Actinic keratosis: information for patients

A clear guide on a common skin injury related to cumulative sun damage.

Summary in 60 seconds

• Actinic keratosis is a rough or scaly lesion that appears on skin with accumulated sun damage.
• It is also known as solar keratosis .
• It is usually seen on the face, ears, scalp with little hair, back of hands, forearms, neck and lips.
• It is not an infection and it is not contagious.
• It is considered a precancerous lesion because in some cases it can evolve into squamous cell carcinoma.
• The risk of transformation of an individual lesion is usually low, but the presence of several lesions indicates greater sun damage and a higher overall risk of skin cancer.
• Sun protection is a central part of management and prevention.
• The dermatologist may treat it with cryotherapy, medicated creams, photodynamic therapy, curettage, laser, or other methods depending on the case.
• It is advisable to consult a specialist if the lesion is painful, grows, changes, bleeds, ulcerates, or does not improve.
• The goal is not to cause alarm: it is to identify it in time and manage it with medical judgment.

What are actinic keratoses?

Actinic keratosis is an area of skin where keratinocytes—cells in the outermost layer of the skin—have undergone changes due to cumulative exposure to ultraviolet radiation. Simply put, it’s a visible sign of chronic sun damage.

It usually feels like a small, rough, dry, or bumpy plaque, sometimes easier to feel than to see. It can be pink, reddish, skin-colored, whitish, yellowish, or brown. On the lips, especially the lower lip, actinic damage can present as actinic cheilitis .

Medical evidence classifies it as a precancerous or potentially malignant lesion because it can be associated with the development of cutaneous squamous cell carcinoma. That said, not all actinic keratosis becomes cancerous; the prudent message is that it should be monitored and, when appropriate, treated. Eisen 2021 ; Kandolf 2024

Actinic keratosis should not cause panic, but it does warrant clinical respect: it is a sign of accumulated sun damage.

Why does it appear?

The main cause is accumulated ultraviolet radiation , from the sun or artificial sources such as tanning beds. Over the years, this radiation can damage the DNA of skin cells and promote the development of actinic lesions.

It occurs more frequently in people with fair skin, a history of sunburns, outdoor work or recreation, advanced age, use of tanning beds, or weakened immune systems. Transplant recipients or those undergoing immunosuppressive treatments are at higher risk and require closer monitoring.

It can also be part of a “field of cancerization”: a large area of seemingly normal skin, but with microscopic sun damage surrounding the visible lesions. Therefore, some treatments target only a specific lesion, while others treat an entire sun-damaged area. (Reinehr 2019 ; Aggarwal 2024)

What does it look like and what symptoms does it cause?

Actinic keratosis typically appears as a patch, plaque, or small raised area with a dry, rough, or scaly surface. Many people describe it as feeling like sandpaper. It may flake off and reappear in the same spot.

The most common areas are:

• Forehead, cheeks, nose and ears.
• Scalp with little hair.
• Back of hands and forearms.
• Neck, décolletage and shoulders.
• Lower lip, when it manifests as actinic cheilitis.

It may be asymptomatic or cause itching, tenderness, mild burning, pain upon rubbing, crusting, or small fissures. A lesion that becomes thicker, painful, ulcerated, bleeding, or grows rapidly warrants medical evaluation, as it may resemble or be evolving into squamous cell carcinoma. DermNet 2025

What can you do today?

The most important measure is to reduce cumulative ultraviolet exposure. Sunscreen does not “erase” all previous damage, but it can decrease new lesions and help stabilize damaged skin. In a classic trial, regular use of sunscreen reduced the occurrence of solar keratoses. Thompson 1993

Safety measures:

• Use broad-spectrum sunscreen, ideally SPF 30 or higher, on exposed areas.
• Reapply if there is sweat, water or prolonged exposure.
• Wear a wide-brimmed hat, glasses, and clothing with coverage.
• Avoid artificial tanning.
• Watch for changes: growth, pain, bleeding, persistent scabs, or wounds that do not heal.
• Take photos in good light to compare evolution, without delaying consultation if there are warning signs.
• Keep the skin moisturized if there is dryness or flaking, without attempting to remove lesions on your own.

A rough lesion that persists, grows, hurts, or bleeds deserves dermatological evaluation.

What NOT to do?

It’s not advisable to pick at, scrape, burn, or cut the lesion at home. It’s also unwise to apply acids, «depigmenting» products, home remedies, or treatments found online without a diagnosis.

Avoid assuming that a rough patch is «just dryness» if it persists, especially if it’s in a sun-exposed area. It’s also important to avoid the opposite extreme: thinking that all actinic keratosis means invasive cancer. The safest approach lies in the middle ground: proper evaluation by a specialist, accurate diagnosis, and management proportionate to the risk.

Do not use medicated creams such as 5-fluorouracil, imiquimod, diclofenac, or tirbanibulin without professional guidance. These treatments are useful in selected patients, but they can cause severe inflammation, burning, erosion, or temporary discomfort; they should be explained and monitored. (Eisen 2022 ; Mayo Clinic 2022)

When should I consult?

Consult a dermatologist if a persistent rough lesion appears on an area exposed to the sun, especially if you have a history of skin cancer, many similar lesions, or immunosuppression.

Warning signs:

• Rapid growth.
• Pain, marked sensitivity, or persistent burning.
• Spontaneous bleeding or bleeding with minimal friction.
• Ulcer, wound or scab that does not heal.
• Very thick, hard or «horn-like» lesion.
• Irregular color change, especially brown, black, gray, or various shades.
• A lesion on the lower lip that cracks, bleeds, or does not improve.
• Appearance of many new injuries in a short time.
• History of transplantation, immunosuppression, or previous skin cancer.

Evidence shows that actinic keratosis may be a marker of increased future risk of skin cancer, not only due to the individual lesion but also due to cumulative sun damage to the skin. Guorgis 2020

What does a dermatologist usually do?

The dermatologist usually begins with a medical history and a complete skin examination. They will ask about sun exposure, previous sunburns, outdoor work, use of tanning beds, personal or family history of skin cancer, immunosuppressant medications, and the progression of the lesion.

Dermatoscopy allows the observation of patterns not visible to the naked eye and helps differentiate actinic keratosis from other lesions such as squamous cell carcinoma, basal cell carcinoma, lentigo maligna, seborrheic keratosis, or inflammatory lesions. In some cases, if the lesion is thick, bleeds, is painful, does not respond to treatment, or the diagnosis is unclear, a biopsy may be indicated to analyze the tissue under a microscope. DermNet 2019

Treatment depends on the number of lesions, their thickness, location, symptoms, age, patient preferences, risk of skin cancer, and immune status. Common options include:

• Cryotherapy: freezing with liquid nitrogen, common for isolated injuries.
• Topical treatments: 5-fluorouracil, imiquimod, diclofenac or tirbanibulin, especially when there are multiple lesions or field damage.
• Photodynamic therapy: application of a photosensitizing substance and activation with light.
• Curettage, shaving or biopsy-excision: in thicker or suspicious lesions.
• Laser or medical peels: in selected situations.

The American Academy of Dermatology guidelines recommend ultraviolet protection, cryosurgery, imiquimod, and 5-fluorouracil as strongly recommended options; a subsequent update added tirbanibulin as a strongly recommended field therapy in the evaluated scenarios. Eisen 2021 ; Eisen 2022

Frequently Asked Questions

Is actinic keratosis cancer?

• It is not usually described as invasive cancer, but rather as a precancerous lesion or one with malignant potential. Some can progress to squamous cell carcinoma, which is why they are monitored and treated when appropriate.

Can it disappear on its own?

• Some small lesions may improve, especially with good sun protection, but they can also persist, recur, or progress. Medical evaluation helps determine whether to monitor or treat them.

Does the treatment hurt?

• It depends on the method. Cryotherapy may burn or hurt for a short time. Medicated creams may cause temporary redness, peeling, burning, and crusting. Photodynamic therapy may cause burning during the session. The dermatologist should explain what to expect before starting.

Does actinic keratosis return after treatment?

• It can return, and new lesions can also appear on sun-damaged skin. That’s why monitoring and sun protection are part of the treatment, not just an add-on.

Is it contagious?

• No. It is not transmitted through contact, towels, swimming pools, kissing, or close contact. It is primarily related to cumulative ultraviolet damage.

Can I wear makeup or cosmetics over it?

• Generally, yes, provided the skin is not irritated or undergoing active treatment. During topical treatments or after cryotherapy, the skin may be inflamed or sensitive; during this period, it is advisable to follow medical advice.

How often should I check my skin?

• It depends on individual risk. A person with many actinic keratoses, a history of skin cancer, or immunosuppression usually requires more frequent checkups than someone with a single lesion and low risk. The interval should be individualized.

Bibliography and sources

• Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, et al. Guidelines of care for the management of actinic keratosis . J Am Acad Dermatol. 2021;85(4):e209-e233. doi: 10.1016/j.jaad.2021.02.082 .
• Eisen DB, Dellavalle RP, Frazer-Green L, Schlesinger TE, Shive M, Wu PA. Focused update: Guidelines of care for the management of actinic keratosis . J Am Acad Dermatol. 2022;87(2):373-374.e5. doi: 10.1016/j.jaad.2022.04.013 .
• de Berker D, McGregor JM, Mohd Mustapa MF, Exton LS, Hughes BR. British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017 . Br J Dermatol. 2017;176(1):20-43. doi: 10.1111/bjd.15107 .
• Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, et al. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization . J Eur Acad Dermatol Venereol. 2024;38(6):1024-1047.
• Reinehr CPH, Bakos RM. Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects . An Bras Dermatol. 2019;94(6):637-657. doi: 10.1016/j.abd.2019.10.004 .
• Guorgis G, Anderson CD, Lyth J, Falk M. Actinic Keratosis Diagnosis and Increased Risk of Developing Skin Cancer: A 10-year Cohort Study of 17,651 Patients in Sweden . Acta Derm Venereol. 2020;100(8):adv00128.
• Glogau RG. The risk of progression to invasive disease . J Am Acad Dermatol. 2000;42(1 Pt 2):23-24. doi: 10.1067/mjd.2000.103339 .
• Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use . N Engl J Med. 1993;329(16):1147-1151. doi: 10.1056/NEJM199310143291602 .
• Blauvelt A, Kempers S, Lain E, Schlesinger T, Tyring S, Forman S, et al. Phase 3 Trials of Tirbanibulin Ointment for Actinic Keratosis . N Engl J Med. 2021;384(6):512-520. doi: 10.1056/NEJMoa2024040 .
• Chen AC, Martin AJ, Choy B, Fernández-Peñas P, Dalziell RA, McKenzie CA, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention . N Engl J Med. 2015;373(17):1618-1626. doi: 10.1056/NEJMoa1506197 .
• American Academy of Dermatology. Actinic keratosis: Overview . AAD; consulted 2026.
• DermNet. Actinic keratosis . DermNet; minor update 2025.
• British Association of Dermatologists. Actinic keratoses: Patient information leaflet . BAD; consulted 2026.
• Skin Cancer Foundation. Actinic Keratosis . Skin Cancer Foundation; consulted 2026.