Actinic keratoses
Actinic keratoses (or solar keratoses) are small red flakey marks on your skin in response to long-term sun damage. They appear many years after sun exposure on sun-exposed areas such as the top of forehead or crown of the head, tops of ears, forearms, hands and lower legs, and so are more common in older people.
They feel like rough patches like sandpaper, and yellow or orange scales can appear that resemble tiny cornflakes. The surrounding skin may be pink or red, and there might other evidence of sun damage such as deep wrinkles, large freckles or brown blotches. They don't usually cause any symptoms beyond a mild itch or soreness, but some people feel self-conscious that they look unsightly.
Doctor’s advice
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Are there any risks?
Actinic keratoses are not cancers in themselves, but they carry a small risk over a number of years of developing into a type of skin cancer called squamous cell carcinoma (SCC). SCC is not a melanoma skin cancer, but if it develops, it needs urgent surgical removal as it carries a risk of disrupting tissues and of spreading around the body. Because of this, it’s suggested that actinic keratoses are treated as and when they arise. This is a simple procedure involving freezing or applying a cream.
They also act as a warning shot that you have had lots of sun damage, so you should keep checks on any new moles or changes to existing moles, and any other lumps or bumps on the skin that aren't going away.
Who gets actinic keratoses?
Because damage takes years of sun exposure, they are unlikely in those under 40 years old.
They are more common in those that burn easily in the sun. This includes those with pale skin, freckles, red or blonde hair and blue eyes. The risk increases if you have a large area of actinic keratoses, called field damage.
Spending significant amounts of time in the sun – such as working outdoors, living in hot climates or sunbathing – puts you at higher risk, along with extensive use of sunbeds. You’re also at higher risk of actinic keratoses and any skin cancers if you’re on immunosuppressive medications.
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Can I prevent them?
Yes, you can prevent further damage by using sun protection and sun avoidance techniques. Unfortunately, you can't reverse the damage already done, but you can minimise the risk so far by taking up treatment, and reduce the risk with further damage.
Everyone should wear sunscreen with broad spectrum ultraviolet light UVA and UVB protection, with a skin protection factor (SPF) of 30 or higher, and it should be reapplied regularly. Ultraviolet light A rays are present from dawn until dusk and all year round, and ultraviolet light B rays give you sunburn and are strongest in the summer between 11am and 3pm. Both can cause damage to skin cells that can lead to cancer so as well as using sunscreen, the best practice is to avoid the sun where possible and wear clothes and hats to cover up.
When should I see my doctor?
You should book a routine appointment with your doctor, who will consider your symptoms and examine you. They may discuss treatment options, depending on how widespread the damage is and your own preference, or they may refer you to a dermatologist.
Treatments include a freezing process called cryotherapy, or a cream applied daily for a month. Both methods aim to remove the uppermost layer of skin, and with it, the actinic keratoses. It can leave the skin of that area looking rather red for a few days so it’s best avoided before any important events or photo opportunities.
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