Hypertrophic Actinic Keratosis Symptoms, Causes and Treatment

Written by Medicover Team and Medically Reviewed by Dr Girishma J , Dermatologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Hypertrophic Actinic Keratosis (HAK) is a common skin condition characterized by thick, rough, and scaly patches that develop due to long-term exposure to ultraviolet (UV) radiation from the sun or artificial tanning sources. It is a variant of actinic keratosis in which the lesions become more raised, hardened, and noticeable than the typical flat lesions seen in other forms of the condition.

These thickened skin growths often appear on sun-exposed areas such as the face, scalp, ears, neck, hands, and forearms. Because of their raised and rough appearance, hypertrophic actinic keratosis lesions may sometimes be mistaken for warts or other benign skin conditions.

Although they are considered precancerous lesions, untreated hypertrophic actinic keratosis can progress to squamous cell carcinoma, a type of skin cancer. Early diagnosis and treatment are important to prevent complications and maintain healthy skin.

What Are the Symptoms of Hypertrophic Actinic Keratosis?

Symptoms often include rough, raised, and crusty skin patches that may itch, burn, or become tender. These lesions commonly develop on sun-exposed areas of the body.

Lesion Appearance

Hypertrophic actinic keratosis lesions are typically thick, scaly, and crusty. They can appear as raised bumps or plaques with a rough surface. The color of these lesions can vary from skin-colored to red or brown.

Sensation

These lesions can be sensitive or painful to touch. Some individuals may experience itching or a burning sensation in the affected area.

Common Locations

Hypertrophic actinic keratosis commonly occurs on sun-exposed areas of the body, such as the face, ears, neck, scalp, forearms, and the back of the hands.

What Causes Hypertrophic Actinic Keratosis?

Hypertrophic Actinic Keratosis develops primarily due to cumulative ultraviolet (UV) radiation damage that causes abnormal skin cell growth and thickened lesions.

Ultraviolet Radiation Exposure

The primary cause of hypertrophic actinic keratosis is chronic exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. UV radiation damages the DNA in skin cells, leading to abnormal growth and the formation of AK lesions.

Genetic Predisposition

Individuals with a family history of skin cancer or actinic keratosis are at a higher risk of developing hypertrophic actinic keratosis. Genetic factors can influence the skin's response to UV radiation and its ability to repair DNA damage.

Skin Type

People with fair skin, light hair, and light eyes are more susceptible to developing hypertrophic actinic keratosis. This is because they have less melanin, the pigment that provides some protection against UV radiation.

When Should You See a Doctor for Hypertrophic Actinic Keratosis?

Consult a dermatologist if you notice persistent rough, thickened, or scaly skin patches, especially on areas frequently exposed to the sun. Early evaluation can help prevent complications and detect any cancerous changes.

Rough, raised, or crusty skin lesions that do not heal
Lesions that grow in size or become thicker over time
Itching, burning, tenderness, or pain in the affected area
Bleeding, ulceration, or recurrent crusting of skin patches
New or changing lesions on the face, scalp, ears, neck, or hands
Personal history of actinic keratosis or skin cancer

Early diagnosis and treatment can help prevent the progression of hypertrophic actinic keratosis to squamous cell carcinoma and support long-term skin health.

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How Is Hypertrophic Actinic Keratosis Diagnosed?

Diagnosis typically involves a skin examination and may include dermoscopy or a biopsy to confirm the condition and rule out skin cancer.

Clinical Examination

A dermatologist can often diagnose hypertrophic actinic keratosis through a physical examination. They will inspect the skin lesions and may use a dermatoscope, a handheld device that magnifies the skin, to get a closer look at the lesions.

Skin Biopsy

In some cases, a skin biopsy may be necessary to confirm the diagnosis. During a biopsy, a small sample of the lesion is removed and examined under a microscope to rule out skin cancer.

How Is Hypertrophic Actinic Keratosis Treated?

Treatment aims to remove abnormal skin cells, reduce symptoms, and prevent cancerous changes through medications, cryotherapy, photodynamic therapy, or surgery.

Topical Treatments

Topical medications are commonly used to treat hypertrophic actinic keratosis by targeting abnormal skin cells directly. They can help reduce lesion size, improve skin appearance, and lower the risk of progression.

5-Fluorouracil (5-FU) : 5-Fluorouracil is a topical chemotherapy drug that targets and destroys abnormal skin cells. It is applied directly to the lesions and works by interfering with DNA synthesis in the affected cells.
Imiquimod: Imiquimod is an immune response modifier that stimulates the body's immune system to attack and destroy abnormal skin cells. It is applied as a cream to the affected area several times a week.
Cryotherapy: Cryotherapy involves freezing the hypertrophic actinic keratosis lesions with liquid nitrogen. This treatment causes the abnormal cells to die and the lesion to fall off. Cryotherapy is a quick and effective treatment but may cause temporary side effects like blistering and pigmentation changes.
Photodynamic Therapy (PDT): Photodynamic therapy involves applying a photosensitizing agent to the lesions and then exposing them to a specific wavelength of light. This activates the agent, which destroys the abnormal cells. PDT is particularly useful for treating multiple lesions and has a good cosmetic outcome.

Surgical Options

Surgical treatments may be recommended for thick, persistent, or suspicious lesions that do not respond to other therapies. These procedures help ensure complete removal and reduce the risk of skin cancer development.

Curettage and Electrodessication: This procedure involves scraping off the lesion with a curette (a sharp, spoon-like instrument) and then using an electric current to destroy any remaining abnormal cells. It is effective for thicker lesions but may leave a scar.
Excisional Surgery: In cases where hypertrophic actinic keratosis is suspected to have progressed to squamous cell carcinoma, excisional surgery may be necessary. This involves surgically removing the lesion along with a margin of healthy tissue to ensure complete removal.

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What Factors Increase the Risk of Hypertrophic Actinic Keratosis?

Certain factors can increase the likelihood of developing hypertrophic actinic keratosis, particularly prolonged exposure to ultraviolet radiation and characteristics that make the skin more vulnerable to sun damage.

Long-term sun exposure
Frequent use of tanning beds
Fair skin, light hair, or light-colored eyes
Increasing age
History of actinic keratosis
Personal or family history of skin cancer
Weakened immune system

How Can Hypertrophic Actinic Keratosis Be Prevented?

Preventive measures include daily sun protection, avoiding tanning beds, wearing protective clothing, and scheduling regular skin examinations.

Sun Protection

The best way to prevent hypertrophic actinic keratosis is to protect your skin from UV radiation. This includes:

Wearing a broad-spectrum sunscreen with an SPF of 30 or higher.
Wearing protective clothing, hats, and sunglasses.
Seeking shade during peak sun hours (10 AM to 4 PM).
Avoiding tanning beds.

Regular Skin Checks

Perform regular self-examinations of your skin to detect any new or changing lesions. If you notice any suspicious changes, consult a dermatologist promptly.

Professional Skin Exams

Schedule regular skin exams with a dermatologist, especially if you have a history of actinic keratosis or skin cancer. Early detection and treatment of precancerous lesions can prevent the progression to skin cancer.