Actinic Keratoses - Naturopathic MedicineNaturopathic Medicine Summary

Naturopathic Medicine

Naturopathic Summary

Actinic Keratoses (AKs) are crusty, scaly growths that are caused by exposure to ultraviolet light.[1] AKs can progress to squamous cell carcinoma,[2] and naturopathic doctors will work with their patient to try to prevent the development of these precancers. Dietary changes along with possible supplementation may be needed as part of the treatment plan. Sun protection is an important part of the approach as well. 

Treatment Philosophy

The treatment of actinic keratosis includes the identification and avoidance of risk factors, especially sun overexposure. Once risk factors are removed, the diet can be addressed, and botanical medicines and supplementation can be used to enhance the effectiveness of the treatment and possibly prevent the development of skin cancer.

Symptoms

Actinic Keratoses (AKs) are patches of thick, scaly, crusty skin growths that are caused by ultraviolet (UV) damage from the sun.[1] Because AKs are related to UV damage, they are found on sun-exposed areas of the skin such as the scalp, face, arms, back of hands and shins.[1] These growths are often described as “a sore that doesn’t heal,” and they are more common in males and people with a fair complexion.[1]

Causes

Actinic Keratoses arise because of localized inflammation, oxidative damage, abnormal cell growth, decreased immune system,[3] and impaired cell death.[3] A small proportion of AKs can lead to skin cancer,[4] while others can resolve on their own.[5]

Risk Factors

Lifestyle

  • Tanning beds: Actinic keratoses are caused by UV damage, and tanning beds are a major contributor to the development of cancerous and precancerous skin lesions[6]

Environment

  • Sun exposure: The sun causes damage to our skin that can lead to the development of an actinic keratosis.[1] People who spend long periods of time exposed to the sun are more likely to develop these growths.[1]

Diet

  • High fat diet: In animals, a high fat-intake has been associated with increased rates of UV-induced skin cancer[7,8]

Naturopathic Therapies

Prevention and immune strengthening modalities

Actinic keratosis can progress to become Squamous Cell Carcinoma (SCC) and care must be taken to prevent this progression.[2] Because actinic keratoses develop in people with a decreased immune system,[3] the naturopathic approach to treating people with this condition would involve boosting the immune system to encourage the body to heal itself. 

Prevention of skin damage from the sun is the best way to avoid the development of actinic keratoses.[2] Avoiding UV damage by using sunscreen, wearing long-sleeve clothing and large hats, and minimizing long periods of time in the sun are methods of preventing the growth of AKs.[2]

Botanicals and Herbs

  • Cat’s Claw: In a mouse study using a topical application of an aqueous extract of Cat’s Claw (Uncaria tomentosa), the extract was shown to temporarily inhibit or delay the growth of cancerous or precancerous lesions, although the product must be applied consistently to achieve results.[9] This has not been studied in humans.
  • Sinecatechins: A botanical drug ointment that is made from the water extract of green tea (Camellia sinensis) leaves may offer protection from sun damage.[10]
  • Ingenol mebutate: The sap of the milkweed (Euphorbia peplus) plant has been used traditionally to treat Actinic Keratoses and other skin conditions. A topical drug for the treatment of AKs was created using the plant derived chemical Ingenol mebutate, which is found in the sap, and it has been found to be effective in treating actinic keratosis.[11,12]

Diet and Lifestyle

Nutrition and diet

  • Diet: Increased intake of fish or red wine has shown a reduction in AK development.[13] Additionally, a low-fat diet can reduce the rates of development of AKs in people who have a history of non-melanoma skin cancer.[7]

Supplements

  • Nicotinamide: A form of vitamin B3 called nicotinamide has been used to prevent skin cancers and may be useful for actinic keratosis[16]
  • Resveratrol: An antioxidant found in grapes and red wine, resveratrol may be useful for the prevention of UV damage, including skin cancer.[14] It may also improve the response of radiation therapies against precancerous lesions.[14] A 2015 study found that a combined treatment of resveratrol with the pharmaceutical 5-fluorouracil may be helpful for the treatment of actinic keratosis.[15]
  1. Goldenberg G, Perl M. Actinic keratosis: update on field therapy. J Clin Aesthet Dermatol.2014;7(10):28-31; PMID: 25371768 Link to research.
  2. Fernandez Figueras MT. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited. J Eur Acad Dermatol Venereol.2017;31 Suppl 2:5-7; PMID: 28263020 Link to research.
  3. Dodds A, Chia A, Shumack S. Actinic keratosis: rationale and management. Dermatol Ther (Heidelb).2014;4(1):11-31; PMID: 24627245 Link to research.
  4. Green AC. Epidemiology of actinic keratoses. Curr Probl Dermatol.2015;46:1-7; PMID: 25561199 Link to research.
  5. Berman B, Cockerell CJ. Pathobiology of actinic keratosis: ultraviolet-dependent keratinocyte proliferation. J Am Acad Dermatol.2013;68(1 Suppl 1):S10-19; PMID: 23228301 Link to research.
  6. Jones MPFF. Dermatological effects from years in the sun: compounding opportunities. Int J Pharm Compd.2006;10(5):336-342; PMID: 23974311 Link to research.
  7. Black HS, Herd JA, Goldberg LH, et al. Effect of a low-fat diet on the incidence of actinic keratosis. N Engl J Med.1994;330(18):1272-1275; PMID: 8145782 Link to research.
  8. Black HS. Influence of dietary factors on actinically-induced skin cancer. Mutat Res.1998;422(1):185-190; PMID: 9920444 Link to research.
  9. Mentor JM, Etemadi A, Patta AM, et al. Topical AC-11 abates actinic keratoses and early squamous cell cancers in hairless mice exposed to Ultraviolet A (UVA) radiation. Dermatol Online J.2015;21(4)PMID: 25933088 Link to research.
  10. Stockfleth E, Meyer T. Sinecatechins (Polyphenon E) ointment for treatment of external genital warts and possible future indications. Expert Opin Biol Ther.2014;14(7):1033-1043; PMID: 24766274 Link to research.
  11. Lebwohl M, Shumack S, Stein Gold L, et al. Long-term follow-up study of ingenol mebutate gel for the treatment of actinic keratoses. JAMA Dermatol.2013;149(6):666-670; PMID: 23553119 Link to research.
  12. Tzogani K, Nagercoil N, Hemmings RJ, et al. The European Medicines Agency approval of ingenol mebutate (Picato) for the cutaneous treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis in adults: summary of the scientific assessment of the Committee for Medicinal Products for Human Use (CHMP). Eur J Dermatol.2014;24(4):457-463; PMID: 25115145 Link to research.
  13. Hughes MC, Williams GM, Fourtanier A, et al. Food intake, dietary patterns, and actinic keratoses of the skin: a longitudinal study. Am J Clin Nutr.2009;89(4):1246-1255; PMID: 19244366 Link to research.
  14. Reagan-Shaw S, Mukhtar H, Ahmad N. Resveratrol imparts photoprotection of normal cells and enhances the efficacy of radiation therapy in cancer cells. Photochem Photobiol.2008;84(2):415-421; PMID: 18221451 Link to research.
  15. Cosco D, Paolino D, Maiuolo J, et al. Ultradeformable liposomes as multidrug carrier of resveratrol and 5-fluorouracil for their topical delivery. Int J Pharm.2015;489(1-2):1-10; PMID: 25899287 Link to research.
  16. Kim B, Halliday GM, Damian DL. Oral nicotinamide and actinic keratosis: a supplement success story. Curr Probl Dermatol.2015;46:143-149; PMID: 25561219 Link to research.