Actinic Keratosis

Also known as Solar Keratosis or sometimes "AKs".

The term is pronounced - ak tin nik / keh rat toes sis. Actinic keratosis are scaley patches of different sizes appearing on skin which has been exposed to excess sunshine.

A number of them - if left untreated will progress into squamous cell carcinomas. Treatment is by cryotherapy or some kind of surgery. These lesions most commonly affect sunshine exposed areas of skin for example the backs of the hands, the top of the scalp particularly in bald headed gentlemen, the face and forehead, sometimes the upper shoulders.

As British residents we are not accustomed to strong sunshine and we tend to get our sun exposure in short bursts e.g. on a summer holiday, or on a bank holiday weekend. Our climate does not provide regular exposure and therefore our skin does not develop much natural protection. All racial groups in Britain can suffer from sunburn but those with very fair skin, multiple freckles and moles, blue eyes and ginger or fair hair are most at risk.

Sunscreens should be applied generously (and I stress generously); they should be applied at least 5 minutes before you go out into the sun; some sunscreens particularly the ones which are water-resistant should be applied at least 30 minutes before going out into the sun and you will need to follow the manufacturer's instructions carefully to achieve the best protection. Please remember that sunscreens are washed off the skin by any moisture including perspiration for example whilst playing tennis; under these circumstances you will need to reapply your protection frequently throughout the day - I would recommend applications about once every 2 hours.

The sun's intensity is greatest between the hours of 11 in the morning and 3 in the afternoon and this rule applies both at home and overseas. During these hours you are at greatly increased risk of suffering a severe sunburn which could ruin the rest of your holiday. You need to limit your exposure during these hours for at least the first few days of the holiday. My rough and ready rule is that you should limit your bare skin exposure during these hours to 15 - 30 minutes maximum per day until you have achieved a reasonable tan after the first few days holiday.

During these first few days, more prolonged bare skin exposure must only occur during those hours of the morning before 11 a. m. and those hours of the afternoon later than 3 p.m., but even then you should wear a sun block.

During these danger hours it is not advisable to rely only upon sun creams which can rapidly rub or wash off; you should also wear some light clothing e.g. a baseball cap to protect the face, a T-shirt to protect the shoulders and Bermuda-style shorts to protect the thighs. Wearing a T-shirt whilst swimming or enjoying other water sports is essential especially for young children.

Certain areas of the body are especially prone to sunburn and deserve a special mention; these areas include bald heads, shoulders, thighs, the nose and forehead, the tops of your feet and bare breasts; in other words those areas pointing up towards the sky and those areas which are usually covered. For these areas I strongly recommend a sun block of factor 20 or higher during the first 7 days of sunshine exposure and apply it at least 3 times per day; more often if you get wet or sweaty. Even during the second week of sunshine exposure I would recommend a sun protection factor of at least 15 to these areas at all times.

Other areas of skin on the arms and body do not bum quite so easily but nevertheless need high-level protection for at least a week. To these areas I recommend the use of a protection factor of at least 10-15 for 7 days and at least factor 4 thereafter.

Sensible exposure will enable you to enjoy the sun without looking silly on the beach or during the evening. If you do burn red you should immediately go indoors until the sun goes down. You must keep warm and drink plenty of water. 1% hydrocortisone cream should be generously applied to all burnt sites twice per day for 2 days; you can buy 1% hydrocortisone at any dispensing pharmacy in the UK without a Doctor's prescription so take some if you go abroad. At all costs you must avoid further sun exposure whilst the skin remains red.

If you are worried by scaly dry skin patches or suspicious change consider an using 'consult the specialist' for my expert help.

by Dr John Ashworth

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