Keratoses

Keratoses are among the most frequently encountered skin conditions, affecting people of all ages and skin types. These benign skin growths occur when there is an abnormal accumulation of keratin, a protein found in the outer layer of the skin. Although keratoses are generally harmless, they can sometimes cause discomfort or cosmetic concerns, prompting individuals to seek treatment.

What are Keratoses?

Keratoses are noncancerous skin tumours that develop when skin cells called keratinocytes grow excessively. While the precise cause of keratoses remains unknown, factors such as genetics, sun exposure, and hormonal changes are thought to contribute to their development. Seborrhoeic keratosis, for example, often runs in families and is more prevalent in people over the age of 50, indicating a potential genetic link and the influence of ageing.

Keratoses are of several types, with seborrhoeic keratosis and actinic keratosis being the most prevalent:

• Seborrhoeic Keratosis: Seborrhoeic keratoses appear as round or oval growths with a waxy or scaly texture, ranging in colour from light tan to black. They commonly occur on sun-exposed areas like the face, neck, chest, and back. They are more common in individuals over the age of 50 and are believed to have a potential genetic link.

• Actinic Keratosis: In contrast, actinic keratoses result from UV damage to the skin and manifest as rough, scaly patches or bumps. Fair-skinned individuals, those with a history of unprotected sun exposure, and older adults are at a higher risk of developing actinic keratoses. This condition is considered precancerous because it can progress to squamous cell carcinoma if left untreated.

The symptoms of keratoses can vary depending on the type and stage of the growth. Common signs to look out for include:

1. Seborrhoeic Keratosis

   • Round or oval-shaped patches that are raised above the skin, with a "stuck-on" appearance.

   • The patches can be brown, black, tan, pink, yellow, or white and sometimes appear in numbers.

   • The surface can be velvety, waxy, or rough, resembling a wart.

   • Occasionally, these lesions can become irritated, itchy, or bleed.

2. Actinic Keratosis

   • Symptoms include rough, dry, scaly patches or bumps on sun-exposed areas such as the face, ears, scalp, neck, hands, and forearms.

   • These lesions may be skin-coloured, reddish-brown, or pink and can be flat or slightly raised.

   • They may be itchy or tender and can range in size from a few millimetres to a few centimetres.

Keratoses can be categorised into the following stages based on whether they are seborrhoeic or actinic:

1. Seborrhoeic Keratosis

Seborrhoeic keratosis is of the following three stages:

1. Initial Stage: The appearance of small, faintly coloured patches that gradually grow and become more pronounced over time.

2. Growth Stage: Lesions become more defined, taking on a "stuck-on" appearance, and can range in colour from light to dark brown, black, or even tan, pink, or white.

3. Established Stage: Lesions are fully developed and can be flat or raised, with a velvety, waxy, or rough texture.

2. Actinic Keratosis

Actinic keratosis, on the other hand, can be categorised into preclinical stage, clinical stage, and progression stage:

1. Preclinical Stage: UV damage accumulates over the years, leading to mutations in skin cells.

2. Clinical Stage: The appearance of rough, scaly patches or bumps on sun-exposed areas, which can be flat or raised and vary in colour.

3. Progression Stage: If left untreated, actinic keratosis can progress to squamous cell carcinoma.

Although the precise cause remains unknown, several factors are thought to contribute to the development of keratoses. Some of these factors include:

• Genetic Composition: Genetic components may play a role, with some individuals inheriting a predisposition to develop multiple seborrhoeic keratoses.

• Sun Exposure: Exposure to sunlight is also believed to be a contributing factor, as these growths often appear on sun-exposed skin, although they can also occur on covered areas.

• Hormonal Changes: Changes in your hormone levels, such as those experienced during pregnancy or oestrogen replacement therapy, may influence the development of keratoses.

• Age: The prevalence of these skin keratoses increases with age, suggesting that the natural ageing process is a contributing factor.

Several risk factors can increase an individual's likelihood of developing keratoses. Some of these risk factors include:

• Age: Age is a significant factor, with most people developing these growths after the age of 50.

• Genetic Predisposition: Having a family history of keratoses also increases the risk, suggesting a genetic predisposition.

• Skin Tone and Texture: Skin tone may also play a role, as individuals with lighter skin are more likely to develop these growths, although they can occur in people with darker skin as well.

• Sun Exposure: Frequent sun exposure (especially for those who work outdoors or reside in sunny regions) is another risk factor, as it may contribute to the development of keratoses, even though they can appear on both sun-exposed and covered skin.

• Hormonal Changes: Hormonal changes may also increase the risk of developing keratoses.

Diagnosing keratoses typically involves the following steps or procedures:

• Physical Examination: A visual examination by a doctor is the first step in diagnosing the condition. The most common type, seborrhoeic keratosis, usually appears as brown, black, or tan growths that may have a warty, smooth, or flat appearance.

• Skin Biopsy: In some cases, if the diagnosis is uncertain or there are concerns about potential skin cancer, a skin biopsy may be performed. This involves removing a small sample of the growth for microscopic examination.

While there are no specific diagnostic tests for keratoses, additional testing may be recommended if the growth appears unusual or there are suspicions of malignancy. Proper diagnosis is crucial for determining the appropriate treatment and management of these benign skin growths.

Once a keratosis has been accurately diagnosed, treatment options can be considered. In many cases, treatment is not necessary for seborrhoeic keratoses unless they are causing discomfort or cosmetic concerns. If treatment is desired, several options are available. Some of these options are listed below:

• Cryotherapy: It involves freezing the growth with liquid nitrogen, causing it to fall off within a few weeks. Cryotherapy can be an effective way to remove keratoses.

• Shave Removal: Alternatively, a doctor may use a special tool to shave off the growth in a procedure known as shave removal.

• Electrocautery: This procedure uses an electric current to burn off the growth.

• Topical Treatments: In some cases, topical treatments such as creams or ointments might be prescribed to help manage symptoms, although these are less common.

In addition to medical treatments, there are several ways to manage keratoses at home. Some points to keep in mind include:

• It is important to avoid scratching or picking at the growths, as this can lead to irritation and infection.

• Regular skin checks can also help identify any changes in the growths that might indicate a more serious condition.

1. Seborrhoeic Keratosis

Seborrhoeic keratosis requires self-monitoring and care to ensure overall skin health.

• Individuals with this condition should perform regular self-examinations to check for new growths or changes in existing ones, such as irregular borders, unusual colours, or symptoms like itching or bleeding.

• While generally harmless, it is advisable to avoid picking or scratching seborrhoeic keratoses to prevent bleeding, swelling, and potential infection.

• If these skin growths become bothersome due to their appearance or cause irritation from clothing, cosmetic removal by a dermatologist is an option.

2. Actinic Keratosis

Living with actinic keratosis requires vigilance and proactive measures to maintain skin health.

• Individuals with this condition should also perform regular self-examinations and attend annual check-ups with a dermatologist to monitor any changes in existing lesions or the appearance of new ones. Early intervention can prevent the progression into squamous cell carcinoma.

• Sun protection is crucial in preventing the development of new actinic keratoses and reducing the risk of progression to skin cancer. This includes limiting sun exposure, especially during peak hours, using a broad-spectrum sunscreen with a high SPF, wearing protective clothing, and avoiding tanning beds.

While many keratoses are benign and do not require immediate medical attention, there are certain situations where consulting a doctor is advisable.

• If you notice any new, rapidly growing, or changing skin growths, it is essential to have them evaluated by a dermatologist to rule out the possibility of skin cancer.

• Additionally, if your keratoses become painful, itchy, inflamed, or start bleeding, it is best to seek medical advice. Your doctor can assess the lesions and recommend appropriate treatment options, such as keratosis removal, if necessary.

• If you have a history of excessive sun exposure or a family history of skin cancer, regular check-ups with a dermatologist are recommended to monitor your skin health and detect any potential issues early on.

• Keratoses are noncancerous skin tumours that develop when skin cells called keratinocytes grow excessively and appear as brown, black, or light tan spots on the skin.

• They can be broadly categorised into seborrhoeic keratosis (benign) and actinic keratosis (precancerous).

• Although generally harmless, keratoses can sometimes cause discomfort or cosmetic concerns, prompting individuals to seek treatment.

• Factors such as age, genetics, sun exposure, skin tone, and hormonal changes are thought to contribute to the development of keratoses.

• If treatment is desired, several options like cryotherapy, shave removal, electrocautery, and topical creams or ointments are available.