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Actinic Keratosis

What are actinic keratoses?

Actinic keratoses are your skin’s response to years of cellular damage from solar radiation (sunlight). The radiation present in sunlight can damage the DNA of the cells that compose skin, and after a certain amount of damage is done to your skin, the cells begin to behave abnormally. The development of redness, scale, or a rough surface is indicative of an abnormally behaving patch of skin cells.

Why did I get actinic keratoses?

Risk factors for the development of actinic keratoses fall into two broad categories – 1) sun related factors; and 2) factors related to your skin. Sun related factors are the total cumulative amount of sun you have received. This includes duration of sun exposure (how long were you in the sun in your life), frequency of sun exposure (how often were you in the sun in your life), and finally, the intensity of sun exposure (typically, in the US, the further south you are the more intense the sunlight is, and the more solar radiation your skin is exposed to). The second set of factors relates to your skin – whether there is a predisposition in you or your immediate family for sun damage and what your skin color is. The paler the skin the more likely it is to be damaged by sun. Characteristics of people most at risk for sun damage include pale white to white skin, freckles in childhood, eye color (blue, green, and hazel), blond or red hair, and a history of burning rather than tanning when exposed to sun.

Why is it important to treat my actinic keratoses?

This is one of the largest controversies in the field of dermatology. Some dermatologists believe that these lesions are considered a precursor to squamous cell cancer of the skin. Others believe that they are very early squamous cell cancers of the skin. Thus, because it is relatively easy to recognize and treat actinic keratoses, your dermatologist will do so.

How can we treat my actinic keratoses?

There are many ways to treat actinic keratoses. The simplest method is to freeze the lesions with liquid nitrogen. This process freezes the abnormal cells and kills them. These then will blister and fall away in the following days and weeks. If the actinic keratosis is particularly worrisome, with features of skin cancer, the doctor may elect to excise the keratosis with a scalpel. This method allows for a pathological evaluation of the keratosis to rule out skin cancer. Finally, if there are too many keratoses to reasonably freeze, another option is one of several available topical applications, which damage the already abnormal cells while relatively sparing the normal cells. This results in inflammation and sloughing off of the abnormal cells after a course of treatment that lasts from weeks to months.

Will these come back?

Nearly inevitably, more actinic keratoses will develop. However, these can be easily treated with any of the above methods. The rate of return can at times be decreased by careful avoidance of sun, through the use of sunscreen to sun exposed areas, full coverage clothing, and avoiding sun between the hours of 10 AM and 4 PM when the sun is at its most intense.