Actinic Keratoses

What is actinic keratosis?

Back to top

Actinic keratosis is a skin disorder in which small, rough, scaly spots appear on the face, arms, hands, or scalp. The rough spots might present as irregular papules or plaques. They often appear on parts of the body that experience chronic sun exposure. The spots themselves are called actinic keratoses. Other names for actinic keratoses include age spots or sunspots.

Actinic keratosis can also be referred to as senile keratosis or solar keratosis. It is one of the most common skin disorders. This skin disorder is particularly common with elderly people who have had decades of sun exposure. That said, the spots can appear on anyone of any age.

Actinic keratosis is not cancerous, though it can develop into a type of skin cancer called squamous cell carcinoma. About 10% of actinic keratosis can develop into squamous cell carcinoma. While age spots rarely become cancerous, the earlier you and your doctor catch skin cancer, the better the outcome. If you notice sunspots appearing, talk to your doctor. You may need to see a dermatologist to have them assessed.

What causes actinic keratosis?

Back to top

Sun exposure causes actinic keratosis. A person’s skin can develop actinic keratoses after extreme sun exposure or repeated exposure to UV rays. Because this skin disorder is related to sun exposure, there are a host of risk factors and groups that can cause someone to be adversely affected by actinic keratosis. See below for an exhaustive list of risk factors and groups for actinic keratosis.

What are symptoms of actinic keratosis?

Back to top

The symptoms of actinic keratosis present as actinic keratoses, a name for the spots. They are rough, discolored patches found on parts of the body that are usually in the sun. The skin might become scaly with yellow or white crust on top, and the actinic keratoses can change color over time. These patches of skin are typically about the size of a small pencil eraser. A person with actinic keratosis might experience burning or itching in these areas.

The actinic keratoses can be a range of colors: pink, red, brown, grey, or the same color as the patient’s skin tone. As time goes on, these growths might become wart-like and hard, or even rough. At first, these areas might be easier to feel than to see, but these areas will become easier to see as the actinic keratosis worsens.

The affected areas can remain the same size, disappear, grow bigger, or even develop into squamous cell carcinoma. As a result, it’s important to keep an eye on spots and moles to track them over time. Visiting a dermatologist regularly can help.

Are there any risk factors or groups for actinic keratosis?

Back to top

Because actinic keratosis is a condition largely related to sun exposure, there are many different risk groups and factors that can affect someone’s likelihood of developing actinic keratosis. People who have a higher risk of developing actinic keratosis include folks who:

  • are over the age of 60
  • are male
  • have blue eyes and light-colored skin
  • have frequently been exposed to sun over their lifetime
  • usually sunburn more easily
  • have had sunburns earlier in life
  • have human papillomavirus HPV
  • live in a place located closer to the Equator
  • have a compromised immune system
  • have a history of actinic keratosis or skin malignancy

If you fit into any of these high-risk groups, pay special attention to the ways in which your skin changes over time. Many of these groups are also at high risk for developing certain types of skin cancer. Consider seeing a doctor for annual skin checks to track any changes in your skin’s health.

How is actinic keratosis diagnosed?

Back to top

Oftentimes, a doctor can diagnose actinic keratosis just by examining the patient’s skin. It is possible that the doctor will take a skin biopsy if any of the patches and lesions look suspicious. The doctor will take a small sample of skin during a skin biopsy to be analyzed in a lab. A skin biopsy will let the doctor know if the lesions have developed into squamous cell carcinoma. Once the biopsy is analyzed, your doctor will either provide a diagnosis or send you on your way.

How is actinic keratosis treated?

Back to top

Actinic keratosis might disappear on its own, but there is always the threat of its return upon more sun exposure. It is best to have actinic keratoses removed because there is no way of knowing which actinic keratoses might develop into skin cancer. Actinic keratosis treatments usually involve removal of affected areas via some type of medication or surgery.

A doctor might prescribe medicated gels or creams to remove actinic keratoses. These medicated gels and creams have the potential to cause scaling, redness, or a burning sensation for a couple of weeks. Examples of these medicated gels or creams are:

  • Fluorouracil (Carac or Fluoroplex)
  • Imiquimod (Zyclara or Aldara)
  • Ingenol mebutate or Diclofenac (Solaraze)

Which surgeries are used to treat actinic keratosis?

Back to top
  • Laser therapy is an increasingly common method of treating actinic keratosis. The doctor will use an ablative laser device to remove the patch, which promotes new skin growth.  A side effect of this surgery is possible scarring and discoloration.


  • Scraping (curettage) is when the doctor will use a curet to scrape off damaged skin cells. This process might include electrosurgery afterwards. In electrosurgery, the doctor uses a pencil shaped instrument to cut out and remove damaged skin tissue. A side effect of this process is possible infection scarring and discoloration.


  • Freezing (cryotherapy) is the most common treatment for actinic keratosis. This process only takes a few minutes. The doctor will apply liquid nitrogen to freeze the affected skin. This can cause peeling and blistering as the affected area heals. Damaged areas fall off and allow new skin to appear. A side effect of this procedure is possible blisters discoloration changes in skin texture scarring or infection.
  • Photodynamic therapy is when a doctor will apply a solution over the affected area. An intense laser light is then used to kill skin cells. More than 80% of patients with actinic keratosis who receive photodynamic therapy respond after one to two treatments, one month apart. Possible side effects include swelling, redness, or a burning sensation during the therapy sessions.

What are lifestyle changes that can help with actinic keratosis?

Back to top

Reducing exposure to sunlight is the primary method of actinic keratosis prevention. Following actinic keratosis prevention can also reduce chances of developing skin cancer. Here are some ways to reduce exposure to sunlight:

  • avoid tanning beds
  • avoid midday sun exposure (this is when the sun is the brightest)
  • wear long sleeves and a hat when out in bright sunlight
  • use sunscreen with an SPF of at least 30

Doing regular skin examinations is another way to monitor actinic keratosis. It is best to reach out to a doctor if any of these skin growths following develop, or existing growths change:

  • moles
  • freckles
  • birthmarks
  • bumps

It is especially important to look for skin growths or development on the ears, neck, face, and tops or undersides of the arms and hands.

Should you see a doctor for actinic keratosis?

Back to top

It is important to reach out to a doctor and schedule an appointment any time a new skin growth or development occurs. If someone has a history of skin issues, it might be helpful to schedule an annual or twice-yearly appointment with a doctor to examine any changes.

If existing actinic keratoses begin to experience any of the following changes, it is important to see a doctor:

  • quick growth
  • bleeding
  • hardening of the area
  • inflammation
  • ulceration
  • redness

These developments could be an indication of squamous cell carcinoma. Squamous cell carcinoma is usually easy for a doctor to diagnose, and better to catch in its earlier stages when the condition is easier to treat.

Once a patient has been treated for actinic keratosis, a doctor or care team might schedule annual tests to look for signs of skin cancer and diagnose squamous cell carcinoma, if necessary.

What is the outlook for people living with actinic keratosis?

Back to top

Actinic keratosis is typically treated through any of the methods listed under the treatments section. This often includes topical medication or surgery. Some of those procedures can take place in just a few minutes in a doctor’s office. When someone is diagnosed with actinic keratosis, it is best to avoid extreme sun exposure even when actinic keratoses are removed. Extreme sun exposure can cause actinic keratoses to develop on the skin again.

People living with actinic keratosis will experience small lifestyle changes in their day-to-day life, but, for the most part, only a small percentage of actinic keratosis develop into squamous cell carcinoma. Actinic keratosis is typically not a life-threatening diagnosis.