Actinic Keratosis
Dr. Keith Knoell

Serving Waynesboro, Staunton, Lexington and  Harrisonburg, VA



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Actinic keratosis (AK) is the most common reason people seek out a local dermatologist. Caused by years of overexposure to the sun or tanning beds, AK is considered pre-cancerous.


Without treatment, it can turn into a skin cancer called squamous cell carcinoma.


What AK Looks Like


AK’s commonly appear as dry, scaly, and rough textured. There are some AK’s that are skin colored and are easier to feel than to see. These AK’s generally feel like sand paper.


Actinic Keratoses also appear as:

  • Red bumps
  • Thick, red scaly patches
  • Crusted growths that vary in color from red, brown, and yellowish black

One AK may only be the size of a pinhead, or it can grow as large as a quarter.

AK Growth

Actinic keratosis can grow rapidly in an upward direction. This upward growth resembles the horn of an animal. Called a “cutaneous horn,” it can range in size from a pinhead to that of a pencil eraser.


Typical of AK’s is their ability to seem less prominent for weeks or months at a time, only to return. This is an important clue that you need treatment.


Left untreated, the damaged cells can continue to grow, and with it, skin cancer.

Where AK Appears Most Often

AK’s appear on skin that gets the most sun exposure:

  • Forehead, chest, neck, and ears
  • Scalp, especially a bald scalp
  • Hands or arms
  • Lower legs, especially in women
  • On the border of the lip

AK that appears on the lip is known as actinic cheilitis. It will look like a white or grayish scaly patch on a lip that is often dry and cracked.

Those Most Prone to Get Actinic Keratosis

  • Fair-skinned people with light colored hair and eyes
  • Adults over the age of 40
  • Anyone who used an indoor tanning bed or live in a sunny climate
  • Those with a weak immune system
  • Those that have a condition that makes them sensitive to UV rays

How to Diagnose AK

Usually, AK is diagnosed by simply looking at it. Sometimes a biopsy is required.



Detecting AK early is key. Treatment is nearly always successfully. Here are the most common types of AK treatment:


Cryosurgery—This is the most common method, which involves freezing skin cells with liquid nitrogen to kill them, then removing the growth.

Photodynamic Therapy—A light-sensitive solution is applied to the growth followed by exposure to a special light, which kills the AK.

Curettage—Cutting or scraping the growth. This is sometimes combined with heat to ensure the destruction of cancerous skin cells.

Chemical Peel—Applied to the cancerous area, a chemical solution deeply penetrates the skin to kill the AK growth.

Laser Skin Resurfacing—Your skin type will determine which laser is right for you.


Topical prescription medications are also another type of treatment for actinic keratosis.

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Prevention of Actinic Keratosis

Protect your skin from the sun! If you’re using a tanning bed, stop. Always wear sunscreen, and re-apply every 2 hours.


Seek shade as needed. Remember, the sun’s rays are most powerful 10 a.m.-2 p.m. If your shadow is shorter than you are, seek shade.


Most of us think of sun protection as “set it and forget it.” Nothing could be further from the truth. Sunscreen actually comes with a built-in set of minutes.

The Sunscreen Formula To Live By

Your maximum time in the sun without burning x the SPF number= safe sun minutes

So, if you’re fair, you may have 10 minutes in the sun before your skin turns pink. Multiply that number by your SPF. Let’s say it’s 30.

10 x 30=300 safe sun minutes


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If you’re swimming, sweating, or towel-drying frequently, cut the number of safe minutes in HALF.


Wear a long-sleeved shirt for protection, as well as a hat, long pants and sunglasses, whenever you can.


Finally, protect your lips with an SPF of 30 or higher.


Call Dr. Keith Knoell and the staff of Valley Dermatology for all of your dermatology skincare needs!