Actinic keratosis – a skin disease that occurs when exposure of the skin to sunlight and is the formation of scaly patches. Pathology is widespread in all age groups (mostly among the elderly) and is characterized by slow but progressive course.
First, on exposed areas of skin a oval patch that is scaly. Then it turns into keratoacanthoma – benign tumor that affects the upper, superficial layers of the skin and is capable of malignant transformation.
Feature of actinic keratosis is that it with identical probability can disappear without any treatment, and will degenerate into cancer of the skin.
Actinic keratosis treat hardware effects or surgical method.
Other names pathology – solar keratosis and senile (senile) of acanthoma.
General data
Actinic keratoses have been found in 25% of the population. Moreover, this pathology falls 14% of all visits to the dermatologist.
Although the main cause of pathology performs excessive exposure, it does not have any pronounced seasonality during the year, regardless of season, the patients with this disease go to the doctor with approximately the same frequency.
Interesting is the fact that the disease is cumulative. This means that for a long time in the skin cells “accumulate” the changes with regular exposure to sunlight, however, they did not occur, but only to a certain time, then to rather manifest severe clinical symptoms. The key is exposure to the skin contributing factors – they are not the immediate cause of the transformation of the dermis, and become a trigger (trigger) to start the development of symptoms.
The disease can occur on the background of complete well-being, when at the moment the person is not exposed to solar radiation. This means that he was exposed to direct sunlight for a long time. The presence of specific primary cells indicates that long-term human stay in the sun in the past.
Reasons
The main immediate cause that triggers the development of actinic keratosis, is a long insolation. In particular, the value of the ultraviolet radiation waves, which have a length of from 280 to 320 nm.
Factors contributing to the emergence of the primary elements of disease, quite a lot. This:
- a certain climate;
- old age;
- characteristics of an organism;
- frequent sunburns in the past;
- family history;
- stress;
- prolonged somatic pathology;
- chemotherapy;
- taking certain medicines;
- uncomfortable clothing;
- endocrine disruptions;
- bad habits.
Most often, actinic keratosis of the sick people who live:
- high in a mountain area;
- in certain climatic zones – namely in the Equatorial, subequatorial and tropical.
If the number of Sunny days per year reaches almost 365, air temperature in summer is 35 degrees Celsius or above, then these conditions are considered most favorable for the occurrence of actinic keratosis. For such regions the index of incidence of the actinic keratosis is the largest. If a person is working in the open air, under these conditions, the risk of developing actinic keratosis increases by almost 100%, the pathology will arise sooner or later (the timing of its occurrence depend on the individual characteristics of the human body).
The age factor is second in importance in the appearance of actinic keratosis. Even the term “senile acanthoma” indicates that it is mainly a pathology of the elderly. The development of this disease contribute to age-related changes in the skin.
A feature of the body, the risk of disease by actinic keratosis increases several times, is a light-colored:
- skin;
- hair;
- eye (iris).
Patients with dark skin, black hair and brown eyes sick with actinic keratosis in three times less than natural blondes. Also noticed that the freckles young people are a specific signal about the high risk of actinic keratosis in the elderly.
In recent years, the role of solar burns as the provocateur of the development of actinic keratosis. They make the skin weaker to the sun and increase the risk of disease described disease.
The role of hereditary factors in appearance of actinic keratosis are still not too well understood. But keep in mind that the skin type is inherited and it means that one way or another fair-skinned children the chance of developing actinic keratosis the same high as their fair-skinned parents.
Stresses play an indirect role in causing this disease. Heavy emotions affect the condition of the Central nervous system, which normally loses its ability to regulate the vital processes in the body – including from the skin. This means that the skin in such cases, less protected and more susceptible to pathological effect.
Prolonged somatic pathology also make the body weaker and more sensitive to external pathogenic factors – this equally applies to the skin.
The role played by the presence of such pathologies as:
- coronary heart disease (CHD) – oxygen starvation of the myocardium (heart muscle) due to pathology of the coronary vessels that supply blood to it;
- chronic pancreatitis – inflammation of the pancreas;
- chronic hepatitis – an inflammatory process in the parenchyma (working tissue) of the liver;
- peptic ulcer and 12 duodenal ulcer – formation of deep defect in the walls of the stomach and 12 duodenal ulcer
and many others.
Chemotherapy weakens regenerative capacity of the skin and enhances its sensitivity to external factors – in particular, exposure to direct sunlight.
The risk of actinic keratosis is enhanced in patients when taking certain medications, mainly:
- hormone treatment is often corticosteroids;
- immunosuppressants – drugs which artificially weaken the body’s immune response (in particular after organ transplantation to prevent rejection by the body);
- antibacterial drugs.
and several others.
Uncomfortable clothing plays the role of traumatic factors – it rubs the skin, thereby contributing to the occurrence of microdamage. Because of this superficial skin layers lose their protective function and are unable to protect themselves from the harmful effects of sunlight – there are prerequisites for the formation of actinic keratosis.
Endocrine disruptions – one of the most common factors against which this pathology develops. People with endocrine diseases affect the actinic keratosis often than those with the endocrine system running smoothly.
Most often, the precipitating factor are:
- diabetes mellitus is a metabolic disorder of carbohydrates on the background of shortage of insulin that causes disruptions in the life of the skin;
- hypothyroidism – decreased amount of thyroid hormones in the blood;
- hyperthyroidism – increased production of thyroid hormones;
- the metabolism of corticosteroids due to adrenal disease.
The appearance of actinic keratosis can provoke not only a pathological imbalance of hormones, but also physiological hormonal changes – in particular, that which occurs during menopause in women.
Any harmful habits can Deplete the resources of the skin, weaken the protective properties and contribute to the development of actinic keratosis. This Smoking (even if the person is a heavy smoker), alcohol and drugs.
The development of the pathology
The primary elements of actinic keratosis occur due to compaction of the stratum corneum of the epidermis (superficial skin layer). This process may also underlie malignant transformation of cells – this explains the relationship between the actinic keratosis and malignant skin pathology.
Described disease can develop hidden for quite a long time – up to several decades. The skin looks unchanged under UV irradiation, but the pathological changes at the cellular level has been steadily evolving and progressing. This latent (hidden) period of the disease.
With age the surface layer of the skin begins a slow but steady change. This deterioration of the skin contribute to the factors that are the instigators of the development of actinic keratosis. In this part of the epidermal cells become undifferentiated – this means that they lose their individual characteristics. Such a process promotes the formation of the hearth of the so-called preinvasive cancer – a malignant tumor that does not grow through the base of the epithelium, and literally crawling on the basal (main) layer of the skin.
In this process of “creeping” proliferation of atypical cells with altered internal structures displace the normal epithelial cells, occupying their place. The epidermis loses its protective role, actinic it is accelerating.
There are several types of this disease.
The type of active process in the epidermis and dermis there are the following options for actinic keratosis:
- hypertrophic;
- pigment;
- ligently;
- proliferative;
- atrophic;
- acantholytic;
- bowencity.
Hypertrophic actinic keratosis develops when the epidermis appear atypical cells with large nuclei that produce light and dark keratin (the substance that provides the cornification of the skin). The alternation of these types of keratin is a symptom of this pathology.
Pigmented actinic keratosis develops when the accumulation in the cells of melanin – a natural pigment, which stains the lesions in dark brown color.
Lichenoid variant of the described pathology occurs when the accumulation in the dermis of lymphocytes in the lesions.
When proliferative actinic keratosis there are dystrophy of the skin (violation of nutrition of tissues and their subsequent depletion), hyperkeratosis (excessive cornification of the surface layers of the skin).
In the atrophic form of actinic keratosis of the upper layers of the dermis are thinned and destroyed, formed a kind of cracked skin.
A feature of autoimmune process is the formation of foci of connective tissue in the skin – it’s like she grows connective tissue.
Baranoia (or bowenoid) a kind of actinic keratosis is actually the initial stage of the cancer, as in this case, accumulate in the skin abnormal cells. Characterized by the following regularity: how many abnormal cells are killed, the same number of them and appears, the process is maintained at a certain level.
There are also atypical variants of the disease are described:
- bullous is when the skin formed small abscesses;
- pagetoday in the upper layer of the epidermis appear pagetoid (precancerous) cells.
Symptoms of solar keratosis
The development of the clinical picture of actinic keratitis is quite specific – it develops suddenly, sharply, amid, it seemed that the absolute well-being.
While in the open areas of the skin, which more than any other was exposed to sunlight, there are patches with these characteristics:
- shape – rounded, with clear contours;
- size – not more than 1 cm in diameter;
- color – reddish;
- as – slightly infiltrated (thickened and compacted).
Pathology takes place without any complaints from the patient’s subjective discomfort in the form of a pain or an itch he cannot feel.
More often than other locations in the pathological process involved the skin of the back of the nose. Often immediately adjacent to the spots you notice telangiectasia – expansion of small blood vessels in the form of stars. Such a variation of the disease called erythematous.
With the development of the pathological process on the forehead and the upper eyelid is formed a kind of plaque, consisting of thick Horny scales. This variant of the disease is defined as hypertrophic (cornea). The diameter of these plaques can be up to 4 see If they are removed, it starts to bleed.
When examination revealed:
- erosive surface;
- the islet atrophy (at healing erosions).
If developed pegatina form of the disease, the lesions are similar to seborrheic wart (due to the shape and brown color).
Similarly manifestoes pigment type of disease.
If actinic keratosis on the lower lip are formed:
- cracks;
- erosion.
Actually develops actinic cheilitis is a form of inflammation of the tissues of the lips.
The rash may be actively formed in such areas as:
- neck;
- shoulders;
- brush;
- of the forearm;
- of the ear;
- cheeks;
- the hairy skin of the head, especially with active hair loss.
Rarer lesions found on the back and upper part of the abdomen – in the case that these areas of the body subjected to intense insolation.
The rash, which occurs, is characterized by variability – in one place it can spontaneously disappear without any treatment, disappear, but immediately appear in another place. Sometimes the rash itself completely regresses. Why is this happening, is that I can not explain. It is only known that this “randomness” is manifested the more, the worse the immune defense of the body.
Pathology can progress, but very slowly. However, it should be continuously kept under control, since, on average, several years after the onset of clinical signs may start the process of malignant transformation. This time around the inflammatory plaques formed a kind of rim, there are soreness and itching.
Diagnosis
Diagnosis of actinic keratosis to be put on the basis of complaints of patient is difficult, as its symptoms are similar to signs of other skin diseases. Therefore, based on the data of the anamnesis (history of disease) and results of additional research methods (physical, instrumental, laboratory).
Important is figuring out what for the life of the patient was subjected to regular exposure to ultraviolet radiation.
Of the physical methods of examination conducted skin examination with a magnifying glass and a light source. In this estimate the shape, size of lesions, their colour and the nature of the surface.
Informative instrumental method is biopsy – a skin with rashes and their subsequent study in the laboratory.
Laboratory methods used in the diagnosis of actinic keratosis, is:
- a General analysis of the blood in malignant degeneration is significantly increased erythrocyte sedimentation rate;
- histological examination under a microscope conduct a study of tissue biopsy;
- cytological examination under a microscope conduct a cellular study of biopsy material.
Differential diagnosis of
Differential diagnosis of actinic keratosis should be quite a large number of skin pathologies. Most often it is:
- seborrhea – an inflammatory skin lesion of the scalp which is caused by a malfunction of the sebaceous glands of the hair follicle;
- benign Lychen – chronic inflammation of the skin of the external genitalia, can lead to its hardening;
- senile lentigo – pigmented spot on the skin that occurs in older people under the influence of ultraviolet rays on the background of metabolic disorders;
- systemic lupus erythematosus – the immune complex diffuse lesions of connective tissue and its derivatives;
- verrucous nevus is a pigmented warty education;
- psoriasis is a noninfectious skin lesions with the formation of dry red, a little elevated above the surface of the skin (papules);
- lichen planus – a disease manifested by lesions in the form of nodules on the skin and mucous membranes (particularly in the mouth and on the red border of the lips);
- the tinea of the body – the skin lesion caused by certain pathogenic fungi;
- Bowen’s disease – cancer of, represented by single or multiple skin tumors that affect the surface layer;
- chondrodermatitis – inflammation of the cartilage of the ear and of the skin covering it;
- keratoacanthoma – a kind of benign skin tumors;
- squamous and basal cell carcinoma – a kind of malignant skin lesion;
- melanoma – a malignant skin tumor originating from melanocytes;
- radiation dermatitis – skin inflammation resulting from radiation exposure at her.
Complications
The complications that most often may be accompanied by actinic keratosis, is:
- infection ulcerative surfaces, if any are observed;
- the malignant degeneration.
Treatment of solar keratosis
To save the patient from manifestations of actinic keratosis is possible with the help of instrumental methods of disposal. The most popular are:
- laser coagulation – removal by means of a laser knife. This is the least traumatic, most painless and effective method;
- cryosurgery – removal by means of liquid nitrogen. Method is the most popular and affordable.
If there is suspicion of malignant degeneration, it shows the consultation of dermatooncology, which may prescribe surgical treatment for removal of degenerated lesions of the skin.
Prevention
To prevent the occurrence of actinic keratosis is difficult, so as to avoid solar radiation throughout life is almost impossible, even if you want – without sun exposure impossible a number of biological processes in the human body.
To reduce the risk of pathology is committed to comply with the following recommendations:
- sunbathing on the beach only during certain hours (morning and evening);
- use of sunscreens;
- for people especially sensitive to sunlight, it will be easy to wear closed clothes that will protect from ultraviolet radiation.
With the appearance of suspicious lesions on the skin that grow and change color, you should immediately consult a dermatologist to prevent the occurrence of malignant consequences of the disease.
Forecast
The prognosis for actinic keratosis different. In the case of a benign course of the life activity of the patient does not change, but should exercise caution in terms of malignant transformation.
