Actinic keratosis — the high-quality new growth which is localized mainly on open sites of an integument at elderly people.
Epidemiology
The actinic keratosis occurs usually at persons 50 years are more senior.
Classification
Allocate the following options of an actinic keratosis (on the basis of pathomorphologic research): • hypertrophic; • atrophic; • bouenoidny.
Etiology and pathogeny of an actinic keratosis
The actinic keratosis appears as a result of long cumulative action of UV rays on the sites of skin which are exposed to insolation. The defeat centers in most cases are located on a face and the back of brushes, is more rare in the lower third of forearms.
Clinical signs and symptoms
Elements of an actinic keratosis represent sharply outlined, dry, erythematic, slightly infiltrirovanny spots of the small sizes covered with skintight yellowish-brown scales after which removal dot bleedings develop. Adjacent sites of skin under the influence of long influence of a sunlight often atro-fichny with teleangiectasias and a dispigmentation.
The diagnosis and the recommended clinical trials
The diagnosis is made on the basis of clinical manifestations and results of a biopsy. Of a pathomorphologic picture it is characteristic focal disorganization of epithelial cells with atypia of kernels of a malpigiyev of a layer of epidermis. • At hypertrophic option the hyperkeratosis with the parakeratosis centers, a small papillomatosis prevails. Epithelial cells lose polarity, polymorphism and atypia of some of them are observed. Sometimes find a thickening of a granular layer, perinuclear hypostasis and a hypergranulosis. In the subject derma — the phenomena of an actinic elastosis. The atrophic type is characterized by an epidermis atrophy, atypia of cells of a basal layer which can proliferate in a derma in the form of tubular structures. Quite often under a basal layer cracks and lacunas are found that reminds an illness to Darya and a lupus erythematosus. The Bouenoidny type does not differ histologically from Bowen's illness. At all options of an actinic keratosis in a derma basphilic destruction of collagen and the dense inflammatory infiltrate consisting mainly of lymphocytes are observed.
Differential diagnosis
Planocellular cancer; at localization of an actinic keratosis on an auricle differential diagnosis is carried out with hondrodermatity, bazaliomy, a seborrheal keratosis, a diskoidny lupus erythematosus.
General principles of treatment of an actinic keratosis
Are shown cryotherapy (double application by a cryoprobe on 5 with, laser destruction, in persistent cases a short-distance roentgenotherapy. Apply also cytostatics: Ftoruratsil, 1 — 2% ointment, locally 2 r / days, 1 week, then break of 1 week and repeated courses (only 4 — 6). For prevention of emergence of an actinic keratosis it is necessary to use photoprotective creams.
Forecast
The actinic keratosis occasionally can be transformed to planocellular cancer, is more rare in bazaliy.
Diseases