Aktinichesky – widespread (especially among elderly people) a disease with the slow, steadily progressing current which emergence is provoked by impact on skin of direct sunshine. Primary element is the oval shelled spot localized on open sites of skin quickly enough transformed in keratoakanty – the good-quality new growth located in epidermis and the top layers terms. The health of patients is not broken. Perhaps both self-permission of process, and regeneration in cancer. Diagnostics is based on the basis of data of a biopsy. Treatment hardware and cosmetic or radical surgical.
The disease known as aktinicheskiya , statistically occurs at every fourth person 45 years are more senior and makes about 14% of all to the dermatologist. In dermatology it also carries the name of "a solar keratoz" or "a senile akantoma". Despite an obvious etiology – long hyper insolation - an illness out-of-season. Aktinichesky possesses a cumulative component: for a decade, being exposed to continuous influence of sunshine, skin asymptomatically "saves" their negative impact. And only with age, against the background of the weakening immunity, the first symptoms of a disease are shown. At the same time the person can not sunbathe, not have any contact with the sun the long period of time – primary elements all the same will appear on open sites of an integument.
Sometimes the reception of antibiotics raising a skin sensitization, the wearing close clothes causing friction on some sites terms, hormonal reorganization of an organism becomes the prime cause of rashes. By the nature primary elements of an aktinichesky keratoz - no other than consolidation of a horn layer of epidermis. The possibility of their regeneration in malignant forms of cancer of skin defines relevance of acquaintance to this disease.
Reasons of an aktinichesky keratoz
The reason causing aktinicheskiya one is a long hyper insolation, continuous ultra-violet radiation with a certain wavelength of a solar range (from 280 to 320 nanometers). But there is a lot of factors participating in emergence and development of a disease. First of all, climate. The people living highly in mountains, in the equatorial, subequatorial, tropical belt where sunny days in a year nearly 365, and temperature reaches> 35 °C in the summer have the biggest index of incidence of an aktinichesky keratoz. Aggravates risk of developing of pathology work in the open air.
The second important factor - age. The term "senile akantoma" indicates that it is a disease elderly. All to whom for 50, are in risk group. The third risk factor – light skin color, a hair and an eye. Blondes with the minimum quantity of the pigmentary cages acting in this case as a peculiar protection against hyper insolation are ill three times more often than owners of swarty skin, black hair and brown eyes. Peculiar "predictor" of emergence of an aktinichesky keratoz in old age are freckles at young people. Not the last role in developing of a disease belongs to solar burns which over and over again "prepare" skin for a disease debut; the heredity, stresses and heavy somatic illnesses forcing patients to accept hormones, immunodepressants, chemotherapy.
Aktinichesky proves nothing for decades. Skin all this time does not change the structure under the influence of ultraviolet, it accumulates negative impact of the sun in the subsoil. It is called the latent, hidden period of a disease. With age against the background of the weakening immunity the blanket of skin begins to change gradually. A part of cells of epidermis become undifferentiated, the center of preinvazivny cancer which does not sprout through the epithelium basis is formed of them, and "creeps" on a basal layer. In the course of such distribution atypical cages replace with themselves a normal epithelium, epidermis loses protective function, in it processes of an orogoveniye accelerate. Over time there comes hour "X" when atypical cages break integrity of a basal membrane, get in a term where create the new center of already malignant tumor. Up to the moment of violation of integrity of a basal layer of epidermis the disease can suddenly self-resolve.
Classification of an aktinichesky keratoz
Classify aktinicheskiya only by patomorfologichesky changes in skin layers. On localization of active process in epidermis and a term it is accepted to allocate typical options of a disease:
- Hypertrophic aktinicheskiya when in epidermis there are atypical largely nuclear cages developing a light and dark keratin. Alternation of layers of a keratin is a diagnostic sign of an aktinichesky keratoz.
- Pigmentary aktinichesky keratoz call a congestion of a large number of cells of the melanin painting the localization center in dark brown color in a basal layer of epidermis.
- Likhenoidny of aktinicheskiya is characterized by active processes on border of a basal layer of epidermis and the top layers terms where on a "corroded" keratozy basal layer of epidermis lymphocytic infiltrates are formed of cages terms.
- Proliferative aktinicheskiya arises against the background of an elastoz (colloidal dystrophy of deep layers terms), it is connected with germination in skin of cells of epidermis and formation of the centers of a giperkeratoz.
- Atrophic aktinicheskiya it is localized in the top layers terms, thinning and destroying them locally, by formation of specific "lacunas" and cracks.
- Distinctive feature of an akantolitichesky aktinichesky keratoz is with formation of the epitelialno-soyedinitelnotkanny centers in depth terms over already existing "lacunas" and "cracks". These local opukholevidny educations grow to the surface of skin.
- The Bouenoidny (bovenoidny) option of an aktinichesky keratoz – an initial stage of cancer, is characterized by a congestion of displazirovanny atypical cages both in epidermis, and in the top layers terms. Atypical cages are in so-called "dynamic balance": how many atypical cages appear, as much them perishes.
On non-standard primary manifestations distinguish atypical forms of an aktinichesky keratoz:
- Bullous aktinicheskiya which cornerstone infiltration terms neutrophils with formation of mini-abscesses in a sosochkovy layer is.
- Pedzhetoidny aktinicheskiya when in the top layer of epidermis atypical pedzhetoidny (predmelanomny) cages appear.
Symptoms of an aktinichesky keratoz
The disease unexpectedly, begins with asymptomatic emergence on open sites of an integument of the shelled, slightly infiltrirovanny reddish spots of small size, to 1 cm in the diameter, with a clear boundary. More often than others nose back skin where against the background of a spot the teleangioektaziya can see is involved in process. It is an eritematozny form of a disease. If process is localized on a forehead and an upper eyelid, primary element is the plaque with thick horn scales (a skin horn), it is hypertrophic, or horn option of an illness. Diameter of such plaques to 4 cm, at their removal appears mini-bleeding and morbidity, and the erosive surface or an island of an atrophy is sometimes bared.
Manifestations depend on a form of an aktinichesky keratoz, communication of primary element with epidermis, dermy. At a pedzhetoidny form of a disease of a rash remind a seboreyny wart because of a form and brown coloring. The pigmentary, or papillomatozny form of a disease is so shown. Aktinichesky is often localized on a lower lip where there are cracks and erosion – it aktinicheskiya heylit. Also the neck, shoulders, brushes, forearms, auricles, cheeks, a hairy part of head skin suffer from emergence of rash. Sometimes rashes are localized on a back and the top third of a stomach - depending on the open parts of a body which are most often exposed to suntan.
The developed rash can spontaneously disappear in one place, but pour out right there in another, and can regress completely. It depends on immunity of the patient and on amount of the "negative" solar energy which is saved up in skin. If the disease progresses, then very slowly. Aktinichesky requires to himself constant attention as in several years its ozlokachestvleniye is possible: around plaques the inflammatory rim, morbidity and an itch appears.
Diagnostics and treatment of an aktinichesky keratoz
It is diagnosed aktinicheskiya on the basis of clinical signs and a histologic research. The differential diagnosis is confirmed only by means of a biopsy. It is necessary to distinguish aktinicheskiya from displays of seborrhea, a good-quality likhen, senile , a red volchanka, a verrukozny nevus, psoriasis, red flat depriving, dermatofitiya of a trunk, Bowen's disease, a hondrodermatit, a prokeratoz, a keratoakantoma, planocellular and bazalnokletochny cancer of skin, a malignant melanoma and radiation dermatitis.
With an aktinichesky keratoz the dermatologist chooses a way of treatment for each patient individually on the basis of full clinical laboratory inspection. At a good-quality senile keratoz use hardware methods of removal of educations. Laser coagulation, the most popular and available at the price - a cryodestruction method is most atraumatic, painless and productive. At a hint on regeneration consultation of a dermatoonkolog and surgical intervention is shown.
Prevention of an aktinichesky keratoz
It is difficult to prevent emergence of an aktinichesky keratoz. All of us are children of the sun. Biologically we depend on it, we like to sunbathe, walk, travel, play sports in the open air. However, that by 40 years not to receive problem skin with a tendency to local cancer regeneration, it is necessary to know when to stop in communication with the Star: to sunbathe in the hours put for this purpose (from 10 in the morning to 14 in the day); to use creams for protection of skin against ultraviolet, including, if necessary and in the winter; to wear convenient sun-protection clothes and to treat very crucially artificial suntan all the year round. At the first signs of growth of a birthmark or any other "plaque" urgent consultation of the dermatologist as it is almost impossible to predict further development of a disease is necessary.