Actinic keratoses

Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure

Features

• small, crusty or scaly, lesions
• may be pink, red, brown or the same colour as the skin
• typically on sun-exposed areas e.g. temples of head
• multiple lesions may be present

Multiple actinic keratoses - hyperkeratotic papules on a background of sun-damaged skin

Management options include

• prevention of further risk: e.g. sun avoidance, sun cream
• fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
• topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
• topical imiquimod: trials have shown good efficacy
• cryotherapy
• curettage and cautery