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Home :: Solar Keratosis
Solar Keratosis
These single or multiple, discrete, dry, rough, adherent scaly lesions occur on the habitually sunexposed skin of adults.
Causes of Solar Keratosis
Prolonged and repeated solar exposure in susceptible persons (SPT I, II, and III) leads to cumulative damage to keratinocytes by the action of ultraviolet radiant energy, principally, if not exclusively, UVB (290 to 320 nm).
Symptoms of Solar Keratosis
- Rough and dry textured skin lesion
- A macule, patch, or growth on the skin
- Itch, burn, or sting
- Range in size from 1 to 3 mm or larger (about the size of a small pea)
- Be numerous, with several patches close together
- Be surrounded by red, irritated skin.
Diagnosis
Usually made on clinical findings. Hyperkeratotic lesions may require biopsy to rule out squamous cell carcinoma (in situ or invasive).
Treatment
Prevention Afforded by use of highly effective UVB/UVA sunscreens, which should be applied daily to the face, neck, and ears during the summer in northern latitudes for SPT I and SPT II persons and for those SPT III persons who sustain prolonged sunlight exposures.
Topical Therapy
Cryosurgery Light spray or with cottontipped applicator is effective in most cases. Longer freeze periods may affect the dermal vasculature and cause a permanent white macule (scar).
5-Fluorouracil (5-FU) Cream 5% Effective, but difficult for many individuals. Treatment of facial lesions causes significant erythema and erosions, resulting in temporary cosmetic disfigurement. Apply bid for 2 to 4 weeks on face; may require longer period of therapy on dorsum of hands or lower legs. Efficacy can be increased and duration of treatment can be shortened if applied under occlusion and/or combined with topical tretinoin. This, however, leads to confluent erosions and may require hospitalization. Re-epithelialization occurs after treatment is discontinued. Pretreatment with light cryosurgery to hyperkeratotic lesions may improve efficacy of 5-FU cream.
Retinoids Used chronically, may be effective for treatment of dermatoheliosis and solar keratoses.
Facial Peels Trichloroacetic acid (5 to 10%) effective for widespread lesions.
Laser Surgery Erbium or carbon dioxide lasers. High cost. Usually effective for individual lesions. For extensive facial lesions, facial resurfacing is effective.
System Therapy
Retinoids Acitretin or isotretinoin are effective in reducing the number of solar keratoses and SCC in situ in patients with advanced dermatoheliosis, many solar keratoses, SCCs in situ, and invasive SCCs, especially if immunocompromised. Lesions recur once therapy is discontinued.
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