Solar keratoses symptoms are as follows:

• The lesions begin as small, dry, rough spots that are easier felt than seen and that have what is often described as a sandpaper like texture,
• With time, the lesions enlarge, usually becoming red and scaly,

• In some cases, a hard, wart like surface,

• Most lesions are only 3-10 mm, but they may enlarge to several centimeters in size,

• Color as varied as pink, red or brown,
• Itching or burning in the affected area.

The patient with solar keratoses is an elderly, fair-skinned, sun-sensitive person. The lesions arise in areas of long-term sun exposure, including the face, ears, and, in men, bald scalp, as well as in the dorsal forearms and hands.

Patients may develop multiple lesions within a single anatomic area, to the extent that the lesions collide and produce confluent solar keratoses over a relatively large area. The following variants can occur:

• Brown (pigmented solar keratoses),
• Atrophic,
• Bowenoid,
• Lichen planus like,
• Exaggerated hyperkeratoses – Produces a hornlike projection, known as a cutaneous horn, above the skin surface.

Common places to solar keratoses are as follows:

• face
• forearms
• hands
• scalp
• ears
• lower legs

Solar keratoses are a reflection of abnormal skin cell development due to DNA damage. Solar keratoses are caused by UV rays. Both epidemiologic observations and molecular biologic characteristics of the tumor cells suggest UV light is sufficient to induce solar keratoses. Sensitivity to UV light is inherited. Solar keratoses occur more frequently in fair, redheaded, or blonde patients who burn frequently and tan poorly. Increased sun exposure and higher intensity exposure increase the chance to development of solar keratoses. Immunosuppression following organ transplantation dramatically increases the risk of developing solar keratoses.

Solar keratoses are more likely to appear if the immune function is poor, due to ageing, recent sun exposure, predisposing disease or certain drugs.

An solar keratoses sometimes disappears on its own, but it typically returns after more sun exposure. Because it’s impossible to tell which patches or lesions will develop into skin cancer.

Treatment of a solar keratoses requires removal of the defective skin cells. Epidermis regenerates from surrounding or follicular keratinocytes that have escaped sun damage.

Tender, thickened, ulcerated or enlarging solar keratoses should be treated aggressively. Asymptomatic flat keratoses may not require active treatment but should be kept under observation.

Medications:

If have several solar keratoses, may be better served by treating the entire affected area. Prescription products that can be applied to skin for this purpose include:

• Topical 5-fluorouracil (5-FU) cream,

• Imiquimod cream,
• Ingenol mebutate gel,
• Topical diclofenac gel.

These creams may cause redness, scaling or a burning sensation for a few weeks.

Photodynamic therapy:

Photodynamic therapy uses a light-sensitizing compound that preferentially accumulates in solar keratoses cells, where it can be activated by the appropriate wavelength of light. Delta-aminolevulinic acid is a component of the heme biosynthetic pathway that accumulates preferentially in dysplastic cells. Once inside these cells, it is enzymatically converted to protoporphyrin IX, a potent photosensitizer. With exposure to light of an appropriate wavelength, oxygen free radicals are generated and cell death results.

Surgical and other procedures:

If have a few solar keratoses, doctor may recommend removing them. The most common methods include:

Freezing (cryotherapy): Solar keratoses can be removed by freezing them with liquid nitrogen. Doctor applies the substance to the affected skin, which causes blistering or peeling. As skin heals, the lesions slough off, allowing new skin to appear. Cryotherapy is the most common treatment. It takes only a few minutes. Side effects may include blisters, scarring, changes to skin texture, infection and darkening of the skin at the site of treatment.

Scraping (curettage): In this procedure, surgeon uses a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which the doctor cut and destroy the affected tissue with an electric current. This procedure requires a local anesthetic.

It can be difficult to distinguish between noncancerous spots and cancerous ones. So it’s best to have new skin changes evaluated by a doctor, especially if a spot or lesion persists, grows or bleeds. SO, early analyze is essential.

• Oxford hand Book of medical Dermatology
• ABC Of Dermatology
• Clinical Dermatology
• Andrew’s Diseases of the skin