Actinitic keratosis: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Actinitic keratosis (syn: senile keratosis, solar keratosis) develops as a result of prolonged exposure to ultraviolet rays on exposed skin areas, usually in persons over 50 years old. Foci of lesion in most cases are located on the face and back of the wrists, less often in the lower third of the forearms, are sharply outlined, dry, erythematous, slightly infiltrated spots or plaques of small size covered with tightly adhering yellowish-brown scales, after removal of which point bleeding occurs. The adjacent areas of the skin under the influence of prolonged exposure to sunlight are often atrophic with telangiectasias and dyschromia. Actinic keratosis can be transformed into squamous cell carcinoma, and basal cell carcinoma develops less often.
Pathomorphology. The leading changes in the epidermis are foci of disorganization of epithelial cells with atypia of the nuclei of the Malyigiv layer. The following variants of actinic keratosis are distinguished: hypertrophic, atrophic and bouonoid, lichenoid variant.
Hyperthrophic variant is dominated by hyperkeratosis with foci of parakeratosis. Small papillomatosis is noted. The epidermis is unevenly thickened with the proliferation of epidermal processes into the dermis. Epithelial cells lose polarity, among them polymorphism and atypia are observed. Sometimes noted thickening of the granular layer, perinuclear gland.
The atrophic variant is characterized by atrophy of the epidermis, atypical cells of the basal layer, which can proliferate into the dermis in the form of tubular structures. Often, under the basal layer, cracks and lacunae are found, which resembles Darje 's disease.
The Bowenoid variant does not differ histologically from Bowen's disease. The lichenoid variant is clinically and histologically very little different from the red flat lichen. It is characterized only by atypia of epithelial cells.
With all variants of actinic keratosis in the dermis, basophilic destruction of collagen and a dense inflammatory infiltrate, consisting mainly of lymphocytes, are observed.
Histogenetically actinic keratosis is associated with the epidermis. Differential diagnosis is performed with keratotic papilloma, seborrheic keratosis, Bowen's disease.
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