Dermatology - Actinic Keratosis

Dermatology - Actinic Keratosis 

UVB (290–320 nm) light, in particular, causes cumulative damage to keratinocytes during prolonged and recurrent sun exposure. The onset typically occurs in middle age and is more prevalent in people who spend a lot of time outside. Actinic keratosis is uncommon in people with darker skin and common in those with lighter complexion. More often, men are impacted.


Tender lesions can form over the course of months or years. People flinch when they are ridiculed.
Damage
Lesions on sun-exposed areas are distinct, dry, rough, adherent, scaly macules or papules that can be solitary or many. Usually, they are accompanied with dermatoheliosis. Scale removal is a painful and challenging process. Lesions are skin-colored, brown, or yellow-brown in appearance, with a reddish undertone frequently present. The lesion is "better felt than seen" because to its rough texture. Lesions are usually circular or oval, and less than 1 cm in size.
Differential diagnosis and diagnosis
Dermatopathology confirms the clinical diagnosis. The differential comprises flat warts, squamous cell carcinoma, superficial basal cell carcinoma, seborrheic keratosis, and chronic cutaneous lupus erythematosus.
While actinic keratoses can go away on their own, they typically persist for years and have the potential to develop into squamous cell carcinoma. Applying regular UVB/UVA sunscreen will help to prevent such incidents.
Although it produces considerable erythema and erosions, topical 5-Fluorouracil (5-FU) cream 5% administered twice daily for 2-4 weeks or longer is beneficial. If administered under occlusion and/or in conjunction with topical tretinoin, efficacy is enhanced and treatment duration may be decreased.
But this causes confluent erosions, which can necessitate hospitalization. Reepithelialization happens when the course of treatment is ended. Using mild cryosurgery as a pretreatment could increase effectiveness. Although it is quite successful, imiquimod, when administered twice a week for 16 weeks, also causes irritation and erosions. Both topical retinoids and diclofenac gel, however unpleasant, are useful in treating and preventing superficial actinic keratoses and dermatioheliosis.

The use of cotton-tipped applicators or light spray cryotherapy is beneficial, particularly when paired with topical retinoids. For large lesions, facial resurfacing or peels work well. For isolated lesions, laser surgery typically works well. Photodynamic therapy is a painful and laborious yet successful treatment.