Actinic keratosis

Last reviewed: 26 Aug 2022
Last updated: 17 May 2022



History and exam

Key diagnostic factors

  • single or multiple scaly macules or plaques
  • scaly lesions with a hyperkeratotic surface
  • well-defined, scaly, brown lesions
  • lesions resembling seborrheic keratosis, melanocytic nevus, and early malignant melanoma
  • hypertrophic conical-shaped protuberances growing from the surface of the skin
  • scaly red roughness with induration, fissuring, and ulceration of the lower lip to the commissures
  • lesion on sun-exposed area of body
  • skin-colored, papillomatous, elevated wartlike papules
  • plaques with very mild scale over very thin shiny skin
  • violaceous well-defined papules with fine white lines on the surface
More key diagnostic factors

Other diagnostic factors

  • evidence of sun damage to skin
  • pruritus or bleeding
Other diagnostic factors

Risk factors

  • chronic exposure to UVB radiation
  • light-colored skin, freckling, and albinism
  • age >40 years
  • male sex
  • immunocompromise
  • xeroderma pigmentosum
More risk factors

Diagnostic investigations

Investigations to consider

  • dermoscopy
  • skin biopsy
More investigations to consider

Treatment algorithm


confluent scalp lesions

head and face lesions, excluding periorbital, actinic cheilitis, and confluent scalp lesions


persistent or severe actinic cheilitis

back of hands

below the knee



Brian Berman, MD, PhD
Brian Berman

Professor Emeritus of Dermatology and Cutaneous Surgery

University of Miami Miller School of Medicine


Skin & Cancer Associates, LLP


Center for Clinical and Cosmetic Research




BB has acted as a consultant for Sirnaomics, Pierre Fabre, Pfizer, Lemonex, Novan, Sonoma Pharmaceuticals (with stock options), Sensus, Encore Dermatology, AiViva, Clark Pharmaceutical, Tigercat Pharmaceuticals, Menlo Therapeutics, BMS, Pulse, Almirall, Mediwound, and PHD Biosciences. BB is on the advisory board for Cutanea, Birch BioMed, Ortho Dermatologics/Valeant, TopMD, Novartis, and Smith & Nephew, and has also been a speaker for Novartis.

Sadegh Amini, MD
Sadegh Amini


Skin and Cancer Associates

Voluntary Assistant Professor

Department of Dermatology and Cutaneous Surgery

University of Miami

Miller School of Medicine




SA declares that he owns stock in AbbVie Inc.

Peer reviewers

David S. Cassarino, MD, PhD

Assistant Professor

Departments of Pathology and Dermatology


Los Angeles



DSC declares that he has no competing interests.

Christopher Shea, MD

Dermatopathology Fellowship Director

University of Chicago

Section of Dermatology




CS declares that he has no competing interests.

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  • Guidelines

    • Guidelines of care for the management of actinic keratosis
    • Guidelines for the care of patients with actinic keratosis
    More Guidelines
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