Actinic keratosis (AK), also called solar keratosis, is a common skin condition caused by long-term exposure to ultraviolet (UV) radiation. It usually appears as a rough, dry, scaly or crusty patch on areas that receive a lot of sunlight, such as the face, scalp, ears, neck, forearms, hands and lips.
An actinic keratosis is not the same as skin cancer, but it is considered a precancerous skin change because some lesions can develop into cutaneous squamous cell carcinoma (SCC). The good news is that AK is usually treatable, and recognising suspicious lesions early can help prevent complications.
The appearance of AK can vary considerably. Some lesions are barely visible but feel rough when you run your fingers over them. Others become red, thick, crusted or wart-like. Because some AKs can resemble other skin conditions — including skin cancer — a persistent or changing lesion should be assessed by a dermatologist rather than diagnosed from appearance alone.
What causes actinic keratosis?
The main cause of actinic keratosis is cumulative UV damage to skin cells. This usually comes from repeated exposure to sunlight, although artificial UV sources such as tanning beds can also contribute.
Over many years, UV radiation can damage the DNA of skin cells called keratinocytes. The resulting abnormal cells may form the rough, scaly patches characteristic of AK.
The risk increases with cumulative sun exposure. People who work outdoors, spend considerable time in the sun, have previously had sunburns, live in sunny climates or have a weakened immune system may be at greater risk.
Importantly, you do not have to remember having frequent sunburns to develop AK. UV damage accumulates over time, and lesions can appear years after the exposure that contributed to them.
What does AK look like on skin?
Actinic keratosis can look different from one person to another.
Typical features include:
- A rough, dry or scaly patch
- A lesion that feels like sandpaper
- A flat or slightly raised area
- Pink, red, brown, grey or skin-coloured changes
- A crusted or thickened surface
- A hard or wart-like growth in some cases
- Itching, burning, stinging or tenderness
- Occasional bleeding or crusting
Some AKs are easier to feel than see, particularly when they are small or early.
They are most commonly found on sun-exposed areas such as the face, ears, scalp, hands, forearms and neck.
A particularly important form is actinic cheilitis, which affects the lips and can cause persistent dryness, scaling, cracking or changes in the lower lip.
Symptoms of actinic keratosis
The symptoms shown in the accompanying graphic are among the features that may occur with AK:
- Dry, rough, scaly patches
- Itching, burning or stinging
- Pain or tenderness
- Hard, horn-like or wart-like growths
- Bleeding or crusting
- Changes in the colour of the skin or lips
Not every person will experience all of these symptoms. A small AK may simply feel rough, while a thicker lesion can become tender or uncomfortable.
Can actinic keratosis turn into cancer?
Yes. Some actinic keratoses can progress to cutaneous squamous cell carcinoma, a type of skin cancer.
However, this does not mean that every AK will become cancer. Many lesions remain stable, regress temporarily or are successfully treated before cancer develops. The risk varies according to factors such as the individual lesion, cumulative sun damage, immune status and previous history of skin cancer.
This is why AK is often described as a precancerous skin lesion. Treating it and monitoring sun-damaged skin can reduce the chance of missing an evolving skin cancer.
Should I worry about actinic keratosis?
An actinic keratosis is usually not an emergency, but it should not automatically be dismissed as an ordinary dry patch.
A dermatologist should assess an AK, particularly if it:
- Becomes thicker
- Grows noticeably
- Becomes painful or tender
- Bleeds repeatedly
- Develops significant crusting
- Forms a lump
- Does not heal
- Changes rapidly
- Looks different from your other AKs
These features do not prove that the lesion is cancerous, but they warrant medical evaluation.
What happens if actinic keratosis is left untreated?
An untreated AK can follow several different courses.
It may remain unchanged, become thicker, regress partially or disappear. However, some lesions can progress to squamous cell carcinoma. In addition, people who develop one AK often have broader areas of sun-damaged skin and may develop additional lesions later.
This makes treatment and ongoing skin surveillance useful, particularly when there are multiple AKs or significant sun damage.
Can AK go away on its own?
Sometimes, but it should not be relied upon.
Research shows that individual AK lesions can spontaneously regress. A systematic review and pooled analysis found complete spontaneous clearance in approximately 23% of individual lesions, while only about 8% of participants achieved complete clearance of all their AKs without active treatment.
In other words, one patch may disappear, but the underlying sun damage remains. New AKs can subsequently appear.
For this reason, persistent or suspicious AKs should be evaluated rather than simply ignored.
How do I know if I have actinic keratosis or cancer?
This can be difficult to determine by looking at the skin yourself.
AK and squamous cell carcinoma can overlap in appearance. A dermatologist may diagnose a typical AK through a clinical examination and, when necessary, dermoscopy. If a lesion looks suspicious or the diagnosis is uncertain, a skin biopsy may be recommended to examine the cells under a microscope.
Signs that deserve particular attention include rapid growth, increasing thickness, persistent pain, bleeding, ulceration, a firm lump or a lesion that repeatedly crusts and returns.
Do not attempt to diagnose skin cancer solely from photographs or online descriptions.
What is mistaken for actinic keratosis?
Several skin conditions can resemble AK. These include:
- Seborrhoeic keratosis
- Common warts
- Psoriasis
- Solar lentigo
- Eczema or dermatitis
- Bowen disease/squamous cell carcinoma in situ
- Cutaneous squamous cell carcinoma
- Basal cell carcinoma
- Certain pigmented lesions, including melanoma
DermNet notes that psoriasis, lentigo maligna and squamous cell carcinoma can sometimes be included in the differential diagnosis of AK.
This is one reason why a new, persistent or changing rough patch should not automatically be assumed to be an actinic keratosis.
What is the best cream to put on actinic keratosis?
There is no single best cream for every person.
Depending on the number, thickness and location of the lesions, dermatologists may prescribe treatments such as:
- 5-fluorouracil (5-FU)
- Imiquimod
- Diclofenac
- Tirbanibulin
These medications are generally used as field treatments, meaning they can treat an area containing visible AKs as well as abnormal sun-damaged cells that may not yet be obvious.
The correct medication, concentration and duration depend on the individual. Some treatments intentionally produce redness, scaling, crusting or inflammation as abnormal cells are destroyed.
Do not start prescription AK medication simply because a rough patch appears to resemble an AK. If the lesion is actually skin cancer, treating it as an ordinary AK could delay the correct diagnosis.
What is the newest treatment for actinic keratosis?
One of the newer approved topical treatments is tirbanibulin 1% ointment, a field therapy for AK on the face or scalp. In the United States, the FDA-approved regimen is once daily for five consecutive days.
Research is also exploring newer combinations and treatment approaches. A 2025 comprehensive review highlighted emerging strategies including combinations involving 5-fluorouracil and calcipotriol, along with other field-directed and lesion-directed approaches.
However, “newest” does not necessarily mean “best” for every patient. Treatment should be selected according to the location, number and characteristics of lesions and the person’s overall circumstances.
What happens if you pick actinic keratosis?
Picking or scratching an AK can cause:
- Bleeding
- Irritation
- Crusting
- Infection
- Delayed healing
- Scarring or pigmentation changes
More importantly, picking does not reliably remove the abnormal cells responsible for the AK.
If an AK is catching on clothing or repeatedly being scratched, ask a dermatologist about appropriate treatment rather than trying to remove it yourself.
Does actinic keratosis come back after treatment?
It can.
Treatment can clear an individual AK, but it does not reverse all of the accumulated UV damage in the surrounding skin. Consequently, another AK may develop in the same area or elsewhere.
Studies have also documented recurrence after apparent clearance. For example, the AAD guideline notes recurrence after treatment with several therapies, while research on tirbanibulin has also demonstrated recurrence in some patients after initial clearance.
Daily sun protection and periodic skin examinations are therefore important even after successful treatment.
At what age do actinic keratoses typically start to appear?
AKs become increasingly common with age because UV damage accumulates over many years. Mayo Clinic notes that they usually first appear in people over 40, although younger people can develop them, particularly when there has been substantial UV exposure or other risk factors.
Age alone does not determine risk. A younger person with considerable sun exposure can develop AK, while an older person may have relatively little sun damage.
What percentage of actinic keratosis turns cancerous?
There is no single percentage that applies to every actinic keratosis.
Some patient-focused sources cite an overall risk in the range of 5% to 10% for untreated AKs, but this figure should not be interpreted as the risk that every individual lesion will become cancer.
Natural-history research has produced substantially different estimates depending on the population and study design. One systematic review reported progression rates ranging from 0% to 0.075% per lesion-year, with higher rates reported in people with a previous history of non-melanoma skin cancer.
The practical message is more important than any single percentage: AK is not cancer, but it can become squamous cell carcinoma, so suspicious or persistent lesions deserve appropriate assessment.
Are there any home remedies for actinic keratosis?
There is no proven home remedy that reliably eliminates the abnormal cells of an AK.
Useful self-care includes:
- Applying broad-spectrum sunscreen with SPF 30 or higher
- Reapplying sunscreen regularly when outdoors
- Wearing a wide-brimmed hat and protective clothing
- Seeking shade
- Avoiding tanning beds and intentional tanning
- Checking your skin regularly
- Attending recommended dermatology appointments
These measures help reduce additional UV damage and the development of new AKs, but they should not replace medical treatment when treatment is recommended.
Avoid applying acids, essential oils, abrasive products or unprescribed wart-removal preparations to a suspected AK.
Is early-stage actinic keratosis cancerous?
No. An actinic keratosis is generally considered a precancerous lesion rather than invasive skin cancer.
However, AK exists on a biological spectrum of UV-induced abnormal changes, and some lesions can progress to squamous cell carcinoma. That is why early recognition and appropriate management matter.
Is it normal for actinic keratosis to grow bigger?
An AK can become larger or thicker over time, but a growing or increasingly thick lesion should be assessed.
Growth does not automatically mean cancer. However, increasing size, thickness, tenderness, bleeding or development of a firm lump can be warning signs that require closer examination.
How long does it take for actinic keratosis to heal?
Healing time depends on the treatment used.
After some treatments, such as cryotherapy, the area may blister, crust and peel before new skin forms. Cleveland Clinic notes that many AKs heal within a few weeks after treatment, although the exact recovery period varies.
Topical treatments can cause redness, irritation and scaling during the treatment period, followed by gradual recovery.
If a treated area continues to worsen, fails to heal or develops a persistent lump or ulcer, contact your healthcare professional.
Should you moisturize actinic keratosis?
A gentle, fragrance-free moisturizer can help reduce dryness and discomfort, particularly if the skin becomes irritated during treatment.
However, moisturizer does not treat the abnormal cells of AK. If you are using a prescription treatment, ask your dermatologist how and when to use moisturizer alongside it, because the timing may matter depending on the medication.
Can I put Vaseline on actinic keratosis?
Plain petroleum jelly such as Vaseline can help moisturize and protect irritated skin, particularly after certain treatments, but it does not cure actinic keratosis.
If your dermatologist has recommended petroleum jelly during the healing phase, it can help maintain a protective barrier while the skin recovers. It should not be used as a substitute for appropriate AK treatment.
How serious is actinic keratosis?
Most AKs are treatable and manageable, so an AK diagnosis does not mean that you have skin cancer.
The significance of AK lies in what it tells us about the skin: it is a marker of substantial cumulative UV damage and is associated with an increased risk of developing additional AKs and skin cancer.
Therefore, AK deserves attention without causing unnecessary panic.
What are the red flags for actinic keratosis?
Arrange a medical assessment if an AK or suspected AK:
- Grows rapidly
- Becomes significantly thicker
- Develops a firm lump
- Becomes increasingly painful or tender
- Bleeds repeatedly
- Develops persistent crusting
- Ulcerates or does not heal
- Changes significantly in colour or appearance
- Appears on the lip and persists
- Looks noticeably different from your other AKs
These signs do not confirm cancer, but they can indicate that a lesion needs closer examination or biopsy.
How is actinic keratosis treated?
Treatment is chosen according to the number of lesions, their thickness, location and the amount of surrounding sun-damaged skin.
Common approaches include:
Cryotherapy: Liquid nitrogen is used to freeze individual lesions. It is particularly useful when there are only a few obvious AKs.
5-fluorouracil: A topical medication that targets abnormal rapidly dividing cells and is commonly used for field treatment.
Imiquimod: Stimulates an immune response against abnormal cells.
Diclofenac: A topical treatment that may be used over a longer treatment period.
Tirbanibulin: A newer topical field treatment used for AKs on the face or scalp in approved settings.
Photodynamic therapy: A photosensitising medication is applied and subsequently activated with a specific light source.
Curettage or other procedures: These may be considered for thick or particularly suspicious lesions.
Current AAD guidance supports several effective approaches, including UV protection, cryosurgery, 5-fluorouracil and imiquimod, with other therapies such as photodynamic therapy, diclofenac and tirbanibulin also having roles depending on the clinical situation.
How can you prevent actinic keratosis?
The most important preventive step is consistent UV protection.
Use a broad-spectrum, water-resistant sunscreen with SPF 30 or higher on exposed skin, reapply it as directed, and combine sunscreen with shade, protective clothing and a wide-brimmed hat. Avoid tanning beds and deliberate tanning.
If you have already developed AK, sun protection becomes even more important because it can help reduce further UV damage and the development of additional lesions.
Frequently asked questions about actinic keratosis
Can actinic keratosis turn into cancer?
Yes. Some AKs can progress to cutaneous squamous cell carcinoma, although most individual lesions do not necessarily become cancerous.
Can AK go away on its own?
Yes, individual lesions can occasionally regress spontaneously, but complete clearance of all AKs without treatment is uncommon.
What is the best cream for actinic keratosis?
There is no universal best cream. 5-fluorouracil, imiquimod, diclofenac and tirbanibulin are among the topical options used depending on the patient and lesion characteristics.
How do I know if I have AK or cancer?
You generally cannot be certain from appearance alone. A dermatologist may examine the lesion with dermoscopy and may recommend a biopsy when cancer cannot be ruled out.
What happens if I pick an actinic keratosis?
Picking can cause bleeding, irritation, infection and delayed healing without reliably removing the abnormal cells.
Does actinic keratosis come back after treatment?
Yes. New lesions can develop and previously treated areas can recur because the surrounding skin may have sustained long-term UV damage.
Is early actinic keratosis cancer?
No. AK is generally considered a precancerous lesion, although it can progress to squamous cell carcinoma.
What is mistaken for actinic keratosis?
Conditions such as seborrhoeic keratosis, psoriasis, warts, solar lentigines and various forms of skin cancer can resemble AK.
Can I use Vaseline on actinic keratosis?
Petroleum jelly can moisturize and protect irritated skin but does not treat the AK itself.
What are the main red flags?
Rapid growth, increasing thickness, persistent pain, repeated bleeding, ulceration, a firm lump, significant change in appearance or a lesion that does not heal should be assessed by a healthcare professional.
Final thoughts
Actinic keratosis is common, especially in skin that has accumulated years of UV exposure. It is not the same as skin cancer, but it deserves attention because some lesions can progress to squamous cell carcinoma.
The most important things are to recognise persistent rough or scaly patches, avoid picking or attempting to remove them yourself, protect your skin from UV radiation and seek professional assessment when a lesion changes, grows, bleeds or becomes painful.
Modern treatment offers several effective options, from cryotherapy and photodynamic therapy to prescription creams and newer topical treatments such as tirbanibulin. The appropriate choice depends on the individual lesion and the surrounding sun-damaged skin.
If you notice a new, persistent or changing rough patch of skin, particularly on a sun-exposed area, it is worth having it examined rather than assuming it is simply dry skin.
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Disclaimer:
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Sources used for medical accuracy
This article was developed after reviewing the three pages you provided — Cleveland Clinic, Mayo Clinic and the 2025 comprehensive review in Postępy Dermatologii i Alergologii — and cross-checking treatment and self-care information against American Academy of Dermatology guidance and systematic reviews.
