Actinic Keratosis

What is actinic keratosis?

Back to top

Actinic keratosis is a rough and scaly precancerous skin growth that develops from chronic exposure to ultraviolet (UV) rays. Also called solar keratosis, this skin condition is the most common precancer and is found all over the body, primarily the face, ears, arms, scalp, or neck. If left untreated, actinic keratosis can turn cancerous over time. Because people often do not protect themselves enough from the sun or expose themselves to UV rays, many people will develop skin patches. At the earliest detection of these skin irregularities, you should seek treatment from your doctor.

What causes actinic keratosis?

Back to top

The primary cause of actinic keratosis is frequent or prolonged to UV rays without proper protection. The sun’s rays and indoor tanning equipment, like tanning beds and sunlamps, directly expose people to UV rays. The long-term exposure alters skin cells over time and creates the rough patches on the skin. One case of actinic keratosis tends to lead to more cases to form in the future. 

The UV rays damage skin cells called keratinocytes in the outermost layer of the skin. The damage manifests as changed skin texture in this outer layer. While actinic keratosis does not always develop into cancer, the damaged cells can become squamous cell carcinoma, a common form of the disease.

What are symptoms of actinic keratosis?

Back to top

The symptoms of actinic keratosis vary appearance from person to person. Some symptoms are easier to feel than they are to see in the initial stages. Typically, the first symptom to develop is rough, scaly patches of skin or raised bumps on the skin in areas with higher sun exposure. These patches can range in color and can be light or dark, skin tone, pink, or red. 

The surface of the patches or bumps can sometimes form a harder, wart-like surface or cause itching, burning, or bleeding. On some darker skin tones, patches of actinic keratosis can appear like an age spot. Actinic keratosis may grow out of the skin and form a horn-like growth, indicating a potentially more severe case. 

Actinic keratosis most often forms on sun-exposed areas of the body. Primarily, actinic keratosis develops on the head, neck, hands, and forearms. New patches of rough skin in any of these locations may be a symptom of actinic keratosis. When the patches occur on the lips, this condition is called actinic cheilitis. A person with actinic cheilitis may notice a loss of color or discoloration of their lips or white patches on the lips that never heal. 

Less common symptoms of actinic keratosis include pain or tenderness of the patches or discomfort caused by the patches clinging to clothing. 

Are there any risk factors or groups for actinic keratosis?

Back to top

There are key risk factors that increase a person’s likelihood of developing actinic keratosis. However, anyone can develop the condition even without having any risk factors. Also, not everyone who meets these risk factors will develop the condition in their lifetime. Knowing the common risk factors for this condition can help you understand your predisposition and can help you be aware of your symptoms and communicate with your doctor about preventative and treatment measures. The following factors may increase your risk of actinic keratosis: 

    • Hair/Eyes/Skin: Red and blond hair are associated with a higher risk as do blue and light eyes. Generally, lighter skin tones and those who freckle in the sun have a higher risk. 
    • Age: People over 40 have a higher risk of developing the condition. 
    • Geographic Location: Those who live in sunny places and places closer to the equator have a higher chance of developing actinic keratosis. 
  • Occupation: People who have occupations that put them outside often and in contact with the sun can be at a higher risk. 
    • Lifestyle: Frequent tanning and long periods of unprotected sun exposure increase a person’s likelihood of the condition.  
  • Weakened Immune System: People with a weakened immune system as a result of their medical history and conditions are prone to having the condition. 
  • History of Sun Exposure or Sunburn: If your skin has already been damaged by sunburn, you could be at a higher chance of developing actinic keratosis. 
  • Skin Conditions: Other conditions that make the skin more sensitive to UV rays makes the person more vulnerable to this condition. Specific conditions like albinism or xeroderma pigmentosum (XP) increase the risk. 


How is actinic keratosis diagnosed?

Back to top

To diagnose actinic keratosis, your healthcare provider will need to examine your skin during an appointment. The doctor should be able to tell if you have the condition by the appearance and characteristics of any patches or bumps on your skin. In combination with a physical examination, your doctor may ask questions about your medical history or any symptoms you are experiencing to help confirm the diagnosis. 

In cases where your doctor cannot confirm an actinic keratosis diagnosis by an examination, they may opt to perform a skin biopsy. In this case, the doctor will take a small sample of the affected skin, and a lab analysis will confirm the diagnosis. The biopsy is a common procedure and can be done in-office with a numbing agent. 

Your doctor may want to see you for regular examinations even if you do not initially receive a diagnosis. They will likely want to make sure no actinic keratosis or other skin cancer develops on the skin.

How is actinic keratosis treated?

Back to top

Given the potential of an actinic keratosis to develop into skin cancer, doctors usually prioritize a treatment plan that removes them. Actinic keratosis can disappear on their own, but it can return to the skin and even multiply over time. Treatment falls into two main categories: medicine and surgical procedures. 


Medicated gels or creams treat the actinic keratosis by killing the abnormal cells. The active ingredient in these treatments varies depending on the option a dermatologist prescribes. The following prescriptions are the most common topical treatments for actinic keratosis. 

  • Fluorouracil 
  • Imiquimod
  • Diclofenac 

A dermatologist may prescribe topical medicines as opposed to procedures if you have many actinic keratoses or if they are at a very early stage. While medicines can be beneficial for killing existing and future patches, they require a strict treatment plan that can be hard to maintain. In addition, the medicines have side effects which can irritate the skin until you are done with your course of treatment. 


There are many procedures doctors can use to remove and treat actinic keratosis, including the following. 

Cryotherapy: This form of treatment is the most common. The goal for cryotherapy is to freeze off the actinic keratosis. In this procedure, your doctor will apply liquid nitrogen to the affected patch. The skin will blister and peel, allowing the dead precancerous cells to fall off. You may need repeated treatments to fully remove the bad cells, but this procedure can be done quickly in the doctor’s office. 

Photodynamic Therapy: This treatment can be effective for people with multiple actinic keratoses or for those that may resist or return after treatment. For this therapy, your doctor will apply a chemical solution to the affected area and then use a special light to destroy the precancerous skin cells. The solution needs to soak into the skin for 60 to 90 minutes before the light can be applied. Your skin will be sensitive after this procedure, so you will need to stay out of the sun for several days and manage possible inflammation following the light therapy. 

Curettage: Doctors using curettage will use a scraping device called a curet to remove the damaged cells from the skin. After the doctor has removed the skin, they may follow up this procedure with an electrodesiccation which uses concentrated heat to kill any remaining bad cells. 

Laser Therapy: Laser therapy consists of removing the patch of actinic keratosis with an ablative laser to allow healthy skin to grow. This treatment option is becoming more common, especially with cases of actinic keratosis on the lips. 

Chemical Peel: Chemical peels work by destroying bad cells and clearing the skin for new, healthy cells to grow. Your doctor will apply a medical-grade chemical peel to the skin in the office. After the peel, the skin will be red and swollen but will heal over time and reveal a healthy layer of skin.

Should you see a doctor for actinic keratosis?

Back to top

You should see a doctor ASAP if you think you are at risk for developing actinic keratosis or if you suspect you already have a developing patch. Actinic keratosis is incredibly treatable in its early stages. However, untreated actinic keratosis can develop into cancer without proper management and treatment. 

Most cases can be treated with one of the treatment methods explained above. Your doctor will likely request regular follow up visits to monitor the treated skin to ensure no new cases of actinic keratosis develop. 

What is the outlook for people living with actinic keratosis?

Back to top

The outlook for people with actinic keratosis is good. This condition has effective treatments to fully remove the patches and prevent new ones from forming. Routine checkups with your doctor are essential for staying on top of any new patches and receiving proper treatment. 

In addition to remaining under a doctor’s care, you can take preventative measures to protect your skin. For example, you can wear sunscreen and protective clothing while reducing your sun exposure in your daily life.