrease any side effects.
Photodynamic therapy
Photodynamic therapy for the treatment of actinic keratosis deserves further study: it is known by the acronym PDT and represents an innovative, non-surgical therapy aimed at eliminating cancerous and pre-cancerous forms of the skin. The technique consists of a chemical process carried out. by light (photochemical therapy): the light is absorbed by a photosensitive substance, with the formation of ROS (reactive oxygen species that destroy the cell inside which they are formed). As a result, the pre-neoplastic cell dies. The photosensitive substance - or photosensitizer - is applied to the skin, penetrates it and identifies the diseased cells. These substances are drugs that, with light, are activated, triggering the photochemical reaction that leads to the death of diseased cells (in this case affected by actinic keratosis).
Prevention
It is a good habit to adopt techniques to prevent a possible actinic keratosis, which should be all the more careful and scrupulous the greater the predisposition of the subject (low phototype, working outdoors, continuous sun exposure, etc.): the use of creams to sunscreens and protective clothing (such as, for example, the hat, especially for bald people) seem trivial measures, but they represent a very valid form of prevention.
Summary
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