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Actinic keratosis (formerly senile keratosis) are changes in the skin that occur as a result of excessive exposure to UV rays. What are the symptoms of actinic keratosis and what is the treatment of such skin lesions?

Actinic keratosiswas formerly also known asactinic keratosisbecause it was mainly observed in elderly or aging people, who for many years were exposed to the harmful effects of UV radiation.

The keratosis itself is a process that occurs naturally in our skin. It consists in dying off and exfoliating the upper layers of the epidermis, which are gradually "pushed" out by young cells located in the deeper layers, which slowly rise to the surface of our skin. Sometimes keratosis, when it is too severe, can become pathological, and in the case of actinic keratosis, the cause of such a condition is (as the name suggests) sun rays.

Actinic keratosis: localization

Actinic keratosis, due to its pathogenesis, is located in areas that are exposed to chronic, intense sunlight. Thus, we can see changes in the type of actinic keratosis mainly on the face, neck, head, and also on exposed parts of the upper and lower limbs.

Actinic keratosis: the appearance of lesions

Usually, actinic keratosis appears as lesions of a gray-yellow-brown color, composed of several layers of rough skin with an uneven surface. These lesions are rough to the touch and may lie level with or protrude above the skin. If you try to remove such a lesion, the skin underneath it will start to bleed slightly. This form of actinic keratosis develops over many years, and before the typical clinical picture appears, thickened, wrinkled skin covered with numerous and deep wrinkles can be observed in these characteristic places. On the surface of the skin, we also see telangiectasias, which are dilated, tiny blood vessels. Such skin, as a result of UV rays, is damaged not only on the surface, but also breaks down and inhibits the synthesis of collagen and elastic fibers in its deeper layers.

How does actinic keratosis develop?

It is already known that for arisingactinic keratosis is caused by the sun's rays. But by what mechanism does skin cells become damaged? UV radiation causes changes directly to the DNA of our cells. Under physiological conditions, we have a certain gene that is responsible for inhibiting their proliferation. UVB radiation damages this gene and the cells start growing out of control. This is especially true of the outermost cells. Cells in the deeper layers "cannot keep up" and therefore, exfoliated, older epidermal cells accumulate on the surface of the skin. All this means that the skin does not have enough time to regenerate after frequent and long-term exposures to the sun.

Is actinic keratosis serious?

When the DNA of cells is damaged, they are devoid of any control. Therefore, actinic keratosis is considered a precancerous condition that can lead to skin cancer after many years, most often squamous cell carcinoma. About 10-20% of actinic keratosis cases are transformed into full-blown skin cancer. A neoplastic change may be indicated by a rapid enlargement of the lesion, tendencies to the formation of erosions and ulcerations, and bleeding.

Actinic keratosis: diagnosis

Actinic keratosis has so characteristic morphology that usually a "glance" of a physician is enough to suspect this disease. However, the diagnosis of all skin lesions should always include a histopathological examination of the specimen, because you can never be sure that the lesion you see is completely harmless. On microscopic examination, actinic keratosis will be characterized by so-called atypical cells, that is, cells that differ in appearance from normal cells. Atypical cells may be larger, altered in shape, and with a different nucleus morphology. In actinic keratosis, such cells are found only in the epidermis. If atypical cells cross the basement membrane, which is the boundary between the epidermis and the dermis, we are talking about a cancer process. This shows us that histopathological examination is essential in making a correct diagnosis, as the management of actinic keratosis differs significantly from cancer therapy.

How to differentiate actinic keratosis?

As mentioned, the diagnosis of actinic keratosis is based on histopathological diagnosis. Clinically, this disease may resemble other dermatoses, such as the aforementioned cancer,seborrhoeic warts, flat warts, Bowen's disease or a hyperkeratotic form of chronic lupus

Actinic keratosis: treatment

After confirming the non-neoplastic nature of the lesion in the histopathological examination, it is recommended to implement treatment in order to limit the ongoing process. Several treatments are available. In the treatment of actinic keratosis, among others, liquid nitrogen cryotherapy, ointments containing retinoids, fluorouracil or a cream containing imiquimod, which is unfortunately very expensive and therefore unavailable to everyone, are used. The use of ointments and creams containing these substances softens rough, calloused layers and thus supports the natural process of keratinization of the skin. Such topical treatments have a variety of regimens and configurations, but typically last for several weeks. If microscopic examination confirms that we are dealing with cancer, we only need radical treatment, which may consist of deep freezing with liquid nitrogen or surgical removal of the entire lesion.

Worth knowing

Actinic keratosis prevention

It is well known that excessive exposure to the sun's rays does more harm than good, so we should always be moderate when sunbathing. People with fair complexion are most exposed to sun damage, as they quickly turn red and sunburn. We must always remember about sunscreen creams - those with a minimum SPF of 30, preferably 50-60. Once we observe actinic keratosis changes, we must remember to regularly visit a dermatologist who will monitor them and implement possible treatment.

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