KERATOSIS, also called SOLAR KERATOSIS, are rough scaly small to relatively large size areas of skin due to damage from sun exposure. Some keratoses can turn into squamous cell skin cancer (one of the most common cancer of skin), however, because of this reason, it is important to perform self-examinations often and catch them early.
PEOPLE AT RISK FACTOR
People with fair skin get sunburn easily; have trouble tanning; and are at high risk of developing keratoses.
Those who have had a lot of sun exposure in their youth are at a high risk as well.
Individual with a weak immune system due to chemotherapy, HIV, or an organ transplant are at higher risk.
The initial spots also commonly appear in elderly (over 50), but they can start appearing in younger adults who have had a lot of sun exposure also. Darker-skinned individuals are rarely affected.
SIGN AND SYMPTOMS
The sun-exposed areas of the face, scalp (where balding), ears, neck, forearms, and backs of the hands are most commonly affected with keratoses, but any part of the skin frequently exposed to the sun can be involved.
Patches are usually less than an inch in size with slight scale (sometimes thick like a wart): pink, dark, reddish, or brownish in color. They are slightly rough to the touch, like fine sandpaper, and maybe a bit sensitive.
Mild, one or two spots, not thick or hard
Moderate, scattered, few spots
Severe, numerous or thick, hard, or bleeding spots
SELF PROTECTION PROTOCOLS
Prevention is very important. Sun protection can reduce the number of new areas occurring and may help small lesions go away on their own.
Avoid direct sun in the middle of the day (10 AM to 3 PM). Remember: snow and water reflect light to the skin, and clouds still let a lot of light through, so you may still be exposed to ultraviolet light even on cloudy days.
Use a hat with a wide brim. A baseball that does not give much protection.
Cover up with tightly woven clothing. Some manufacturers make specialty clothing with a high sun protection factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can “wash” SPF into your clothing.
Use sunscreen on all exposed skin areas, including the lips, before going outdoors. A broad spectrum (blocks UVB and UVA light), with an SPF of at least 30, is best. Apply generously 30 minutes before going outdoors and reapply every 2 hours or after swimming or sweating a lot.
Do not use tanning beds!
A low-fat diet (less than 21% calories from fat) has been shown to reduce the incidence of keratoses.
Once a month, you should perform a self-exam to look for signs of skin cancer. It is best to perform the exam in a well-lit area after a shower or bath. Use a full-length mirror with the added assistance of a hand mirror, when necessary. Using a hair dryer can help you examine any areas of skin covered by hair, such as your scalp.
In front of a full-length mirror, inspect the front of your body making sure to look at the front of your neck, chest (including under breasts), legs, and genitals.
With your arms raised, inspect both sides of your body making sure to examine your underarms.
With your elbows bent, examine the front and back of your arms as well as your elbows, hands, fingers, area between your fingers, and fingernails.
Inspect the tops and bottoms of your feet, the area between your toes, and toenails.
With your back to the mirror and holding a hand mirror, inspect the back of your body, including the back of your neck, shoulders, legs, and buttocks.
Using a hand mirror, examine your scalp and face.
As you perform your monthly self-exam, familiarize yourself with the moles, freckles, and other marks on your body, and look for any changes in them from month to month, including shape, size, color, or other changes, such as bleeding or itching.
WHEN TO SEEK MEDICAL TREATMENT
If you have severe changes or have a spot that is growing or bleeding, see the doctor. Sometimes a biopsy may be done to look for skin cancer.
Local destruction with freezing (cryosurgery), scraping (curettage), burning (electrocautery), dermabrasion, or a laser
Creams with either tretinoin, adapalene, fluorouracil, diclofenac, or imiquimod
Treatment for more advanced or widespread cases of keratosis includes medication in the form of various creams and gels. Some medicated creams include:
These creams and gels are applied directly to affected areas of the skin. They may produce side effects in some people who may experience rashes, redness, and swelling at the site of application.
In cases where a person only has a few spots or patches, a doctor may recommend removing the affected area through minor surgery. Two of the more common surgery options are curettage and cryotherapy.
Scraping, which is referred to as curettage, involves a device called a curette, to scrape off the damaged skin cells. In some cases, electrosurgery is used immediately after scraping. Electrosurgery involves a doctor using a pen-shaped instrument, to destroy and cut away the affected tissue with an electric current.
Both procedures require a local anesthetic. Some people experience side effects, including scarring, discoloration, and infection.
Freezing, referred to as cryotherapy, removes the lesions by freezing them with liquid nitrogen. A doctor applies the liquid nitrogen to the skin when the extreme cold causes the affected area to blister and peel. As the skin heals, the lesions fall off, allowing new, undamaged skin to appear.
Cryotherapy is the most common treatment for actinic keratosis. This is partly because it can be done in the doctor’s office and takes only a few minutes. Side effects may include:
changes to skin texture
discoloration of the skin at the site of treatment
Photodynamic therapy involves the application of a chemical to the affected areas of skin. The doctor then shines an artificial light on the chemical, which, in turn, kills the damaged cells and removes the actinic keratosis.
Side effects may include redness, swelling, and burning, which may be felt during the procedure.
A person and their doctor will work together to decide the best option or options. In some cases, a person may have regular treatment for recurring patches.
METHOD OF PREVENTION
The main methods of prevention of actinic keratosis are through lifestyle changes and a person being aware of their exposure to UV rays.
A person should take proper precautions when outside, such as wearing hats, loose-fitting clothes that cover most areas of the body, and sunscreen.
They may want to avoid being in the sun for prolonged periods of time, as well.
People should avoid excessive exposure to UV light from tanning either indoors or outdoors.
It is important to remember that this condition may occur from any source of UV light, including indoor tanning beds
keratosis is a marker of severe skin changes and damage to the skin, as a result of UV exposure. These changes put a person with keratosis at high risk of developing skin cancer.
People with keratosis early tend to have a good chance of removing the risk of developing cancer. However, if left untreated, keratosis may develop into skin cancer.
Once treated for actinic keratosis, a person will probably need to schedule yearly dermatologist appointments, to screen for recurrence and check for other signs of skin cancer.
Written by: Shababiru Yakubu.
Photo from: gadermctr.com