Actinic keratosis also known as solar keratosis is basically dry scaly patches formed on the skin due to damage from years of sun exposure. Actinic Keratosis is usually found on face, hands, ears and bald scalp. In women, they are found on the legs. When it comes to periocular region, most of actinic are located on the upper eyelid. Initially, these patches may be too small for you to even notice to resolve temporarily after their first appearance.
However, eventually they turn pink, red or brown in colour. The patches can vary in size from a few millimetres to a few centimetres. The skin in affected areas is sometimes thick and they occasionally look like horns or spikes.
Although the patches are usually harmless and sometimes get better on their own, they can be sore, itchy and look hideous. If left untreated, there is a risk that the patches could develop into a type of skin cancer called squamous cell carcinoma.
Actinic keratosis are most commonly seen in fair-skinned individuals, especially the ones with blue eyes, red hair, freckles and people whose skin have a tendency to burn easily in the sun. Men are affected more often than women.
People who live or work in a sunny place, or who work outdoors or enjoy outdoor hobbies, are most at risk. Actinic keratosis takes time to develop. They usually don’t develop before the age of 40.
Research suggests that around one in every four or five people over the age of 60 has actinic keratoses. If you have actinic keratosis, you have a 10% chance of developing a form of skin cancer called squamous cell carcinoma, according to the Skin Cancer Foundation. Most of the times, cases of squamous cell carcinoma result from untreated cases of actinic keratosis. The development of actinic keratosis is an indication that the underlying skin is damaged from many years of sun exposure.
Your doctor will be able to diagnose actinic keratosis by examining the patches on your skin.
In some cases, the diagnosis may need to be confirmed by removing a small sample of skin to examine it. The base of the lesion is examined to exclude invasive squamous cell carcinoma. Hence, biopsies of suspected actinic keratoses should include the base of the lesion. Treatment options include excision, cryotherapy and a variety of topical agents to extirpate the lesions.
If the patches are not worrisome, your doctor may recommend you to keep a tab on them and get back to him if you notice a change in them like if you develop a patch growing quickly, bleeding or forming an ulcer.
Most of the times, actinic keratoses are often removed because people think that they may develop into skin cancer or for other cosmetic reasons. Some experts state that in about 20% of patients with actinic keratoses, squamous carcinoma may develop in one or more of the lesions. However, when squamous cell carcinoma arises in actinic keratosis, the risk of subsequent dissemination is between 0.5%-3%.
The patches can be removed using a variety of treatments, depending on your condition. There are many gels and creams that can be topically applied on the lesion. Commonly used creams include 5-fluorouracil cream, imiquimod cream, diclofenac gel and ingenol mebutate gel.
Another method is cryotherapy. Under this method, the patches are freezed. It causes blistering and shedding of the sun-damaged areas of skin. A light freeze usually leaves no scar. But if your lesion is thicker, it might need longer freezes that can leave a dark mark on the area.
In some cases, your doctor may use scraping. The abnormal patches are scraped off with a sharp spoon-like instrument called a curette. This procedure is done to treat thicker patches and early skin cancers.
Cautery (heat treatment) is another method used to stop any bleeding after the cells have been removed. Usually, a scab forms after the procedure, but it generally heals over a few weeks and might leave a scar.
If your doctor suspects the patch may be cancerous or pre-cancerous, they may cut it out using a scalpel under local anaesthetic and close the wound with stitches. The piece of skin is then examined under the microscope to confirm the diagnosis.
Wearing glasses was associated with a significantly lower rate of developing actinic keratoses on periocular skin, according to the results of a large multicenter clinical trial. Patients who didn’t regularly wear eyeglasses had a 40% higher rate of developing this tumour on periocular skin. Even some of the experts suggest that eyeglasses can reduce the impact of ultraviolet radiation filtered to your eye.
If you have suspicious skin abnormalities on your eyelids, contact your doctor for a definitive diagnosis.