Integrative Dermatology Approaches to Actinic Keratosis

Chronic sun exposure over many years can cause the skin to develop rough, scaly patches known as actinic keratosis. These skin lesions are common on the face, lips, forearms, ears, scalp, neck, or back of the hands.

Actinic keratosis is the most frequent premalignant skin disease in the white population, with 37.5% of whites 50 years of age or older and 58 million Americans having at least one actinic keratosis. Since this condition develops from repeated exposure to the sun, it is most common after age 40.

An integrative approach to actinic keratosis helps reduce UV damage to the skin and support the body in healing. Nutrition, supplements, and lifestyle measures can all reduce skin damage and help to heal actinic keratosis.

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What is Actinic Keratosis?

An actinic keratosis or solar keratosis is a slow-growing scaly spot or patch that develops on the top layer of skin after many years of sun exposure. These lesions can look like age spots, pimples, patches of irritated skin, or a badly chapped lip.

They are most common in areas that receive frequent sun exposure over many years, such as the face, head, neck, ears, back of the hands, and forearms. When an actinic keratosis forms on the lip, it is known as actinic cheilitis.

Actinic Keratosis Signs & Symptoms

Actinic keratosis involves the development of lesions on sun-exposed areas of skin like the head, neck, ears, hands, and forearms. The most common signs and symptoms include:

• Scaly spots or patches on the top layer of sun-exposed skin, usually less than one inch in diameter
• Rough texture to patches of skin that may feel like sandpaper
• Rough, scaly bumps that may look like pimples
• Hard wartlike surface or a growth that looks like an animal horn that develops on the patches over time 
• Dry, scaly lips that never heal or scaly, white patches on lips
• Red, light or dark tan, white, pink, flesh-toned coloration, or a combination of colors
• Itching, burning, bleeding, or crusting

Without treatment, about 5-10% of actinic keratosis will turn into squamous cell carcinoma skin cancer.

Actinic Keratosis Possible Causes 

Actinic keratosis develops when the skin is exposed to frequent or intense ultraviolet (UV) rays from the sun, sun lamps, or tanning beds. They are more common in people with red or blond hair and blue or light-colored eyes, those who burn often or tend to freckle when exposed to the sun, and those with a weakened immune system. Since actinic keratoses develop after chronic sun exposure, they most commonly occur in people over the age of 40 and those who live in sunny climates and/or who work outdoors. 

UV exposure can damage keratinocytes that are found in the outermost layer of the skin and give your skin its texture. Over time, UV light damages these cells causing the skin to feel rough and scaly, appear discolored, and develop bumps and horn-like growths.

Functional Medicine Labs to Test for Root Cause of Actinic Keratosis

Functional medicine testing looks for root causes and underlying factors that may contribute to the development of actinic keratosis. This allows for a more targeted approach to the treatment and prevention of future lesions.

Vitamin D

Adequate levels of vitamin D in the blood are important for proper immune function and preventing skin damage and cancer. Measuring vitamin D can help target the repletion of low levels to reduce the risk of skin damage from the sun and adequate prevention and treatment of actinic keratosis. 

Vitamin D Receptor Genetics

Vitamin D receptor (VDR) polymorphisms are associated with an increased risk of developing actinic keratosis. This can be measured via a blood test. Individuals with the TaqI polymorphism of the VDR TT/tt genotype have an increased risk of developing actinic keratosis, especially when they are fair-skinned.

Conventional Treatment for Actinic Keratosis

Dermatologists can diagnose and treat actinic keratosis using several approaches depending on the extent, type, and severity of the condition. 

At-home treatments for actinic keratosis include topical medications that are applied to the skin in affected areas, such as 5-fluorouracil (5-FU) cream, diclofenac sodium gel, imiquimod cream, and tirbanibulin ointment.

In the dermatologist’s office, one option that is frequently used is cryosurgery to freeze the lesions and get them to fall off after a few days. Very cold liquid nitrogen is applied to the affected skin, which may then develop a crust or blister before falling off in a few days. 

A medical-grade chemical peel is sometimes used to destroy the top layers of skin where actinic keratosis is found. The skin becomes red, swollen, and sore, and healing is triggered to replace the area with new healthy skin.

When an actinic keratosis is very thick, curettage can be used to scrape the lesion off of the skin, followed by electrodesiccation which heats the treated area to destroy any remaining impacted cells.

Photodynamic therapy may be used for people with many actinic keratosis lesions and/or who continue to get new lesions or lesions that return after other treatments. This treatment involves applying a solution to the skin to make it very sensitive to light and then treating these areas with blue or red light to activate the solution and destroy the actinic keratosis. 

Laser resurfacing may also be used to remove the surface layer of skin in affected areas.

Functional Medicine Treatment for Actinic Keratosis

Since many of the topical immunomodulatory agents used to treat actinic keratosis have poor side effect profiles, functional medicine treatment strategies may be used to complement care and reduce skin lesions. 

Nutrition Considerations for Actinic Keratosis

An anti-inflammatory diet rich in antioxidants like beta-carotene and vitamins C, E, and A, as well as omega-3 fatty acids, can help to keep skin healthy and mitigate the damage caused by unstable free radicals that form from too much exposure to UV radiation from the sun and lead to damage to keratinocytes.

The specific type of fat consumed seems to make a difference. Inflammatory dietary fat intake is associated with cancers of the breast, prostate, ovary, and colon. A study followed 76 patients for 24 months and showed that a low-fat diet reduced the incidence of actinic keratosis. Participants limited calories from fat to 20% of their total caloric intake, with about 15% of caloric intake from protein and 65% of calories from carbohydrates, along with emphasizing foods containing sufficient vitamins and minerals to meet the recommended dietary allowances for adults. 

Moderate intake of oily fish and wine (an average of half a glass a day), as emphasized in a Mediterranean diet, may decrease the acquisition of actinic keratosis.

Supplements & Herbs for Actinic Keratosis

In addition to using diet to reduce inflammation, several supplements, herbs, and vitamins have been studied for their ability to help treat and heal actinic keratosis.

Kanuka Honey

Kanuka honey is sourced from New Zealand and has immunomodulatory, anti-inflammatory, and anti-cancer effects. It is commonly used topically for various skin conditions. A case study showed that three months of topical application of Kanuka honey resulted in remission of actinic keratosis on the hand immediately following the treatment period with no signs of recurrence at nine months.

Birch Bark

Birch bark is rich in triterpenes such as betulin, which have antiviral, analgesic, anti-inflammatory, and antineoplastic properties. Studies show that betulin cream was as effective as cryotherapy in reducing early-stage actinic keratosis.

Petty Spurge 

The latex sap of the lactiferous petty spurge or milkweed has been traditionally used for treating skin conditions since it contains toxic diterpene esters such as ingenol mebutate that have cytotoxic activity and can influence cellular differentiation. A randomized, double-blind, placebo-controlled study found that 0.025% and 0.05% ingenol mebutate gel was highly effective at clearing actinic keratosis (75% and 100% clearing- versus 0% clearing with placebo) when applied once a day for three days. 

Vitamin D

Since vitamin D has been shown to help with immune system revolution and protection against several cancers, including non-melanoma skin cancers, those who are reducing their sun exposure to reduce the risk of further actinic keratosis should obtain adequate levels from D-enriched foods and/or from vitamin D supplements. Repleting adequate serum levels of vitamin D also improves the response of actinic keratosis to photodynamic therapy with methylaminolevulinate.

Nicotinamide

Nicotinamide is a form of vitamin B3 and the precursor of nicotinamide adenine dinucleotide (NAD+), which is needed for energy production in the form of ATP. Nicotinamide counters some of the negative impacts of UV radiation, such as immunosuppression, while enhancing DNA repair. A randomized controlled study showed 500 mg of oral nicotinamide supplementation twice a day significantly reduced rates of new actinic keratosis lesions in high-risk patients.

Complementary and Integrative Medicine for Actinic Keratosis

To minimize damage to your skin and decrease the risk of actinic keratosis, you can reduce your time spent in the sun’s strongest rays between 10 a.m. and 4 p.m. when there is the most harmful UVB radiation. Sun-protective clothing and a wide-brimmed hat can help protect the delicate skin of the face and lips that are prone to developing actinic keratosis. 

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Summary

Rough, scaly patches on the skin can develop from years of sun exposure, especially on the face, lips, ears, forearms, scalp, neck, or back of the hands. These lesions are actinic keratosis, a common precursor to squamous cell skin cancer. 

Assessing micronutrient levels and vitamin D status can help with healing the skin and preventing future actinic keratosis lesions. An integrative approach to actinic keratosis incorporates nutrition, supplements, and lifestyle measures to reduce skin damage and help to heal UV damage to the skin.