Introduction:
Actinic keratosis(actinic keratosis) is a disease characterized by hyperkeratosis of the epidermis caused by long-term sun exposure or ionizing radiation stimulation. Also known as solar keratosis or senile keratosis. It is the most common type of epithelial precancerous skin lesion. Men who are more likely to have middle-aged or older are more likely to be exposed. The clinical manifestations are brown or yellow flat papules or plaques. A few can be converted to squamous cell carcinoma, but metastasis is extremely rare. Individuals can be treated with topical medication or physical therapy. Early surgical resection is suspected of malignant transformation.
Cause:
(1) Causes of the disease
Sunlight, ultraviolet light, radioactive heat, as well as bitumen or coal and its extracts can induce the disease, and the patient's susceptibility plays a decisive role.
(two) pathogenesis
Histopathology can be divided into 3 types: hypertrophic, atrophic, and carcinoma in situ.
Hypertrophic type: The epidermal hyperkeratosis is obvious, the parakeratosis is incomplete, the acanthal hypertrophy and atrophy exist, and the acanthosis cells are disordered and vacuolar degeneration occurs. The mitotic figures are more common, but not typical, with atypical cells.
Epidermal atrophy: Atypical cells and keratinocytes with loose spines are visible in the basal layer.
In situ cancer-like type: the epidermis is thickened, the epidermal cells are disorderly arranged and there are atypical cells, and the epidermis and dermis are clearly defined.
The superficial layer of the three types of dermis has obvious elastic degeneration, and there is a medium density infiltration mainly composed of lymphocytes.
symptom:
1. Susceptible and predilection lesions are more common in middle-aged men exposed to sunlight, such as the face, auricle, back of the hand. In male patients, skin lesions can occur in the bald area, auricle and lower lip, and women are more common in the forearm extension.
2. The clinical symptom damage is limited, with brown-red or yellow spots or plaques, and the boundary is clear, from the tip of the needle to a diameter of more than 2cm, most of which are several millimeters, the number is uncertain. It can be slightly higher than the leather surface, but it does not have a high edge. The surface is rough and keratotic scales are visible. Forcibly remove the scales, showing that the base surface below is ruddy, uneven, and papillary. Sometimes the skin lesions can be angularly raised to form a skin angle. The lesion develops slowly and has no symptoms. There may be telangiectasia around the lesion.
According to clinical manifestations, it is generally not difficult to diagnose. The diagnosis must be pathologically examined.
diagnosis:
1. Seborrheic keratosis has oily scales on the surface, soft texture, smooth surface and no hard surface layer. Histopathology shows the formation of epidermal cysts in the epidermis.
2. Discoid lupus erythematosus has dilated follicular pores and hair follicle horn plugs, and has atrophy, skin lesions are good for facial expression, especially on the cheeks and nose, which is butterfly-like.
3. Malignant freckle-like sputum occurs at the exposed site, which is a pigment spot and is not higher than the skin surface. It can be gradually expanded to a few centimeters in diameter and is brown or black. About one-third of the lesions in the elderly can develop into malignant melanoma.
4. Should also pay attention to the identification of linear epidermal squamous cell carcinoma, squamous cell carcinoma.
complication:
20% can be secondary to squamous cell carcinoma. When the lesion is combined with inflammation, erosion and ulceration, it is a sign of secondary squamous cell carcinoma.
treatment:
(a) treatment
The disease may be converted to skin cancer, so it should be treated early.
1. Systemic treatment of multiple lesions can be taken orally with B-cis retinoic acid or a retinoic acid etetate, 0.5 ~ 1.0mg / (kg · d).
2. Local medication
(1) Preparation of benzoic acid preparation: 5 ml of aminobenzoic acid, 60 ml of ethanol, 10 ml of glycerin, and water to 100 ml to prepare a coating agent of benzoic acid, once a day.
(2) Anti-tumor drugs: For general-purpose patients or anti-tumor drugs, such as 20% grass leaf fat, 5% fluorouracil or 10% fluorouracil propylene glycol, but should be followed up regularly after treatment to observe whether there is recurrence.
It has also been reported that after topical application of 1% fluorouracil solution, 5% anti-inflammatory pine cream can be applied to relieve side effects such as pain and inflammation. Or a small amount of steroid solution in 1% fluorouracil can also play the same role.
(3) 10.5% retinoid ointment or combined with 5% fluorouracil ointment is effective for refractory skin lesions.
3. Chinese medicine treatment
(1) Crystal paste rubbing: The so-called crystal paste is 15g of mineral lime, researched into fine powder, soaked with concentrated alkali water (about 100m1). The alkaline water is 2 fingers higher than the lime surface, and 50 grains of glutinous rice are taken and sprinkled on the ash. Soak for 1 day and night, take out the rice and smash it into a paste. Once every 2 days in winter. Apply crystal cream to the skin lesions, do not hurt normal skin, and heal after dislocation.
(2) Decolorization or black peeling stick therapy: Apply the cream to the skin lesion after softening and softening. After 3 to 5 days, remove the ointment and scrape off the softened keratin with a blunt knife. If it does not heal, repeat it until the lesion disappears. It can also be used after the skin lesions are thinned, and then rubbed with 5-fluorouracil cream, the effect is better.
4. Physical therapy Carbon dioxide laser method, electrocautery method, liquid nitrogen freezing method can quickly remove skin lesions, and fewer adverse reactions.
5. Surgical resection can be surgically removed for skin lesions suspected of having cancer or cancer.
6. X-ray irradiation treatment.
(two) prognosis
20% can be secondary to squamous cell carcinoma. It is generally believed that squamous cell carcinoma with actinic keratosis is non-erosive, rarely metastasized, and has a good prognosis.
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