Actinic keratosis (AK), also known as solar keratosis, is one of the most common skin conditions that dermatologists encounter, especially among people with fair skin who have a history of sun exposure. At mySkinDoc, we aim to educate our patients on recognising early signs of skin changes, such as actinic keratosis, to promote timely treatment and prevent progression to more serious conditions, such as skin cancer.
In this article, we will explore the following:
- What is actinic keratosis?
- What does actinic keratosis look like?
- Who is at risk?
- How is actinic keratosis diagnosed?
- Treatment options for actinic keratosis.
What is Actinic Keratosis?
Actinic keratosis is a rough, scaly patch that forms on areas of the skin that are frequently exposed to the sun. These areas typically include the face, ears, scalp, neck, shoulders, forearms, and backs of the hands. They are considered a form of precancerous lesion, as a small percentage can develop into squamous cell carcinoma (SCC), a type of skin cancer. Early detection and treatment are key to preventing this progression.
What Does Actinic Keratosis Look Like?
Recognising actinic keratosis can be tricky, as the appearance may vary from person to person. However, there are several common characteristics that can help identify it:

1. Rough, Scaly Texture
The most distinct feature of actinic keratosis is its rough texture. When you run your fingers over the lesion, it often feels like sandpaper. These rough patches can be either small or cover larger areas of the skin.
2. Colour Variations
Actinic keratoses can range in color. They are often red or pink, but can also be brown, tan, or even flesh-coloured. In some cases, the lesion may appear white or grey, especially if it's thicker or crusty.
3. Flat or Raised
Initially, an actinic keratosis may be flat and feel like a dry patch of skin. Over time, it can become raised and more noticeable. Some AKs can grow into a horn-like projection called a cutaneous horn.
4. Size
The size of an actinic keratosis can vary, but most lesions are typically less than 1cm in diameter. However, some lesions can grow larger over time, especially with continued sun exposure.
5. Sensitive to Touch
Some individuals with actinic keratosis report mild discomfort when the lesion is touched or rubbed. In certain cases, the patch may itch, bleed, or become inflamed.
Where Do Actinic Keratoses Commonly Appear?
Actinic keratosis usually occurs on areas of the skin that have received the most exposure to ultraviolet (UV) radiation from the sun or tanning beds. These areas include:
- Face and Forehead: AKs are frequently seen on the forehead and around the nose, often in individuals who do not regularly wear sunscreen or protective hats.
- Scalp: Balding men are particularly susceptible to AKs on the scalp, where the skin is exposed to the sun throughout the day.
- Ears: The tops of the ears are common sites, especially in those with short hair or without head coverings.
- Neck and Chest: These areas, frequently exposed to the sun, are vulnerable to actinic keratosis, especially in individuals who spend a lot of time outdoors.
- Arms and Hands: The backs of the hands and forearms are common sites, especially in people who work outside or have hobbies like gardening or golfing.
Who is at Risk of developing Actinic Keratosis?
Certain factors increase your risk of developing actinic keratoses:

1. Prolonged Sun Exposure
People who have spent a significant amount of time outdoors without adequate sun protection are at a higher risk. UV radiation from the sun damages skin cells over time, leading to the development of actinic keratosis.
2. Fair Skin
Those with fair skin, light-colored eyes, and light hair are more likely to develop actinic keratosis due to their reduced natural melanin protection against UV rays.
3. Age
As you age, the cumulative effects of sun exposure increase the likelihood of developing actinic keratosis. People over the age of 40 are more prone to developing these lesions.
4. Weakened Immune System
Individuals with compromised immune systems, such as those on immunosuppressive medications or people with certain medical conditions, are at a higher risk.
5. History of Tanning Bed Use
Exposure to artificial sources of UV light, such as tanning beds, can also increase the risk of developing actinic keratosis.
How is Actinic Keratosis Diagnosed?
Diagnosing actinic keratosis often involves a physical examination by a dermatologist. At mySkinDoc, our experienced dermatologists will examine the affected area closely to determine whether the lesion is actinic keratosis or another type of skin condition. In some cases, a biopsy may be required to rule out skin cancer, especially if the lesion looks suspicious or has changed in appearance.
Treatment Options for Actinic Keratosis
There are various treatment options available to address actinic keratosis, and the choice of treatment depends on the number and severity of lesions, as well as the patient’s skin type and overall health.
1. Cryotherapy
This is the most common treatment, where the lesion is frozen with liquid nitrogen, causing the abnormal skin cells to die and fall off. It is quick, effective, and typically well-tolerated.
2. Topical Medications
Prescription creams and gels, such as 5-fluorouracil (5-FU) or imiquimod, are used to treat AKs over larger areas. These medications work by stimulating the immune system to destroy abnormal cells.
3. Photodynamic Therapy (PDT)
PDT uses a combination of a light-sensitising agent and a special light to destroy AK cells. It is particularly useful for treating multiple lesions on large areas of the skin.
4. Curettage
In some cases, the dermatologist may scrape away the lesion using a special instrument. This method is often followed by cryotherapy or another treatment to ensure complete removal.
5. Laser Therapy
For more stubborn lesions, laser therapy can be used to target and remove the affected skin cells.
6. Chemical Peels
Chemical peels can exfoliate the damaged outer layers of skin, revealing healthier skin underneath. This method is effective for treating superficial AKs.
Prevention of Actinic Keratosis
Preventing actinic keratosis involves protecting your skin from the sun’s harmful UV rays. Here are a few tips:
- Wear Sunscreen: Always use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days.
- Wear Protective Clothing: Cover up with long-sleeved shirts, wide-brimmed hats, and sunglasses when outdoors.
- Seek Shade: Avoid direct sun exposure during peak hours, typically between 10 a.m. and 4 p.m.
- Avoid Tanning Beds: These artificial UV sources are just as damaging as natural sunlight.
Conclusion
Recognising the signs of actinic keratosis and seeking early treatment is crucial for preventing progression to skin cancer. At mySkinDoc, our dermatologists specialise in diagnosing and treating all types of skin conditions, including actinic keratosis. If you notice any unusual skin changes or are concerned about a rough patch on your skin, don't hesitate to book an online consultation. Early detection is the key to effective treatment and better outcomes.