Solar keratosis, also known as actinic keratosis (often abbreviated to AK) is a skin condition marked by the formation of rough patches of dry skin. The exact appearance and size can significantly vary among those affected – while some notice just small points, no larger than a pinhead, others might struggle with scales 3cm in diameter. In terms of colour, they appear in various shades of red, pink, dark or bright. In addition to this, the affected area of the skin will seem to be slightly raised, hard or wart-like to touch and surrounded by redder than usual skin.

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What is actinic keratosis

Keratosis is a skin condition that manifests on the face, neck, ears, scalp and backs of hands and forearms in most cases, but it can also appear on the chest, back and legs in some people, especially if those affected have been sunbathing recently. Similarly to this, while the condition usually causes no additional symptoms, itchiness and tenderness of the affected area can occur in some cases.

Actinic keratosis is the single most commonly diagnosed skin condition caused by prolonged sun exposure in the UK. According to recent estimates, roughly 20% of the population aged 60 or more are thought to be affected by the condition with men being somewhat more susceptible as compared to women. In people under 45 years of age, the appearance of characteristic lesions is highly unlikely, although genetic factors are thought to play a significant role in determining the severity of the condition.

According to statistical research, people with fair skin, blue eyes and blonde or red hair are more commonly affected by more severe forms of actinic keratosis. Despite the fact that this condition isn’t dangerous in itself, medical treatment is highly advised due to the risk of the condition evolving into a type of skin cancer called squamous cell carcinoma (or SCC for short).

What causes solar keratosis?

While the exact root causes of this condition are still a subject of debate in the medical community, it seems fairly certain that actinic keratosis occurs as a consequence of long-term unprotected exposure to direct sunlight. In time, the UV radiation will compromise the skin’s repair functions due to subtle changes of the genetic makeup of the epidermal layer. So, when the body repairs the skin, the damaged, abnormal or atypical cells will also get replicated, resulting in a hardened or scaly patch.

Actinic keratosis treatment

While in some cases actinic keratosis will improve and sometimes even disappear on its own, the condition is still likely to reactivate or develop in some other area. Because of this, it is highly advisable to reduce direct exposure to the sun if you get diagnosed. In order to stay protected, you should wear a sunscreen with SPF 15 minimum, and use a hat to cover the skin on the top of your head. In addition to this, it would be ideal if you can completely avoid being outside between 11am and 3pm when the sun radiation is at its strongest.

Picato gel

Developed by Leo pharmaceutical company, Picato gel is among most commonly prescribed medicines used for the treatment of solar keratosis. Based on ingenol mebutate as an active ingredient, this topical gel will stimulate the immune system to attack the abnormal cells, eliminating them and leaving just the healthy skin behind. This treatment is applied once a day over the course of two to three days, depending on the location and the severity of the condition. Within four weeks following the first application, healthy skin should begin reappearing in the affected area.

Solaraze gel

Another actinic keratosis treatment that achieved exceptional success is Solaraze gel that relies on non-steroidal anti-inflammatory agent called diclofenac. This compound works by limiting inflammation and swelling at the affected site. While it will provide significant relief from the unpleasant symptoms of the condition, this treatment is not that effective in mitigating the damage caused to the skin cells. As such, Solaraze gel, developed and marketed by Almirall pharmaceutical company, can contribute even to the disappearance of noticeable symptoms, but the chances of reactivation of the condition will remain high.

How to prevent actinic keratosis?

Solar keratosis can be successfully prevented by avoiding prolonged and direct sun exposure. If spending time under the hot sun, especially in the period of the day when the UV radiation levels are at the highest (between 11am and 3pm), then there are certain precautions you can take to minimise the risk of damage to the skin cells.

Wearing sunscreen with a protection factor of at least 15, a hat and clothes that cover the skin can all go a long way in preventing damage to the cells and the onset of actinic keratosis. In addition to this, regular use of emollients seems to be rather beneficial when it comes to prevention of this medicine.

What type of keratosis treatment is the best for me?

The two most commonly prescribed actinic keratosis treatment, namely, Picato and Solaraze, are both topical gels and as such, they set the standard for the treatment of this condition. However, despite this, different keratosis medicines work in different ways, even when they are applied in exactly the same manner. For Picato gel, mechanism of action includes stimulation of the immune system to react to the damage and confront and eventually eliminate the abnormal cells, leaving healthy skin behind. Ingenol mebutate, the active ingredient of this medicine is a purified extract obtained from the Euphorbia peplus plant, more commonly known as milkweed.

On the other hand, Sikaraze is classified as an anti-inflammatory drug that primarily acts by reducing swelling and redness in the affected area. As such, it is not able to mitigate the cellular damage or contribute to the elimination of abnormal cells, but it can provide a quick and efficient relief from the unpleasant symptoms.

However, following consultations, your doctor will be able to assess your suitability for any of these treatments, so he will be able to give you the most precise answer to the question which treatment is the best for you.

Are there any side effects of these treatments?

As is the case with all medicines, the topical gels used for the treatment of solar keratosis too come with certain risks of adverse side effects. For detailed information regarding the known side effects, please refer to the official patient information leaflet that you can find within every pack of your preferred medicine.