Spotting Actinic Keratosis Early: Warning Signs and When to See a Dermatologist

Actinic keratosis, while highly treatable, is a common skin condition you should not ignore if you believe you may have it. Also known as solar keratosis, this skin issue is a precancerous, non-melanoma skin growth that is caused by long-term exposure to UV rays from direct sunlight, tanning beds, or sunlamps.
Direct exposure to UV radiation over time causes damage to the keratinocytes (cells that make up the skin), which can put the cells into a precancerous state. According to the Skin Cancer Foundation, Actinic keratosis affects nearly 58 million Americans each year, and early detection and treatment are essential to prevent skin cancer from developing.
In this post, we do a deep dive into this common skin issue, including warning signs to look out for and when you should schedule a visit with your dermatologist.
Warning Signs of Actinic Keratosis
Actinic keratosis typically manifests as rough, scaly patches or bumps on the skin. In the early stages, it can be difficult to see, but it will appear as an area of skin with a “gritty” texture that does not heal. It can look like other harmless skin conditions, so if you notice a persistent area of rough skin, it’s best to see your dermatologist.
This skin condition most often affects the areas of the skin that are unprotected from the sun, such as the lips, ears, scalp, neck, forearms, or hands. When actinic keratosis forms on the lips, it is called actinic cheilitis, and it often resembles a badly chapped lip. Although it can occur anywhere on the lips, actinic cheilitis most often forms on the lower lip.
Actinic keratosis is a slow-growing condition and is highly treatable, but because it is a precancerous skin growth, it can develop into squamous cell carcinoma if left untreated.
Who is Affected by Actinic Keratosis?
Anyone can develop actinic keratosis, but certain factors can increase its likelihood of forming.
- A history of prolonged, unprotected sun exposure or sunburns
- Fair skin that burns more easily
- Light colored hair and eyes
- Frequent tanning bed use
- Age – individuals over the age of 50 are more likely to develop some type of skin cancer
- A weakened immune system, whether from medication or a health condition
Any level of sun exposure over time increases your chances of developing skin cancer, so even if you haven’t had a history of bad sunburns or tanning bed use, you can still be at risk.
Warning Signs: What to Look For
Because actinic keratosis resembles other common skin issues, it can be hard to identify as something potentially serious. We always recommend annual skin checks because your board-certified dermatologist can spot something you may overlook.
Here are the common warning signs of actinic keratosis to help you notice any changes early:
- Areas of the skin that feel scaly, crusty, or rough like sandpaper.
- Pink, red, tan, brown, grey, or flesh-colored spots on the skin.
- Sensitive spots on the skin that itch, burn, sting, or are tender when touched.
- “Gritty”, irritated, or even bleeding areas on the skin that do not heal or go away.
- Rough skin patches on areas that are most commonly exposed to the sun, like the face, ears, scalp, shoulders, hands, neck, and lips.
You may notice actinic keratosis by touch rather than by sight. If you have a persistent area of rough texture, it’s best to see your dermatologist, even if there are no visual changes.
When to Visit Your Dermatologist
With any skin issue, it’s best to see your dermatologist to be checked and rule out anything serious. It is also important to identify a possible treatment to relieve discomfort or mitigate a worsening issue.
If you notice any of the warning signs on your skin, especially on areas most commonly exposed to the sun, see your dermatologist. Even if the area seems small, is not bothersome, or is in an area typically protected from the sun, you should have it checked to rule out actinic keratosis or any other form of skin cancer.
Your dermatologist can typically diagnose actinic keratosis with a visual skin exam; in some cases, they will perform a biopsy to confirm the diagnosis and rule out cancer. Your dermatologist will ask you about your history with sun exposure and any previous skin issues.
Actinic keratosis is highly treatable when diagnosed early, and treatment options can include:
- Cryosurgery: The application of liquid nitrogen directly to the precancerous cells to destroy them.
- Topical Treatments: Topical creams, when applied for several weeks, are highly effective at treating precancerous cells.
- Photodynamic Therapy (PDT): A topical medication is applied to the affected areas and activated by a wavelength of light that destroys precancerous cells.
- Electrodessication and Curettage: A combination of scraping the lesion immediately followed by heat to destroy the precancerous cells. This technique is often reserved for larger precancerous lesions, or patients who cannot tolerate topical treatments or liquid nitrogen.
- Laser + Light Treatments: Using intense energy in the form of light to destroy the precancerous cells.
Actinic keratosis is common, but you can prevent its formation by practicing sun-safe habits:
- Wearing a daily sunscreen with an SPF of 30 or higher and applying an SPF 50 or higher for prolonged time outside in the sun, such as at the beach. Remember to reapply!
- Wear sun-protective clothing, such as SPF shirts, pants, and hats
- Avoid tanning beds
While actinic keratosis may start small, it is a sign of sun damage and a warning that you could develop skin cancer. Seeing a dermatologist as soon as you have concerns is the best way to prevent cancer growth and preserve healthy skin.
At Optima Dermatology, our board-certified dermatologists can perform a skin exam and help rule out skin cancer or other skin issues. If you are diagnosed with actinic keratosis, we will work with you to establish a treatment plan.
Schedule an appointment today for an evaluation so you can be confident in your healthy skin!










