Best prevention strategies for Actinic Keratosis

What is actinic keratosis?

AK lesions typically appear as rough, scaly, or crusty patches of skin that may be red, pink, white, tan, or a combination of colors. They can be textured and may be flat or slightly raised. AK most commonly occurs on sun-exposed body parts, such as your face, lips, ears, scalp, neck, forearms, and the backs of your hands. [5] Actinic keratosis develops primarily due to chronic exposure to UV radiation, even from short-term, regular sun exposure. [1, 2] If left untreated, it can progress to squamous cell carcinoma, a type of skin cancer. [1, 2, 3]

Although the risk of an AK lesion progressing to squamous cell carcinoma is relatively low (around 5-10%), having multiple AK lesions increases your risk significantly. Patients with AK also have a much higher risk of developing other skin cancers, such as basal cell carcinoma and melanoma, than people with seborrheic keratoses. [5, 6]

How common is actinic keratosis?

Nearly 58 million Americans have actinic keratosis. It’s the most common precancerous skin condition, especially among older adults and people with fair skin. Studies have reported prevalence rates ranging from 28% to 49% in some populations. [4]

Risk factors for actinic keratosis

Several factors can increase your risk of developing actinic keratosis, including:

• Chronic UV exposure: Prolonged, unprotected exposure to UV rays, even in short bursts, can lead to the development of AK over time. This is why AK lesions appear on the areas of your skin that see the most sun. [11-17]

• Fair skin and light-colored eyes: People with fair skin, blonde or red hair, and blue/green/gray eyes are at higher risk for AK. Those with darker complexions are less susceptible. [13, 14, 18, 19]

• Advanced age: AK is more common in older adults, as sun damage accumulates over the years. It usually first appears in people over 40. [13, 20]

• Being immunosuppressed: People with weakened immune systems, such as organ transplant recipients or those with HIV/AIDS, are at increased risk of developing multiple AKs that may progress to skin cancer. [16, 17, 21]

• Certain genetic conditions: Rare disorders that make the skin extremely sensitive to UV radiation, like albinism or xeroderma pigmentosum, predispose people to AK. [13, 18]

• Certain medications: In studies, people who used photosensitizing medicines as well as calcium channel blockers for heart disease developed more severe AK. [22]

• HPV: Some forms of human papillomaviruses (HPV) may contribute to the development of cutaneous squamous cell carcinoma, with Bowen's disease being a potential precursor lesion. [23]

• Balding: The degree of baldness in men is a risk factor for AK, as the lack of hair coverage exposes more of the scalp to UV radiation. [22, 24]

• Diet: There is some evidence that a low-fat diet may serve as a preventative measure against AK in individuals with a history of non-melanoma skin cancer. [22]

Preventive measures for actinic keratosis

The best way to prevent actinic keratosis is through comprehensive skin protection and regular monitoring of your skin’s condition.

Avoid prolonged sun exposure

The most effective preventative measure against AK is avoiding prolonged exposure to the sun. [11-13] There is no safe way to tan, including on tanning beds, as all ultraviolet (UV) radiation, including tanning beds, increases the risk of actinic keratosis and skin cancer. [11, 13 ]

The sun’s UV rays cause damage to your skin every time you step outdoors during daylight, even if it’s just for a short time. The resulting damage to your skin builds up over time and can eventually lead to AK lesions and, potentially, skin cancer.

Wear sunscreen every day

Apply a broad-spectrum sunscreen with an SPF of 30 or higher daily, even if you’ll only be outdoors for a few minutes. Daily application can prevent new actinic keratoses and reduce the risk of progression to squamous cell carcinoma. [14-17] Look for sunscreen that is:

• Broad-spectrum: Choose a sunscreen that protects against both UVA and UVB rays.
• SPF 30 or higher: The American Academy of Dermatology recommends using a sunscreen with an SPF of at least 30.
• Water-resistant: If you will be swimming or sweating, opt for a water-resistant sunscreen that maintains its SPF for 40-80 minutes when wet.
• Mineral-based: Sunscreens with zinc oxide or titanium dioxide as active ingredients are less likely to irritate sensitive skin and provide excellent UV protection.

Apply sunscreen generously to all exposed skin, including the face, neck, ears, and hands, at least 15 minutes before going outdoors. Reapply every two hours (more frequently if swimming or sweating heavily). Remember that sunscreen alone is not enough to prevent skin damage; combine it with other sun-protection measures, such as protective clothing and seeking shade between 10 am and 4 pm when the sun’s rays are strongest. [7, 8, 9, 10]

Wear protective clothing

Covering up with long-sleeved shirts and pants shields your skin from the sun’s harmful UV rays. [11 13] Consider UV-protective clothing blocks UV rays more than loosely woven materials. Don’t forget to protect your scalp, face, ears, neckline, and shoulders with a wide-brimmed hat and sunglasses to protect these delicate but often-missed areas.

Visit the dermatologist regularly

If you have a history of AK, a dermatologist should check your skin at least once or twice a year. [18,19] If you develop actinic keratosis lesions, the sooner you get them treated by a dermatologist, the easier it is to clear them, and the less likely you are to develop skin cancer.

If you have had AK before, have a weakened immune system, or have other high-risk factors for AK, talk to your dermatologist about preventive treatments, such as topical creams or photodynamic therapy, which may reduce the risk of developing AK lesions. [19-21]

Protect your skin barrier

Keeping your skin well-moisturized and avoiding harsh products can help maintain your skin’s barrier function and prevent or treat other underlying skin conditions, reducing your risk of developing actinic keratosis. [11, 13]

Some moisturizing lotions contain topical ingredients that help reduce the risk of developing actinic keratosis by gently exfoliating dead skin cells and bumpy skin associated with keratosis pilaris, a precursor to AK. CeraVe Moisturizing Cream with Salicylic Acid, AmLactin KP Bumps Be Gone, or TOUCH Glycolic Acid Lotion all contain chemical exfoliants such as salicylic acid, lactic acid, or glycolic acid that can help prevent KP from developing into AK. Keep in mind that the active ingredients can irritate your skin if not taken as directed, so follow instructions carefully and introduce new products gradually.

Self-check for new growths

Ask your dermatologist to guide you on what to look for. But AK is easily recognizable by the rough texture that you will feel. After every shower, make a habit of moisturizing your skin and checking your skin for new rough spots or changes to existing ones. If you notice anything suspicious or new, make an appointment with your dermatologist to get your skin checked immediately.

Citations:

1. Reinehr, C. P. H., & Bakos, R. M. (2019). Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. Anais brasileiros de dermatologia, 94(6), 637–657. https://doi.org/10.1590/abd1806-4841.20199346
2. Padilla, R. S. (2022). Epidemiology, natural history, and diagnosis of actinic keratosis. UpToDate. https://www.uptodate.com/contents/epidemiology-natural-history-and-diagnosis-of-actinic-keratosis
3. Actinic Keratosis Epidemiology. (2019, March 27). News Medical Life Sciences. https://www.news-medical.net/health/Actinic-Keratosis-Epidemiology.aspx
4. Flohil, S. C., van der Leest, R. J., Dowlatshahi, E. A., Hofman, A., de Vries, E., & Nijsten, T. (2013). Prevalence of actinic keratosis and its risk factors in the general population: The Rotterdam Study. Journal of Investigative Dermatology, 133(8), 1971–1978. https://doi.org/10.1038/jid.2013.134
5. Feldman, S. R., & Fleischer, A. B., Jr (2011). Progression of actinic keratosis to squamous cell carcinoma revisited: clinical and treatment implications. Cutis, 87(4), 201–207. https://pubmed.ncbi.nlm.nih.gov/21644496/
6. Actinic Keratosis. (n.d.). The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/actinic-keratosis/
7. Neugebauer, R., Levandoski, K. A., Shen, L., Huang, V., Arron, S. T., Butterfield, T., Feldman, S. R., Fleischer, A. B., Jr, Kempers, S., Maibach, H. I., Mostaghimi, A., Pariser, D. M., Stein Gold, L. F., & Bhatia, N. (2018). A real-world, community-based cohort study comparing the effectiveness of topical fluorouracil versus topical imiquimod for treating actinic keratosis. Journal of the American Academy of Dermatology, 78(4), 710–716. https://doi.org/10.1016/j.jaad.2017.10.039
8. Nguyen, K. P., Thi Nguyen, N. P., Thi Nguyen, T. H., Thi Nguyen, T. N., Tran, N. V., & Tran, N. D. (2022). Daylight photodynamic therapy for actinic keratosis: Reflectance confocal microscopy-aided monitoring. Photodiagnosis and photodynamic therapy, 37, 102634. https://doi.org/10.1016/j.pdpdt.2022.102634
9. Patel, G., Armstrong, A. W., Naik, H. B., Lea, J. N., Lew, R. A., & Livingston, M. (2018). Efficacy of photodynamic therapy vs other interventions in randomized clinical trials for treating actinic keratoses: a systematic review and meta-analysis. JAMA dermatology, 154(12), 1427–1436. https://doi.org/10.1001/jamadermatol.2018.3818
10. Cramer, P., & Stockfleth, E. (2020). Actinic keratosis: where do we stand, and where is the future going to take us?. Expert opinion on emerging drugs, 25(1), 49–58. https://doi.org/10.1080/14728214.2020.1730810
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