Actinic keratosis: Wikis

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Actinic keratosis
Classification and external resources

Actinic keratosis on the lip
ICD-10 L57.0
ICD-9 702.0
DiseasesDB 29438
MeSH D055623

Actinic keratosis (also called "solar keratosis"[1] and "senile keratosis"[1]) is a premalignant condition[2] of thick, scaly, or crusty patches of skin.[3]:719[4] It is more common in fair-skinned people. It is associated with those who are frequently exposed to the sun,[5] as it is usually accompanied by solar damage. Since some of these pre-cancers progress to squamous cell carcinoma,[4] they should be treated. Untreated lesions have up to twenty percent risk of progression to squamous cell carcinoma[6].

When skin is exposed to the sun constantly, thick, scaly, or crusty bumps appear. The scaly or crusty part of the bump is dry and rough. The growths start out as flat scaly areas, and later grow into a tough, wart-like area.

An actinic keratosis site commonly ranges between 2 and 6 millimeters in size, and can be dark or light, tan, pink, red, a combination of all these, or have the same pigment as the surrounding skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.

Contents

Prevention

Preventive measures recommended for AK are similar to those for skin cancer:

  • Not staying in the sun for long periods of time without protection (e.g., sunscreen, clothing, hats).
  • Frequently applying powerful sunscreens with SPF ratings greater than 30 and that also block both UVA and UVB light.
  • Wearing sun protective clothing such as hats, long-sleeved shirts, long skirts, or trousers.
  • Avoiding sun exposure during noon hours is very helpful because ultraviolet light is the most powerful at that time.

Diagnosis

Doctors can usually identify AK by doing a thorough examination. A biopsy may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer. Seborrheic keratoses are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. Seborrheic keratoses may be mistaken for an actinic keratosis.

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Histopathology

Actinic keratosis usually shows focal parakeratosis with assocatiated loss of the granular layer, and thickening of the epidermis. The normal ordered maturation of the keratinocytes is disordered to varying degrees, there may be widening of the intracellular spaces, and they may also have some cytologic atypia, such as abnormally large nuclei. The underlying dermis often shows severe actinic elastosis and a mild chronic inflammatory infiltrate[6].

Treatment

Various modalities are employed in the treatment of actinic keratosis:

Regular follow-up after the treatment is advised by many doctors. The regular checks are to make sure no new bumps have developed and that old ones haven't become thicker.

Experimental treatments

In 2007, Australia biopharmaceutical company Clinuvel Pharmaceuticals Limited began clinical trials with a melanocyte-stimulating hormone called afamelanotide (formerly CUV1647)[9] for mitigation of photodynamic therapy side effects in organ transplant patients.[10][11 ]

Another Australian biopharmaceutical company, Peplin,[12] is also developing a topical treatment for actinic keratosis. Formed in 1998 they are currently developing Ingenol Mebutate, which is the first in a new class of compounds and which is derived from Euphorbia peplus, or E. peplus, a rapidly growing, readily-available plant, commonly referred to as petty spurge or radium weed. The sap of E. peplus has a long history of traditional use for a variety of conditions, including the topical self-treatment of various skin disorders, such as skin cancer and pre-cancerous skin lesions. The company has recently redomiciled to the USA and is about to enter phase III trials with Ingenol Mebutate.

See also

External links

References

  1. ^ a b Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. Chapter 108. ISBN 1-4160-2999-0.  
  2. ^ Prajapati V, Barankin B (May 2008). "Dermacase. Actinic keratosis". Can Fam Physician 54 (5): 691, 699. PMID 18474700. PMC 2377206. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=18474700.  
  3. ^ Freedberg, et. al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
  4. ^ a b Quaedvlieg PJ, Tirsi E, Thissen MR, Krekels GA (2006). "Actinic keratosis: how to differentiate the good from the bad ones?". Eur J Dermatol 16 (4): 335–9. PMID 16935787. http://www.john-libbey-eurotext.fr/medline.md?issn=1167-1122&vol=16&iss=4&page=335.  
  5. ^ actinic keratosis at Dorland's Medical Dictionary
  6. ^ a b c Weedon, David (2010). Weedon's Skin Pathology, 3rd Edition. Elsevier. ISBN 978-0-7020-3485-5.  
  7. ^ Ericson MB, Wennberg AM, Larkö O (February 2008). "Review of photodynamic therapy in actinic keratosis and basal cell carcinoma". Ther Clin Risk Manag 4 (1): 1–9. PMID 18728698.  
  8. ^ Hadley G, Derry S, Moore RA (June 2006). "Imiquimod for actinic keratosis: systematic review and meta-analysis". J. Invest. Dermatol. 126 (6): 1251–5. doi:10.1038/sj.jid.5700264. PMID 16557235.  
  9. ^ "World Health Organisation assigns CUV1647 generic name" (PDF). Clinuvel. 2008. http://www.clinuvel.com/resources/pdf/asx_announcements/2008/20080617WHOGenericName.pdf. Retrieved 2008-06-17.  
  10. ^ Clinuvel » Investors » FAQs
  11. ^ Australian Life Scientist - Tackling skin cancer in organ transplant patients
  12. ^ Peplin

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