EpistemisActinic keratosis
Specialty: Skin.
Why it occurs
- Cumulative exposure to solar ultraviolet radiation (cellular DNA damage with induced mutations in the p53 tumor suppressor gene)
- Clear skin phototype (Fitzpatrick types I and II, with lower protective melanin production)
- Chronic immunosuppression (solid organ transplant recipients, HIV infection)
- Previous exposure to radiotherapy or prolonged phototherapy treatments
- Outdoor occupational exposure without physical or chemical photoprotection.
Initial workup
Clinical diagnosis supported by palpation ("sandpaper" sensation) and dermatoscopy ("strawberry" pattern characterized by background erythema and whitish follicular pseudonetwork). Directed shave or punch biopsy if there are signs of suspected histological malignancy.
red flags
Rapid growth of the lesion with notable increase in basal induration, persistent surrounding erythema, active ulceration, easy bleeding with minimal contact or localized pain in the lesion (signs highly suggestive of progression to invasive squamous cell carcinoma).
Standard management
- Topical fluorouracil 5% cream — chemotherapeutic that inhibits thymidylate synthase, inducing selective cell necrosis; applied 1 or 2 times a day for 2 to 4 weeks
- Imiquimod 5% cream — modulator of the immune response that activates Toll-like 7 receptors, stimulating local immunity
- Diclofenac sodium 3% in hyaluronic acid gel — non-steroidal anti-inflammatory that promotes cell apoptosis; continuous use for 60 to 90 days
- Cryosurgery with liquid nitrogen (first choice physical destructive treatment for individual and isolated lesions).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4