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Over 58 million Americans have actinic keratosis, a skin condition caused by damage from the sun’s ultraviolet (UV) rays. With this condition, you develop scaly, discolored spots called actinic keratoses.

Actinic keratosis lesions can appear on any part of your body regularly exposed to sun, but they frequently appear on the face. According to a 2020 German study involving 3,409 people, 75.6% of participants with the condition had at least one lesion on their face.

A single lesion generally doesn’t pose a major cause for concern, but there’s a small chance that an actinic keratosis can become cancerous. The more lesions you have, the higher your cancer risk becomes.

Read on to learn more about facial actinic keratosis and how to protect your skin.

Actinic keratosis can resemble other skin issues like age spots and acne. Here’s a quick guide to help you identify a spot on your face.

What do the spots look like?

These spots take the form of rough bumps with a scaly or flaky texture. They come in many colors: red, pink, gray, or a slightly darker shade of your skin color.

Although people with light skin are more likely to have actinic keratosis, these spots can appear on people with any skin tone. If you have darker skin, your spots may closely resemble age spots, with a brown, black, or gray hue. However, real age spots are smooth, not scaly.

Actinic keratoses on your mouth can resemble chapped lips that never seem to heal. You might also notice your lips lose color, with the edges fading into the same hue as the rest of your face.

Where do the spots appear?

The 2020 study mentioned listed how frequently AKs appear on each area of the face:

  • Forehead: 36.9% of cases
  • Temples: 23.4% of cases
  • Cheeks: 20.4% of cases
  • Nose: 15.9% of cases
  • Eyes: 2.8% of cases
  • Mouth or chin: 1.9% of cases

Meanwhile, facial acne will most often erupt in your T-zone, which includes your chin, nose, and forehead.

Other signs of actinic keratosis

Actinic keratoses are often painless, and you usually won’t notice them unless you’re looking in a mirror. However, sometimes AKs may cause symptoms like:

  • itching
  • stinging
  • tenderness when touched

Due to their rough texture, AKs can also catch on scarves, hats, or masks. If your clothing tears off the top layer of skin, the lesion may bleed.

The sun constantly releases UV radiation, which, like most forms of radiation, isn’t great for your skin. Your body can heal some of the damage from the sun’s rays, but the effects of radiation accumulate with every exposure. Eventually, it will cause visible changes to your skin.

According to the Skin Cancer Foundation, sun exposure is a major factor in the development of actinic keratosis. Your risk increases if you live near the equator, work outdoors, or skip protection like sunscreen and hats.

Tanning beds can also cause actinic keratosis since they emit UV radiation.

FYI

Other risk factors for actinic keratosis include:

  • Being over 50 years old: Accumulated sun exposure typically increases with age.
  • Having light, easily sunburned skin: Lighter skin has less melanin, a skin pigment that protects you from the sun.
  • Having thinning hair or baldness: Thinning hair and hair loss expose your scalp to more sunlight.
  • Being immunodeficient: A weakened immune system will have a harder time healing sun damage to your skin.
  • Having xeroderma pigmentosum: This rare genetic condition causes extreme sensitivity to sunlight.

Actinic keratosis is a precancer, meaning that it can serve as a warning sign for future skin cancer.

Estimates on the risk vary widely by source, but the Skin Cancer Foundation estimates that 5%–10% of actinic keratosis lesions become cancerous.

A 2020 Swedish study examined the risk of developing certain cancers in the 10-year period after an actinic keratosis first appears. Compared to the general public, people with actinic keratoses were:

  • 7.7 times more likely to develop squamous cell carcinoma, a cancer in the outer layer of skin cells
  • 4.4 times more likely to develop basal cell carcinoma, a cancer that affects cells at the bottom of the epidermis (basal cells produce new skin cells to replace old cells)
  • 2.7 times more likely to develop malignant melanoma, a cancer that affects melanin-producing cells called melanocytes

While many actinic keratoses pose no medical risk, they’re worth paying attention to, just in case one turns cancerous. If you catch skin cancer early, you have a greater chance of success with treatment.

Cutaneous horns

In many cases, it’s not easy to tell which lesions will become cancerous and which will stay benign. But there’s one exception to this: a rare type of actinic keratosis called a cutaneous horn, which resembles a tiny curved horn coming out of your face.

Cutaneous horns are much more likely to become cancerous than other types of actinic keratosis, so if you have one of these on your face, a dermatologist should examine it right away.

Actinic keratosis treatment can reduce your risk of cancer and smooth out your facial complexion.

Many dermatologists recommend seeking treatment for each lesion you develop since there’s no surefire way to predict which will become cancerous.

Several different kinds of actinic keratosis treatment exist. Your doctor may recommend one or a combination, depending on factors like:

  • how many lesions you have
  • where they appear on your face
  • whether your doctor suspects cancer

Surgical procedures

Your doctor may recommend surgical treatment if you have only one or two isolated lesions. Types of surgery include:

  • Cryosurgery: The surgeon covers the AK in liquid nitrogen, and the frozen tissue falls off in a few days. A blister may appear in the same spot after treatment.
  • Curettage: The surgeon physically shaves off the AK with a blade.
  • Laser resurfacing: The surgeon removes the surface layer of your skin with a laser. This treatment may work especially well for lesions on your lip.

Topical medications

If you have multiple lesions on your face, your doctor may prescribe a topical cream or gel you can apply at home. The Food and Drug Administration (FDA) has approved the following medications:

  • 5-Fluorouracil (Carac, Efudex, Fluoroplex): You apply this once or twice a day for several weeks.
  • Imiquimod (Aldara, Zyclara): You apply this medication for several weeks on limited areas of your face.
  • Diclofenac (Solaraze) and hyaluronic acid: You apply this twice a day for 2–3 months. This medication may be a good option if you have sensitive skin.
  • Tirbanibulin (Klisyri): You apply this to your face once a day for 5 days.

Other treatments

Other treatments that may help address widespread actinic keratosis include photodynamic therapy — specifically, blue light therapy — and chemical peels. You’ll need to receive these treatments from a licensed healthcare professional, such as a dermatologist, in a medical office.

With photodynamic therapy, your dermatologist will spread a chemical agent across the actinic keratoses on your face. Then, they’ll expose your skin to blue light, which activates the chemical agent to remove the lesions.

With a chemical peel, your dermatologist will apply a caustic chemical to your skin to peel back the outer skin layer. Your face may be a bit red and sore for a few weeks after this treatment.

You can take steps to prevent actinic keratoses from appearing in the first place. Preventing these lesions becomes especially important if you have risk factors like pale skin or immunodeficiency.

A few basic tips to prevent actinic keratosis include:

  • Buy quality sunscreen: Look for sunscreen with broad-spectrum UV protection and an SPF of 30 or higher.
  • Wear protective clothing: Cover your face with a wide-brimmed hat or visor. You may want to consider also wearing wraparound-style sunglasses.
  • Take advantage of the shade: The sun’s rays reach their greatest strength between 10 a.m. and 4 p.m., so try to find tree cover or a nice beach umbrella during those times.
  • Check your skin regularly: It’s wise to pay attention to new marks or spots that just won’t go away. Don’t forget to check the sides of your face, too — not just the front.

Even if you already have a few spots, preventing future actinic keratoses can still lower your cancer risk.

It’s also a good idea to consider visiting a dermatologist at least once a year to monitor your skin health and any new spots or moles.

Actinic keratosis is a common skin condition that frequently appears on the face. Anyone can develop these lesions, but you’re more likely to develop them if you’ve had a lot of unprotected sun exposure.

Actinic keratosis can sometimes turn cancerous, so it’s important to monitor and treat these spots when you find them. A dermatologist or other doctor can help diagnose these spots and recommend the best treatment plan for your needs.


Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.