Actinic Keratoses Dermatologist2019-06-11T09:48:04+00:00

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Actinic keratoses, also known as solar keratoses, are areas of sun damaged skin

IN THESE VIDEOS, I EXPLAIN THE SYMPTOMS AND CAUSES OF ACTINIC KERATOSES – AND HOW TO TREAT THEM

In the videos above, I explain things in a simple way that applies to most people who have actinic keratoses. Of course, no video or website can replace the value of a personalised consultation. At your consultation, you can have your skin carefully examined and get an expert recommendation to help you resolve your condition.

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How do actinic keratoses impact people on a day-by-day basis?

THEY MAY CAUSE NO SYMPTOMS AT ALL, OR THEY MAY CAUSE SOME BOTHER

What they look like and where you can get them

The patches can be red, pink, brown or skin-coloured. They can be rough (like sandpaper) or scaly, flat or stick out from the skin (similar to warts). Actinic keratoses can be a few millimetres to a few centimetres across. You might have actinic keratoses in sun-exposed areas such as the head and neck, the ears, the backs of the hands, the forearms and lower legs.

Actinic keratoses are sometimes sore or itchy

Occasionally they itch or produce a prickling or tender sensation. They can also become inflamed and surrounded by redness. In some instances, actinic keratoses can even bleed.

Can they turn into something worse?

We now know that the risk of an actinic keratosis turning into skin cancer, or squamous cell carcinoma, is minimal and probably around one in 1000. However, patients with a large number of actinic keratoses have an increased risk of skin cancer (around 10%). It is therefore essential that you check your skin regularly and seek medical advice if you develop a non-healing, growing, painful, or bleeding lump.

What are the causes of actinic keratoses?

The leading cause of actinic keratoses is cumulative sun exposure resulting in sun damage. Other risk factors include fair skin, outdoor hobbies or outdoor work, living in sunny climate, and a compromised immune system.

Can we cure Actinic keratoses?

Treatments are highly effective in treating your existing actinic keratoses. However, the treatments will not prevent new actinic keratoses from forming. This means that you will need to protect your skin from further sun damage and keep an eye on your skin. Should any new areas develop, I can treat these in the same way.

What my patients love about my service

MY PATIENTS ARE MY BEST PROMOTERS

Please pass on my thanks to Dr Pratsou for her assessment on my continued taking of roaccutane.

She was completely right, I didn’t need a new course, I needed to move away from the drug. The creams she gave me and Cetaphil recommendation have meant my skin has been the best it’s ever been (ongoing and since I saw her) ALL SUMMER :))))) I’ve had zero problems…and I’m loving it.

Thank you once again.


Phillip, Acne

“Dear Dr Pratsou,

Following the consultation today I feel it appropriate to say thank you for your help in dealing with my rosacea.

On each occasion, I have visited your department I have noticed the kindness and cheeriness of all the staff I have encountered and particularly wanted to say that you made me feel at ease with your calmness and excellent manner.

All is much appreciated.”


Anne, Rosacea

“Thank you very much!!

You three were (and are) a great team!

I will remember you.

You made me feel comfortable.”


Ellie

“Tania,

Please pass to Dr Pratsou my thanks for her skilled work.

The wound is healing beautifully and now the stitches are out it looks as though it will be almost invisible once fully healed.”


Graham, Skin cancer removal

“Dear Dr Penelope, Rena & the team, (I can’t remember the nurse’s name who helped me during my 2 procedures at the Spire!)

I wanted to thank you for your support and help during a very difficult time. You guys do a wonderful job – and we are eternally grateful for your help.”


Clarissa, Skin cancer

“I would like to put on record how impressed I was with the operation you performed for the removal of the SCC on my neck. I cannot even see where the cut or the stitches were! I am indeed very grateful for the excellent work you do.”


Harry, Squamous Cell Carcinoma

“Dear Dr Pratsou,

I am very grateful to you for your diagnosis, recommended treatment and advice. Your letter to my GP sets out both the course of events, and your own analysis of probable condition and possible cause, clearly summarising our discussion.

I hope there will be no recurrence but I will certainly come back to you if there is.”


Ryan, Skin rash

“Dear Tania,

Please pass on my thanks to Dr Pratsou. I saw her this morning for a mole check. She was so lovely and reassuring. Please also thank the two nurses who assisted her during the mole removal procedure. I was very nervous, but they were very efficient, which meant I did not have too long to think about it, but most of all they were very kind. They kept me distracted and calm, which made a huge difference. Thank you also for your efficiency in both booking me in so quickly.”


James, Mole removal
Dear Ms. Pratsou,

I am writing to thank you for the care you have given me in the past few months. From the moment I walked into your consulting room with a lesion on my cheek, a lesion that I fully expected to be some sort of skin cancer (and it was), you have been thorough, reassuring, respectful and in every way professional.

You recognised that I had some insight into the condition of my skin and the procedures required to treat me. You listened to me. You projected expertise and compassion.

During the procedure to remove the growth you ensured that the atmosphere in the treatment room remained not only calm, but actually pleasant. Had it not been that you were excising a growth and sewing me up, I almost felt as if you, me and the nurse were at some sort of women’s discussion group. The time flew by. I had zero anxieties about the procedure and as we both know now, the wound healed flawlessly.

Thank you for your expertise and your communication skills and all round good nature. I feel very lucky.


Karen Tatom, Skin cancer removal

We have replaced the images and names of real patients who provided these testimonials to protect their privacy.

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More information about actinic keratoses

FOR THOSE WHO WANT THE DETAILS

Actinic keratoses, also known as solar keratoses, are areas of sun-damaged skin. We commonly find them in exposed areas on the skin in people with fair skin who have had a lot of sun exposure. These can be asymptomatic, or they may cause some bother.

Actinic keratoses symptoms and lifestyle impacts:

You might have actinic keratoses in sun-exposed areas such as the head and neck, the ears, the backs of the hands, the forearms and lower legs.

They can vary in appearance, however, they are most commonly seen as small red rough patches that at first are easier to feel than to see.

You might see some actinic keratoses as areas of thickened or warty skin.

Actinic keratoses may cause no symptoms, in some cases, they can be itchy and or sore.

You may dislike their appearance and want them treated for this reason.

There is a minimal risk that this could turn into something more sinister, known as a squamous cell carcinoma (SCC), which typically appears as a painful enlarging nodule.

However, most commonly, these actinic keratoses are simply a marker for sun damage.

The leading cause of actinic keratoses is cumulative sun exposure resulting in sun damage. This sun damage affects cells in the topmost layer of the skin.

Risk factors for actinic keratoses include:

  • fair skin
  • outdoor hobbies or outdoor work
  • living in sunny climates
  • a compromised immune system.

I offer a full skin examination to assess the whole skin for evidence of sun damage. I normally make the diagnosis clinically and with the use of a special lens known as dermatoscope. In some cases, you may need a small biopsy so that I can confirm the suspected diagnosis.

There are many treatment options for actinic keratoses, and this depends on the type and extent of actinic keratoses.

Cryotherapy, which is a gentle freezing spray using liquid nitrogen, can be offered for distinct lesions. This treatment is generally a one-off, and I can perform it on the same day as your consultation.

Where there are large numbers of actinic keratoses, or if these are ill-defined, and in some sensitive areas (for example, eyes and lips), treatment with topical preparations might be preferable.

These include Efudix cream, Picato gel, and Aldara cream. These treatments are reliant on the patients using them at home and as instructed. Topical preparations typically result in inflammation. It is nothing to worry about, and it tends to resolve fully with excellent results.

Photodynamic therapy (PDT)

Photodynamic therapy is an excellent choice for people with extensive sun damage in specific areas such as the face and scalp. A nurse will apply a special cream called Metvix, first for 20-30 minutes. The sun-damaged cells take these up and then become more sensitive to specific wavelengths of light.

Conventional PDT is performed with a special light source, however, the process can be uncomfortable. More recently, we have introduced daylight PDT, which takes advantage of natural sunlight. Many patients tolerate this well and in some cases, some even report it’s a pleasant experience!

Curettage and cautery is a minor procedure, where I skim and cauterise particularly thickened actinic keratoses off the surface of the skin, having first injected a small amount of local anaesthetic.

“Is there anything I can do myself to improve my actinic keratoses?”

There is good evidence to suggest that, in the case of mild actinic keratoses, regularly using a good sunblock can allow 30% of these mild actinic keratoses to resolve. This measure will also contribute to preventing new areas from forming.

“Will the treatments you describe cure my actinic keratoses?”

All these treatments are highly effective in treating your existing actinic keratoses. However, the treatments will not prevent new actinic keratoses from forming. This means that you will need to keep an eye on your skin and, should any new areas develop, I can treat these in the same way.

“Will my actinic keratoses turn cancerous?”

We used to aggressively treat actinic keratoses because we thought that leaving them would result in skin cancer. However, we now know that the risk of one of these areas turning into skin cancer, or squamous cell carcinoma, is minimal and probably around one in 1000.

However, patients with a large number of actinic keratoses have an increased risk of skin cancer (around 10%). It is therefore essential that you check your skin regularly and seek medical advice if you develop a non-healing, growing, painful, or bleeding lump.

“Might my actinic keratoses come back after treatment?”

Actinic keratoses generally respond well to treatment.

However, having had some actinic keratoses, this means that your skin is susceptible to sun damage and further actinic keratoses.

You should ensure that you are looking after your skin in the sun by taking special sun precautions.

Additionally, people with a large number of actinic keratoses have an increased risk of developing a type of skin cancer known as squamous cell carcinoma. That is generally a new arising skin lesion and not necessarily arising from actinic keratosis. It would help if you, therefore, looked out for any signs of possible skin cancer. For example, keep an eye out for any new, growing, painful or bleeding lumps, especially in sun-exposed sites. Your GP or a dermatologist should assess suspicious skin lesions.

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About the author

Dr Penelope Pratsou | Consultant Dermatologist

MBChB, MRCP (UK) (Dermatology)

I’m Dr Penelope Pratsou, a skilled independent Consultant Dermatologist based in Berkshire. I have specialist expertise in the diagnosis and management of all skin cancers, and in performing mole checks. I’m a trained skin surgeon and remove skin cancers, moles, skin tags, cysts and warts.

I also have invaluable experience in dealing with all skin conditions, from the common skin complaints of acne, rosacea, eczema and psoriasis, to the rarer and more complex skin problems, having seen it all through years of NHS work.

After I obtained my Membership to the Royal College of Physicians, I undertook rigorous specialist training in dermatology, before being appointed as a Consultant Dermatologist at the Royal Berkshire Hospital, Reading. There, I helped set up and lead a busy clinic for the diagnosis and treatment of suspected skin cancer. I was also actively involved in supervising and training both dermatology and GP trainees.

Alongside my increasingly busy private practice, I have maintained an NHS practice in Oxford in order to continue to engage with challenging cases and to develop my specialist interest in skin allergy.

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