Actinic keratosis is a pre-cancerous condition of the skin that many of us have but most of us have never heard about. Stopping the progession of actinic keratosis to invasive squamous cell carcinoma. Actinic keratosis is very easy for your doctor to treat, but it is even better to prevent it with careful sun protection and a few helpful nutritional supplements.
What is an actinic keratosis?
A keratosis is literally a rough patch of skin. An actinic keratosis is rough skin that has the potential to become cancerous.
This all-too-common complication of excessive sun exposure usually starts as a small patch of rough skin, usually on a part of the body that receives a lot of direct sun, such as the hands, the forearms, the ears, or the sides of the face, especially the temples.
At first an actinic keratosis is easier to feel than it is to see. At first the actinic keratosis has the same pigmentation as surrounding skin. Later it may turn gray, pink, or red.
In older people, an actinic keratosis may become a tough, horn-like growth, especially when it occurs on bald scalp. As the photo of an cross-section of an actinic keratosis magnified 4 times at the left shows, sometimes the deformation sends an inflammatory infiltrate into the lower layers of the skin.
When this happens, the precancerous patch of skin may become itchy or hurt all the time. Even before the keratosis becomes cancerous, it can cause the skin to ooze blood all the time.
People who have fair skin are much more likely to develop actinic keratoses than people who have dark skin. People who work outdoors or who never use sun block are more likely to develop the disease.
Areas closer to the equator that have dry, sunny summer have many people develop the condition. Between 40 to 60% of the people of Australia develop actinic keratoses by the age of 40, and over 80% of people in Phoenix, Arizona.
If I have actinic keratosis, will it become a skin cancer?
Only 0.1% to 10% of actinic keratoses actually become squamous cell cancers. When the area of sun damaged skin does transform itself into cancer, the process usually only takes about two years. Even when the keratosis becomes metastatic cancer, it is usually confined to the face, where it deforms facial structure.
In the 10% of squamous cells cancers that spread to other parts of the body, usually when there is some kind of immune deficiency such as that caused by HIV or treatment for cancer or rheumatoid arthritis, the 5-year survival rate is very low.
Squamous cell carcinoma must be treated by a physician. Actinic keratosis should be treated by a physician, because it is so easy to treat. A dab of liquid nitrogen after a week of pre-treatment with a topical agent such as prescription 5-FU or diclofenac or imiquimod can get rid of the problem for good. But as the photo at left suggests, treating sooner is better than treating later. And prevention is better still.
How to prevent actinic keratosis
In my book Healing without Medication, I mentioned five basic rules for preventing actinic keratoses.
1. Put on sunscreen with an SPF of 15 or higher every day before leaving the house. White clothing that has become wet (for example, a wet T-shirt) is not a substitute for sunscreen. Wet white clothing offers no protection against the sun.
2. Don’t go overboard and try to avoid the sun completely. Sun avoidance depletes the body’s supply of vitamin D and, ironically, can increase the risk of certain kinds of skin cancer.
3. Do not try to remove actinic keratoses by “rubbing them off.” Some of the damaged cells will remain in the skin only to multiply again, and breaking the skin increases the risk of infection.
4. Don’t try to tan. Sun exposure and sunbathing produce gradual skin damage even if sunburn is avoided. Ten to forty years can pass between the time of sun exposure and the development of skin cancer.
5. People who have had any form of skin cancer should have a skin exam every 6 months to 1 year.If you live in a part of the world that has a sunny climate, see the dermatologist at least every 18 months or as your doctor directs.
What I would add now is that certain sunscreen ingredients are far more effective for blocking out the UV-A rays of the sun that cause actinic keratotis. Look for titanium dioxide, zinc oxide, avobenzone (which is sometimes identified by its chemical name butyl dimethylbenzoylmethane or its trade name Parsol 1789), Tinosorb (also known as bis-ethylhexyloxyphenol methoxyphenyl triazine), and Mexoryl SX (terephthalylidene dicamphor sulfonic acid).
If you have African-American skin, you probably want to avoid titanium oxide or zinc oxide, since they can leave a purple case on the skin. Clinique, Coppertone, and Neutrogena all offer sunscreens formulated with avobenzone. If you have fair, dry skin, pressed powder with sunscreen is not a good idea for your only sunscreen, although it is fine for touching up makeup during the day.
What about nutritional supplements?
The nutritional supplements that do the most good for protecting the skin against sun damage are antioxidants. Laboratory experiments with skin cells have found that providing the cells with selenium, vitamin C, and vitamin E before exposure to ultraviolet light greatly reduces the amount of DNA damage.
Even after exposure to sunlight, selenium and vitamin E help the skin make glutathione, which in turn stops the process through which sunlight causes apoptosis, the initiation of skin cell death. N-acetyl cysteine (NAC), vitamin C, and vitamin E work together to protect p53, the gene that ensures that cells repair defects in their DNA before multiplying.
There are two products that I know of that are good sources of selenium, C, and E that can be applied directly to the skin. One is the Sesvalia product Sesderma-C. It's not especially easy to find.
The other product that contains these ingredients (and I use myself) is sea buckthorn oil. It doesn't smell exactly great when the first minute it comes out of the bottle, but the odor dissipates in a minute of less.
Use at night after cleansing your skin and patting it dry. You could also use pure sea buckthorn oil applied to moist (but not wet) skin with a clean cotton ball. You will get better results by applying antioxidants to your skin rather than taking them by mouth.
If you choose to take oral nutritional supplements, the best program (taken daily during the summer or all year round if you live anywhere near the equator) is:
∆ N-acetyl cysteine (NAC): 400 mg per day.
∆ Selenium: 200 micrograms per day.
∆ Vitamin C: 1,000 mg per day.
∆ Vitamin E: 400 IU per day.
Photo credit: By LWozniak&KWZielinski (Own work)