Actinic Keratosis, or Solar Keratosis, is a lesion that generally affects adults, over 40 years of age, who often work outdoors. The lesions are located anywhere in the body, but particularly in the areas exposed to the sun, like the face and the back of the hands.
The typical lesion is flat or raised, usually characterized by multiple squamous formations with an erythematous background, and an initial diameter of 3-10 mm, but with a tendency to extend superficially.
This skin alteration, tends to occur usually on light-damaged skin, and is often associated with actinic dyschromia and elastosis.It shows atypical cytoarchitecture limited to the epidermal compartment, and for that reason it is considered a true carcinoma in situ; in some studies, the percentage of evolution towards invasive carcinoma ranges from 0.025% to 16%, and it is obvious that this percentage tends to increase in immunosuppressed subjects.
It is, however, a pre-cancerous skin lesion that tends to evolve toward spinous cell carcinoma, and for this reason it is important to apply preventive and curative therapy.
It is important to know which therapies can be used; the most practiced in USA is cryotherapy or liquid nitrogen, which, however, has a variety of side effects, such as pain, erythematous and bullous reactions, dychromia with central depigmentazion, and hyperchromic edges.
Other therapies are based on curettage, electrocoagulation, laser, Interferon and systemic retinoids; additional therapies are evolving, such as the immunotherapy based sull'imiquod 5%, anti-inflammatory topical therapy with diclofenac sodium 3% in hyaluronic acid, and photodynamic therapy with 5-aminolevulinic acid.
The choice is based on the location, extent of the lesions and possible achievable esthetic result: it is possible to combine several treatments in sequence, such as cryotherapy for hyperthrophic Keratotic lesions with subsequent applications of topical medications.
Finally, it is interesting to know how well the association between diclofenac and hyaluronic acid suppresses the growth of epithelial tumors and the phenomenon of neoangiogenesis of the skin by various mechanisms; it also induces cellular apoptosi in spinous carcinoma cells of the skin. This is in fact due to greater bioavailability of diclofenac in the Epidermis induced by hyaluronic acid.
This association represents an innovative therapeutic approach to Actinic Keratosis, as compared to other treatments that exert pro-inflammatory effects.
BIBLIOGRAPHY
DALLA CHERATOSI ATTINICA AL CARCINOMA Ugo Bottoni
CAMPO DI CANCERIZZAZIONE Mauro Alaibac e Matteo Bordignon
DICLOFENAC/ACIDO IALURONICO Gino A. Vena
Luca Gabriele Punziano
General Practitioner Specializing in Preventive Medicine and Hygiene, Umberto I Rome, Italy
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Actinic Keratosis, or Solar Keratosis, is a lesion that generally affects adults, over 40 years of age, who often work outdoors. The lesions are located anywhere in the body, but particularly in the areas exposed to the sun, like the face and the back of the hands. 
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