Actinic keratosis (AK) is the most common precancerous skin condition among Americans. If left untreated, it has the potential to transform into invasive squamous cell carcinoma (SCC). 

Brian Berman, a professor emeritus of dermatology and dermatologic surgery at the University of Miami in Florida, explains the pathogenesis, prevention approaches, and new treatment options for AK.

AK is thought to develop as a result of the damaging effects of ultraviolet (UV) radiation to the skin that accumulates over a lifetime of sun exposure, but actually, its pathophysiology is complex, similar to its progression from premalignant precancerous lesions to skin cancer.

The degree of the abnormal expression of specific genes in sun-exposed skin correlates with the progression from AK to SCC, by the up-regulation and down-regulation from a normalized gene expression rate.

Berman explained that the increase in the number of AKs impacts the relative risk of developing SCC. 

Age and a weakened immune system are known risk factors for developing AKs; also people with a history of 5 or more multiple, severe sunburns possess a 2fold increased risk of skin cancer.

Berman also explained the role of vitamin B3 in the prevention of AK. 

Nicotinamide does not reduce cholesterol or cause flushing, but replenishes cellular NAD levels and is a PARP inhibitor (PARP-1 have a negative effect on energy production, DNA repair and genetic stability).

He further explains that tirbanibulin ointment, used for AK, inhibits polymerization and halts the G2/M keratinocyte cell cycle. It has shown a mean 87.5% reduction in AK lesions at day 57 after using tirbanibulin 1% ointment on the face and scalp in a study.

Source: Dermatology Times [Internet]. Update on Actinic Keratosis Causes and Care Plans, November 2021. Available from: https://www.dermatologytimes.com/view/update-on-actinic-keratosis-causes-and-care-plans