Actinic Keratoses (AKs)

Actinic Keratoses (AKs)

Actinic Keratoses (AKs)

Actinic Keratoses (AKs)


Actinic Keratoses (AKs)

Actinic keratoses (AKs), also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays. They are often elevated or rough in texture. Most become red, but some will be tan, pink, and/or flesh-toned. If left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC) over the course of 10 years.


AKs are caused by years of ultraviolet ray (UV) exposure from the sun or indoor tanning beds. They are considered precancerous, and if left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC) over the course of 10 years.

Risk Factors

  • Fair-skinned people with light-colored hair and eyes have a higher risk for developing AKs.
  • Excessive time spent in the sun.
  • Use of tanning beds or sun lamps, even if it was many years ago.
  • Prolonged residence in an area that gets intense sunlight, such as Florida, the Caribbean, or northern Australia.
  • Those with conditions or on medications that make them more sensitive to UV rays.


A single AK may range from the size of a pinhead to larger than a quarter. Most AKs are dry, scaly, and rough textured, but not all AKs look alike. Some are skin colored and may be easier to feel than see. These AKs often feel like sandpaper. Other AKs can appear as red bumps, thick red scaly patches or growths, or crusted growths varying in color from red to brown to yellowish black.

Sometimes an AK grows rapidly upward, and you see a growth that resembles the horn of an animal. When this happens, the AK is called a "cutaneous horn." Horns vary in size from that of a pinhead to a pencil eraser. Some horns grow straight, others curve.

AKs often seem to disappear for weeks or months and then return. This makes treatment important. Left untreated, the damaged cells can continue to grow and skin cancer may develop.

When AKs develop, they tend to appear on skin that receives the most sun, including the:

  • forehead, neck, chest, ears
  • scalp, especially a bald scalp
  • arms or hands
  • lower legs, especially in women
  • border of the lip (an AK on the lip and surrounding skin is known as "actinic cheilitis" and looks like a white or grayish scaly patch on a dry, often cracked lip)


AKs are diagnosed on physical exam of the skin but some may require a biopsy (sample) if they do not have a classic appearance.

Your dermatologist can perform a biopsy during an office visit using local anesthesia. It is quick, safe and easy to perform. Your dermatologist will take a sample of all or part of the suspicious skin, and the sampled skin will be sent to a lab where it can be examined under a microscope.


American Academy of Dermatology



When detected early, AKs can be successfully treated. When treating AKs, dermatologists may use one or several therapies. Treatments available in a dermatologist’s office include:

  • Cryosurgery
    This is the most common treatment for AKs. It involves freezing skin cells with liquid nitrogen to treat them and reduce the AK.

  • Photodynamic therapy
    This treatment consists of 2 phases. First, a chemical is applied to the skin. This chemical is allowed to incubate for several hours. Then, the treated area is exposed to a special light that activates the chemical to cause reduction of potentially dangerous cells. This is best when there are multiple AKs on one body site (like the face, scalp, or hands and arms).

  • Curettage
    A procedure that treats AKs by cutting or scraping (curettage) that can be combined with heat (electrosurgery) to treat diseased skin cells.

  • Chemical peel
    A chemical solution is applied to the skin to penetrate the skin deeply to treat an AK.

  • Chemotherapy for the skin
    5-fluorouracil is a cancer-fighting cream that you apply to the AK. The skin will become raw and irritated. As it heals, healthy skin appears. Another treatment such as cryotherapy may be necessary to treat thick AKs.

  • Immunotherapy for the skin
    Imiquimod cream and ingenol mebutate gel are medications that work with the body’s immune system to help destroy AKs.

    Diclofenac sodium gel is a medication that you apply to your skin and is recommended for skin with many AKs. It is an anti-inflammatory and anti-cancer treatment that fades AKs over a 30 day period.

    Additional in-office treatments may be needed following treatment with some of these topical prescriptions. Research and development of other treatments for AKs is ongoing. No one therapy works on all AKs or in all individuals.


American Academy of Dermatology


How can I prevent AKs?

Daily sun protection is an important part of skin cancer prevention. The following are some of The Skin Cancer Foundation’s list of prevention tips:

  • Seek the shade, especially between 10 AM and 4 PM.
  • Do not let your skin burn.
  • Avoid tanning and never use UV tanning beds.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher (most dermatologist recommend 30 or higher with zinc) every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher (again, most dermatologist recommend a higher SPF, of 50 or higher if planning on being outside).
  • Apply 1 ounce (2 tablespoons, or 1 shot glass) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.


American Academy of Dermatology
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