Actinic Keratosis: Pictures, Symptoms & Treatment
Actinic keratosis — also called solar keratosis — is a rough, scaly patch caused by years of sun exposure. It is the most common precancerous skin lesion and can progress to squamous cell carcinoma if left untreated.
Quick answer
Actinic keratosis appears as a rough, dry or scaly patch on sun-exposed skin — often on the face, scalp, ears, hands, forearms or neck. It is not cancer yet, but 5–10% of untreated lesions may become squamous cell carcinoma. Treatment options include cryotherapy for single lesions and topical creams or photodynamic therapy for multiple lesions. Daily SPF 30+ sunscreen and sun avoidance help prevent new ones.
What actinic keratosis looks like
The classic description is a rough, sandpaper-like patch that you can feel before you can clearly see. Colours vary from skin-toned and pink to red or brown. Some people have a single patch; others have many scattered lesions, a pattern called field cancerisation.
Common locations
- Face, especially cheeks and nose
- Bald scalp or thinning hairline
- Ears and lips
- Backs of hands and forearms
- Neck and upper chest
Warning signs
- Rough, dry or scaly texture
- Patch that comes and goes in the same spot
- Itching, burning or tenderness
- Bleeding, crusting or thickening
- Rapid growth or hard, wart-like surface
For visual reference, see our skin cancer pictures guide, which includes actinic keratosis alongside melanoma, BCC and SCC.
Causes and risk factors
Actinic keratosis is caused by cumulative ultraviolet (UV) damage to keratinocytes, the main cells of the epidermis. UV radiation creates DNA mutations, particularly in the p53 tumour-suppressor gene, that allow damaged cells to keep growing. The damage builds slowly, so AKs usually appear after decades of sun exposure.
| Risk factor | Why it matters |
|---|---|
| Age over 40 | Cumulative UV exposure reaches a threshold where AKs become common. |
| Fair skin that burns | Less melanin means less natural UV protection. |
| Outdoor work or hobbies | Chronic, often incidental sun exposure adds up over years. |
| History of sunburns | Blistering sunburns, especially in childhood, increase risk. |
| Tanning beds | Concentrated UV-A and UV-B accelerate DNA damage. |
| Weakened immune system | Organ-transplant recipients can have a 65–250× higher risk of SCC from AKs. |
Treatment options
Dermatologists choose treatment based on the number, thickness and location of lesions. The goal is to clear visible AKs and treat the surrounding "field" of sun-damaged skin where new lesions can form.
Cryotherapy (freezing)
Best for a small number of thin lesions. Liquid nitrogen freezes the AK, which blisters and peels off over 1–2 weeks.
Topical field therapy
Used when there are many lesions or widespread sun damage. Options include 5-fluorouracil (5-FU), imiquimod and ingenol mebutate. These creams trigger inflammation that clears AKs over several weeks.
Photodynamic therapy (PDT)
A light-sensitising cream is applied to the area, then a specific light wavelength activates it to destroy abnormal cells. Useful for the face and scalp.
Chemical peels, laser or surgery
Reserved for thick, suspicious or treatment-resistant lesions. A biopsy may be taken to rule out squamous cell carcinoma.
When to see a dermatologist
See a dermatologist if you notice any new rough, scaly patch, especially one that is growing, bleeding, painful, thickening or not healing. People with a history of AKs should have full skin checks every 6–12 months because new lesions commonly develop.
Red flags for progression
- A patch that becomes raised, hard or wart-like
- Bleeding, ulceration or persistent crusting
- Rapid growth over weeks to months
- New pain, tenderness or swelling in the area
- A lesion that does not respond to standard treatment
Frequently asked questions
What does actinic keratosis look like?
Actinic keratosis usually looks like a rough, dry, scaly patch on sun-exposed skin. It can be skin-coloured, pink, red or brown, and is often easier to feel than see. Common sites are the face, scalp, ears, lips, back of hands, forearms and neck.
Is actinic keratosis skin cancer?
Actinic keratosis is not skin cancer yet, but it is a precancerous lesion. An estimated 5–10% of untreated actinic keratoses may progress to squamous cell carcinoma over a decade, so dermatologists usually treat or monitor them.
What is the best treatment for actinic keratosis?
Treatment depends on how many lesions you have and how thick they are. A single thin lesion is often frozen with cryotherapy. Multiple lesions may need field therapy such as topical 5-fluorouracil, imiquimod, ingenol mebutate or photodynamic therapy. Suspicious or thick lesions may be biopsied.
Can actinic keratosis go away by itself?
Some actinic keratoses can temporarily regress, but they frequently recur in the same spot. Because it is impossible to predict which ones will progress to squamous cell carcinoma, dermatologists generally recommend treatment and regular monitoring.
Who is most at risk of actinic keratosis?
People over 40 with fair skin and a history of sunburns, outdoor work, tanning-bed use or immunosuppression are at highest risk. Men are affected more often than women, largely because of greater lifetime sun exposure on average.
How can I prevent new actinic keratoses?
Consistent sun protection is the most effective prevention: broad-spectrum SPF 30+ sunscreen applied generously, protective clothing, wide-brimmed hats, sunglasses, shade between 10am and 4pm, and avoiding tanning beds.
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