Actinic and seborrheic keratosis

Actinic keratosis (also called light keratosis) is a rough, scaly, raised skin lesion of grayish-brown color that develops after years of sun exposure.

It occurs on skin areas that are usually exposed to the sun’s rays:

  • Face
  • lips, especially the lower lip,
  • on the nose,
  • Ears
  • on the back of the hands,
  • on the fingers near the nail,
  • Forearms
  • Scalp
  • Neck.

Actinic keratosis is a form of precancerous disease because it can develop into skin cancer.


Is the light keratosis of the skin dangerous?

Actinic keratosis is usually harmless, but it can be annoying and unaesthetic.
The biggest concern is that the development of the changes is a type of skin cancer:

  • spinalioma (squamous cell carcinoma),
  • Basal cell carcinoma.

Evolution of keratosis

  • In 26% of cases, it regresses on its own.
  • The risk of squamous cell carcinoma for a patient with more than 10 light keratoses is about 10-15%.

If the light keratosis thickens or ulcerates, you should consult a doctor for control.
Squamous cell carcinoma:

  • manifests itself at the initial stage like a papule or a small pink nodule with irregular edges;
  • with further progression, a large plaque or irregular lump appears, ulcerative and often resembles a volcanic crater on the skin.

Causes of actinic keratosis

This skin disease is caused by prolonged exposure to sunlight.

The risk factors are:

  1. fair skin, blue or green eyes, or blond or red hair;
  2. organ transplantation;
  3. taking drugs that suppress the immune system;
  4. a medical history of severe sunburns in childhood or adolescence;
  5. age, because in fact it is a disease in old age.

Symptoms of actinic keratosis

Most often, actinic keratosis occurs:

  • facial
  • on the scalp,
  • on the back of the hands,
  • on the chest.

Particularly at risk are the places exposed to the sun,

1. The initial skin lesions are flat and scaly.
2. They have white or yellow scales and resemble an encrustation in the skin texture.
3. The skin growths can be the same color as the skin, but can also be pink, red or gray. After that, they can become hard, similar to a wart, grainy and rough.
4. The contour of keratosis is usually red.

Types of actinic keratosis

Actinic keratoses can be divided into:

  • Hypertrophic type,
  • actinic cheilitis,
  • pigmented type,
  • lichenoid type,
  • Atrophic type,
  • Bowenoid type.

Hypertrophic keratosis Hypertrophic keratosis
is a subtype of actinic keratosis, which usually presents with scaly plaques and rough.
A later extent of hypertrophic keratosis is the formation of a “skin horn” or conical grandeur.
A skin biopsy can confirm the origin of the underlying lesion.

Actinic cheilitis Actinic keratosis can also occur on the lips, this disease is then called actinic cheilitis
Pathology is characterized by:

  • Red
  • scaly,
  • open lips.

The lip edge can often not be demarcated.
If an ulcerative skin lesion develops that does not heal, a biopsy must be performed to rule out squamous cell carcinoma.

Pigmented actinic keratosis
Their color is more brown than red, but the biological characteristics are similar to those of other actinic keratoses.
These skin changes are similar:

  • Freckles.
  • Birthmarks
  • or melanoma in situ, called lentigo maligna.

There are important distinctions to be made here.
Pigmented actinic keratosis, which does not pass after treatment with liquid nitrogen, must be examined by means of a biopsy, as melanoma can be suspected.

Lichenoid actinic keratosis Lichenoid actinic keratosis
is a premalignant disease that requires consultation of a physician.
Some of these changes may progress to squamous cell carcinoma.
Usually they have a size of 2-6 mm.
The color is:

  • red or brown,
  • From light to dark.

Bowenoid actinic keratosis Bowenoid actinic keratosis
(Bowen’s disease) is the first stage of squamous cell carcinoma in situ, which is similar to actinic keratosis.

Diagnosis and examinations of actinic keratosis

Usually, the doctor can make this diagnosis by looking at the skin.
To confirm the diagnosis, the doctor may use some imaging techniques, such as:

  • dermoscopy,
  • confocal laser scanning microscopy “in vivo”.

Treatment of actinic keratosis

The therapy of light keratosis consists in the removal of the damaged skin.
After that, a deeper new layer of skin is formed, which is not damaged by sunlight.

Among the possible treatments there are:

Icing with liquid nitrogen is the most commonly used form of treatment for actinic keratosis; It causes:

The keratosis on the face resolves after about 10 days, those on the hands in about 3 weeks, but skin lesions on the legs (lower limbs) may also heal only after 12 weeks.
The therapy:

  • takes 5 minutes,
  • is performed on an outpatient basis.

Short-term icing usually leaves no scar, but if treatment takes longer (for thicker lesions or skin tumors in the initial stages), it causes bright spots or scars. The lesions may recur over time.

Curettage and diathermy
This therapy is indicated for thickened keratosis and is a common method in the early treatment of squamous cell carcinoma.
Curettage refers to the removal of a lesion by means of a sharp instrument. In diathermy, keratosis is destroyed by heat and bleeding is prevented.
A grind is formed, which:

  • heals after a few weeks,
  • leaves a small scar.

Surgical removal
Ablation of the lesion (biopsy of the removed material) leads to complete elimination of these skin lesions.
This is important if the lesion is cancerous.
Usually, the wound is surgically sutured.
This surgical procedure leaves a permanent scar.

5-Fluorouracil (Efudix) is used when there are many keratosis foci on the face. The ointment is applied to the face once or twice a day over a period of two or four weeks.

Imiquimod Imiquimod
(Aldara) is a product that is used as an ointment that affects the immune response. It is applied to the areas affected by light keratosis for one to four months two to three times a day, then paused for a month and finally repeated the treatment.
The results vary, but mostly excellent.

Photodynamic therapy Photodynamic therapy
(PDT) involves applying an aminolevulinic acid-based photosensitizing cream to the skin areas in question before exposure to a visible light source (sunlight is sufficient, but some treatments involve the use of red light). In the skin area, a burn develops and healing occurs after about two weeks.

Diclofenac gel and hyaluronic acid Diclofenac gel together with hyaluronic acid (for example, Solaraze) is an effective therapy for actinic
To be applied twice daily for 3 months.

Natural remedies

An effective remedy for keratosis is the one-weekly application of sesame oil to the affected skin lesions.