WHY DOES MY SKIN FEEL LIKE SANDPAPER? I hear this question frequently from patients who present in my office. 
They note their skin always feels rough and on occasion will feel painful or sensitive to touch. Frequently they will have individual lesions on the face that feel rough or raw but commonly there are broad areas of involvement such as the forehead, temples, cheeks, nose and rarely the lips. This roughness and scaling does not seem to improve with scrubbing or with the application of appropriate moisturizers. Occasionally these lesions will bleed causing more concern.
Actinic keratosis (AKs) is a premalignant skin condition that affects millions of people around the world. Considered a precancer, actinic keratosis, present as rough, gritty bumps on the sun exposed skin. Although they are generally pink in color, they can appear as white, tan or flesh-toned skin lesions. Early on they can be subtle and are more likely to be recognized by touch rather than visualized by the naked eye.
Actinic keratosis is the result of excessive sun exposure. Sun exposure is a cumulative lifetime process. The more sun exposure you have the more potential there is for precancerous AKs to occur. A single severe burn can initiate mutations in skin cells that may manifest as actinic keratosis as early as the third decade of life. More commonly seen in individuals over 60, AKs are most common in patients who are more likely to sunburn.
Once actinic keratosis has occurred in the skin they will continue to occur for the life of the patient. Early on in their existence AKs will come and go on their own without intervention. Over time AKs become more persistent, thicker and generally more painful to touch. They can eventually become broad and cover large areas rather than existing as a single lesion. In addition to AKs we can see and feel are “subclinical” AKs which are damaged skin cells which we are not able to see or feel. This burden of precancer makes it more likely that an individual will develop skin cancer. The most common skin cancer linked to AKs is squamous cell carcinoma which is the second most common type of skin cancer. Basal cell carcinoma, the most common skin cancer, has also been linked to actinic keratosis.
Because skin cancers are treated surgically they are more likely to leave a scar following treatment. AKs on the other hand can be treated using less invasive therapies such as cryotherapy (liquid nitrogen), topical creams or gels which kill precancer cells or initiate an immune response to the abnormal cells via immune upregulation, and/or light therapy with blue or red light applied to the face following the application of a topical medicine. These treatments can be tailored to the individual patient depending on personal preference and severity of precancerous change. Very thick AKs may require biopsy to rule out skin cancer or may require more intense freezing with scraping to ensure they have been adequately treated. Precancerous change in the skin tends to be a chronic process which requires continued follow up to reduce the overall burden of AKs and minimize the risk of evolution to skin cancer.
These treatments can help reduce the total number of precancers occurring on the skin and minimize the overall risk of the development of more invasive skin cancer. If you or someone you know suffers with AKs please contact us online or call Dr. Benjamin Carter at Riverside Medical Arts for an appointment at 435.628.6466.
