Actinic Keratosis During Pregnancy

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Elizabeth has red hair and freckles. She burns easily when her skin is exposed to the sun. She is also one of the many women who have gotten pregnant over age 40 with the help of assisted reproductive technology. She’s about 5 months along when she discovers a rough, scaly patch on the skin of her left forearm about an inch in diameter. It itches a little and bleeds when she scratches it. She chalks it up to pregnancy hormones and applies steroid cream to it. A month later, the scaly patch has not gone away, so she makes an appointment with her doctor. Elizabeth’s doctor tells her she has actinic keratosis.

What is Actinic Keratosis?

Actinic keratosis is a skin condition that is not associated with pregnancy. It takes years to develop and is usually seen in people over the age of 40. It is caused by years of exposure to harmful UV rays from the sun or tanning beds. However, UV rays from the sun are getting stronger, so we may start seeing actinic keratosis in younger populations. Furthermore, more women over 40 are becoming pregnant making actinic keratosis a condition that could be commonly seen in pregnancy in this group of women.

Actinic keratosis is a dry, rough, scaly patch on skin, sometimes accompanied by itching or burning. A person can have one or multiple patches, that are roughly 2.5 centimeters (1 inch) in diameter. These patches usually show up on sun-exposed areas, such as the ears, face, arms, or neck. If untreated, it can proceed to a type of skin cancer called squamous cell carcinoma. Not all actinic keratoses become skin cancer. It’s important to visit your doctor if you suspect you have actinic keratosis so she can determine a proper course of treatment.

What are the Risk Factors for Actinic Keratosis?

Elizabeth has many risk factors for developing actinic keratosis. First, she has a light complexion and her skin burns quickly when she is exposed to the sun. Though she has avoided tanning beds thus far, she has had multiple sunburns over the course of her life. Finally, she is over 40. Other risk factors that Elizabeth doesn’t have are a history of skin cancer or a weakened immune system.

People with the following risk factors are more likely to develop actinic keratosis:

  • Over 40
  • Fair complexion that burns easily or freckles
  • History of multiple sunburns
  • Exposure to tanning beds
  • History of skin cancer
  • Immune-compromised.

 How Can Actinic Keratosis Be Prevented?

When Elizabeth was a teenager, she often went to the beach without putting on sunscreen. She just didn’t like the way it felt on her skin. In addition to that, she wanted to fit in with her friends and was too embarrassed to wear a hat or a cover up. As a result, she often came home with a peeling sunburn. Even though she started protecting her skin in preparation for a day at the beach as a grown up, the skin on her left forearm went unprotected while the sun streamed in through the window of her car during her daily commute.

You can prevent actinic keratosis by always wearing sunscreen with a high (30 or more) SPF and by covering up arms with long sleeves (think about it when you’re driving). Wearing a wide-brimmed hat when out in the sun will help protect the delicate skin on your face and lips. Furthermore, you should NOT frequent tanning beds. Contrary to some beliefs, there is nothing healthy about excess UV exposure. DO frequently check your skin for changes, paying special attention to sun-exposed areas. Remember, actinic keratoses can be removed, eliminating the risk of progression to skin cancer.

How is Actinic Keratosis Treated?

There are multiple ways to treat actinic keratoses. According to the American Academy of Dermatology, treatment could be done at home with topical prescription medication (medication you put on your skin). These medications include 5-fluorouracil (5-FU) cream, diclofenac sodium gel, imiquimod cream, or ingenol mebutate gel. Treatment could also involve cryotherapy, chemical peel, curettage, photodynamic treatment, or laser resurfacing.

Treatment options for actinic keratosis:

  • 5-fluorouracil (5-FU) cream
  • diclofenac sodium gel
  • imiquimod cream
  • ingenol mebutate gel
  • cryotherapy
  • chemical peel
  • curettage
  • photodynamic treatment
  • laser resurfacing

If you are pregnant and if you think you have developed actinic keratosis, visit your doctor right away. She will determine whether treatment is required and which treatment option to pursue that will be safest for both you and for your pregnancy.

Janette DeFelice
Dr. Janette DeFelice is a writer currently focusing on how the changing environment affects our health. She holds a Doctor of Medicine degree from Chicago Medical School where she taught clinical and diagnostic skills to beginning medical students, and a Master’s degree in Humanities from the University of Chicago. She also has a Bachelor’s degree in Political Science. Her writing can be seen online at BeTheChangeMom, ChicagoNow, and Medium, and she’s very excited to have published her first novel, Delia Rising: A Ballet in Three Acts. She lives in Chicago’s west suburbs with her school-age twins, her husband, and a family cat named Clara Barton.

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