Signs of rosacea in skin of color

If you have skin of color, dermatologists recommend that you make a dermatology appointment if you notice any of the following on your face:

  • A warm feeling most of the time

  • Dry, swollen skin and patches of darker skin

  • A dusky brown discoloration to your skin

  • Acne-like breakouts that acne treatment won’t clear

  • Yellowish-brown, hard bumps around your mouth, eyes, or both

  • Burning or stinging when you apply skin care products

  • Swelling and thickening skin on your nose, cheeks, chin, or forehead

If you have an actinic keratosis (AK) on your skin, you have one of the most common skin conditions that dermatologists treat.1 It is estimated that more than 40 million Americans develop actinic keratoses (AKs) each year.2

These precancerous skin growths are common because many people seldom protect their skin from the sun with sunscreen, clothing, and shade. Without sun protection, the sun’s harmful rays can damage your skin. While your body may repair some of this damage, the sun’s rays continue to damage unprotected skin. Over the years, this damage builds up and can cause precancerous changes to your skin.

Actinic keratosis

An actinic keratosis often appears as a reddish spot (as shown here) that develops on skin you seldom protected from the sun over the years.

People who use (or have used) tanning beds, sunlamps, or both also get AKs. The amount of the harmful radiation produced by a tanning bed is similar to that of the sun, and in some cases might be stronger.3

AKs tend to appear on skin that’s been the most badly damaged by the sun. That’s why they often appear on the face, ears, balding scalp, hands, neck, or lips. These areas tend to get the most sun.

When an AK forms on a lip, the medical name for this precancerous growth is actinic cheilitis.

Many people who develop AKs and actinic cheilitis are otherwise healthy. They don’t feel ill or rundown.

Still, it’s important to know if you have any of these precancerous growths on your skin. Some AKs and actinic cheilitis turn into a type of skin cancer called squamous cell carcinoma.

Paying attention to your skin can help you find a precancerous growth. This is especially important if you’ve spent a lot of time outdoors without protecting your skin from the sun or used tanning beds.

It may be helpful to know that some AKs look harmless. They can look like a new age spot, pimple, or patch of irritated skin. On the lips, these precancerous growths can look like a badly chapped lip.

What color is an actinic keratosis?

AKs come in many colors. You may see a scaly pimple-like bump or patch of skin that is:

  • Red or pink

  • Skin-colored

  • Gray

  • Yellow

  • Brown or tan

  • White

Does an actinic keratosis hurt?

While most people see only a change to their skin, an AK can:

  • Itch

  • Burn or sting

  • Feel tender or painful when touched

  • Stick to your clothing, causing discomfort

  • Bleed

If you find a change on your skin that could be an actinic keratosis, protect your health by seeing a board-certified dermatologist. Should that change be an AK, you have a greater risk of developing skin cancer. Being under the care of a board-certified dermatologist helps to find skin cancer early when its highly treatable.

While having skin that’s been badly damaged by the sun or indoor tanning greatly increases your risk of developing AKs, other things can increase your risk.

How can UV light cause actinic keratosis?

When UV light hits our skin, it can damage cells in the skin called keratinocytes. These cells live in the outermost layer of the skin and give our skin its texture. When UV light damages these cells, changes occur that cause our skin to:

  • Feel rough and scaly

  • Appear discolored

  • Develop bumps and horn-like growths

These are signs of AKs.

Do some people have a higher risk of developing actinic keratosis?

Yes, the people most likely to get AKs have certain risk factors. A risk factor is anything that increases your risk of developing a disease.

The risk factors for AKs are:

  • Fair skin (burns easily and rarely tans)

  • Naturally red or blond hair

  • Light-colored eyes

  • Sun exposure (seldom protected your skin from the sun)

  • 50 years of age or older

  • Tanning bed use

  • Organ transplant recipient

  • Weakened immune system

  • Albino skin

  • Xeroderma pigmentosum, Rothnord-Thomson syndrome, or Bloom syndrome

Most people who get AKs have spent a lot of time outdoors without protecting their skin from the sun and are now 50 years of age or older.

Most people who get actinic keratosis have spent a lot of time outdoors without protection from the sun

The people most likely to develop precancerous skin growths on their skin have fair skin, light-colored eyes, and signs of sun damage that show they rarely protected their skin from the sun over the years.

If you used tanning beds or lived in a region that is warm and sunny year-round, you may develop AKs at a younger age. AKs can appear in your 20s or earlier.

Anyone who has received a transplanted organ tends to develop many AKs. The medication you take to prevent your body from rejecting the transplanted organ suppresses your immune system so greatly that your body has difficulty healing any damage caused the sun’s UV light. This causes AKs to develop more quickly.

If you notice a rough patch on your skin or a chapped lip that won’t heal, dermatologists recommend that you have it examined. Left untreated, some AKs turn into a type of skin cancer called squamous cell carcinoma.

How do dermatologists treat actinic keratosis?

The treatment that is right for you depends on several considerations, including:

  • How many AKs you have

  • Where the AK(s) appear on your body

  • What the AK(s) look like

  • Whether you’ve had skin cancer

  • Your other medical conditions, such as living with a transplanted organ

If you have one or a few AKs, a procedure that your dermatologist can perform during an appointment may be the preferred treatment. At-home treatment is often recommended for patients who have several AKs.

Here’s what’s involved with each treatment.

Procedures for treating actinic keratosis

You can often complete treatment in 1 or 2 office visits. The procedures that dermatologists use to treat AKs include:

  • Cryosurgery: During cryosurgery, your dermatologist freezes the AK. The goal is to get the AK to fall off after a few days. Some AKs need more than one cryosurgery treatment before they fall off.

    To freeze the AK, your dermatologist will apply a very cold substance like liquid nitrogen to the AK. Your dermatologist can do this during an office visit while you remain awake. After cryosurgery, you may see crusting or a blister on your treated skin. This is normal and expected.

  • Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. You cannot get this type of chemical peel at a salon or from a kit sold for home use.

    After a medical-grade chemical peel, the treated skin will be red, swollen, and sore. As the area heals, you will see new healthy skin.

  • Curettage: If you have an extremely thick AK, this may the best treatment. During this procedure, your dermatologist first scrapes the AK from your skin, using a technique called curettage. Your dermatologist may follow this with a electrodesiccation, which heats the treated area to destroy any remaining AK cells.

  • Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that return after treatment. This procedure is a bit time-consuming because it consists of 2 parts.

    During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You’ll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you’ll be treated with either a blue or red light.

    The light activates the solution, which can destroy the AKs. As the treated skin heals, you’ll see new, healthier skin.

    For 48 hours after treatment, you’ll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction. Your dermatologist will explain how to protect your skin so that you can get home.

    Most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first.

  • Laser resurfacing: This may be a treatment option for actinic cheilitis, a precancerous growth on the lip. It works by removing the surface layer of the skin. After treatment, the skin will feel raw and sore. When it heals in 1 or 2 weeks, you see new, healthier skin.

At-home treatment for actinic keratosis

If you have many AKs or AKs that you can feel but not see, your dermatologist may recommend at-home treatment.

When you treat at home, you apply medication to your skin as directed.

The advantage of using a medication to treat your AKs is that the medication can treat many AKs, including the ones you cannot see yet. Using this approach can reduce your risk of developing new AKs and possibly skin cancer.

The downside of applying medication to your skin is that some patients say it’s difficult to follow the treatment plan. To be effective, you need to apply the medication as often as your dermatologist recommends. Even when the medication causes a skin reaction, which indicates that it’s working, you’ll need to keep applying the medication.

After you finish treatment, you’ll see new, healthier skin.

The medications that dermatologists prescribe include the following, which have all been approved by the US. Food and Drug Administration (FDA) to treat AKs:

  • 5-fluorouracil (5-FU) cream: You apply this once or twice a day for 2 to 4 weeks.

    5-FU is not a treatment option for a woman who is pregnant. This medication can harm an unborn baby.

  • Diclofenac sodium gel: This medication tends to cause less of a skin reaction than 5-FU, but it can still be very effective. You will need to apply it twice a day for 2 to 3 months.

    While using this medication, you must protect your treated skin from the sun. Your dermatologist can tell you the best way to protect your skin.

  • Imiquimod cream: This can be a good option for the face because you can apply it once (or twice) a week, so you don’t get lots of redness and crusting. You may need to apply it for 12 to 16 weeks.

    If 12 to 16 weeks is too long, you may be able to use the medication a bit differently. You’d apply imiquimod every night for 2 weeks. For the next 2 weeks, you’d give your skin a break. Then you’d apply it again, using it every night for 2 weeks.

  • Tirbanibulin ointment: This may be an option for treating AKs on your face and scalp. You apply this medication for five days in a row. After five days, the treatment ends.

    You want to apply this ointment carefully. Spread it evenly over the skin that your dermatologist says to treat. Avoid applying this ointment to other areas, especially around your eyes or on your lips.

To effectively treat the AKs, your dermatologist may prescribe both a procedure and medication that you apply at home.