Exploration of the dermoscopic features of actinic keratosis

This article provides an in-depth exploration of the dermoscopic features of actinic keratosis (AK), a common skin condition predominantly affecting the elderly with a history of significant sun exposure. By examining the dermoscopic patterns of both non-pigmented and pigmented AK, this study aims to enhance clinical discernment and facilitate more accurate differential diagnoses.

Actinic keratosis, a form of keratinocytic neoplasm, predominantly emerges on the sun-exposed skin of the elderly.dermoscopy of actinic keratosis Despite its prevalence, the dermoscopic characteristics of AK have been understudied, with most reports concentrating on facial non-pigmented AKs. The "strawberry pattern" is a quintessential dermoscopic feature of facial non-pigmented AK, highlighting the importance of dermoscopy in clinical diagnosis.

Dermoscopic Characteristics of Non-Pigmented AK:

The "strawberry pattern" in non-pigmented AK is typified by a backdrop of erythema or a red pseudonetwork. This network is composed of large, unfocused vessels that are interspersed among hair follicles. Additionally, the pattern is distinguished by the pronounced visibility of hair follicle openings, each encircled by a stark white halo.

Dermoscopic Features of Pigmented AK:

Pigmented AK exhibits a unique set of dermoscopic traits, particularly on the face. These include the presence of numerous slate-gray to dark-brown dots and globules that congregate around the hair follicle openings. An annular-granular pattern and a brown to gray pseudonetwork are also characteristic of pigmented AK, setting it apart from other skin lesions.

Clinical Utility of Dermoscopic AK Features:

The recognition of AK's specific dermoscopic features is paramount for clinicians in differentiating AK from melanocytic lesions such as lentigo maligna (LM) and other non-melanocytic lesions. The differentiation is crucial for appropriate management and to prevent potential malignant transformation.

Diagnostic Challenges and Histopathology:

While dermoscopy offers a non-invasive method to identify AK, there are instances where the clinical presentation and dermoscopic findings may be ambiguous. In such cases, histopathologic examination is indispensable to confirm the diagnosis and rule out other conditions.

Dermoscopy plays a pivotal role in the accurate identification of AK, especially differentiating it from melanocytic and non-melanocytic skin lesions. The detailed examination of dermoscopic patterns not only aids in early detection but also in the formulation of effective treatment strategies. As AK can progress to squamous cell carcinoma, the importance of precise diagnosis using dermoscopy cannot be overstated.