Sandpaper Skin

Sandpaper Skin is a dry rough skin condition. It is a pre-malignant skin condition.

Sandpaper Skin

Sandpaper Skin is common in elderly people. It is even found more frequently if they are often exposed to the sun’s UV rays.

Sandpaper Skin is medically called as Actinic keratosis (abbreviated AK for short) is also called solar keratosis or senile keratosis.



Sandpaper Skin

Sandpaper Skin: also called Actinic keratosis is Common on the Vertex Due to Male Pattern Hair Loss Exposing Unprotected Scalp to the UV Ray.


Actinic keratosis Seborrheic keratosis
Other names Senile keratosis, solar keratosis (differential diagnosis includes acquired mole, congenital nevus) Seborrheic verruca, senile wart ( differential diagnosis: skin tag)
Tumor characteristic

Associated cancer


Squamous cell carcinoma


Basal cell carcinoma

Location Only exposed skin part All location
Cell origin keratinocyte keratinocyte
Causes UV radiation Unknown, non-viral

Likely somatic mutation in FGFR3 gene

Texture Sandpaper feel, dry rough Smooth
Size Mostly 2-6 mm. But can reach few cm Very small – 2.5cm
Appearance Thick, scaly, crusty Pasted-on, scab
Color Light tan to dark, pink , red Light tan to dark
Symptom Mostly asymptomatic. Tender, itchy, burning or itching and bleeding Asymptomatic except aesthetic
Salient features Rough surface Smooth surface
Others Untreated lesion has 20% chance progressing to cancer Never progress to cancer.



Actinic Keratosis is Common on the Vertex Due to Male Pattern Hair Loss Exposing Unprotected Scalp to the UV Ray.

Actinic Keratosis is Common on the Vertex Due to Male Pattern Hair Loss Exposing Unprotected Scalp to the UV Ray.

The lesion is small to a few cm diameter in size. The color can be light tan to dark, pink, and red. The surface is rough like a sandpaper texture. It is located in exposed body parts like the hand, arm, neck, face, head, body, leg. They normally occurs in big number and extensively.

Sandpaper Skin: Diagnosis

Sandpaper Skin is diagnosed by various way.

Key features are that they are found in exposed body parts and having a rough surface. Confirmation is by HPE as the gold standard.

Sandpaper Skin: Treatment

Sandpaper Skin is treated by a number ways as listed.

  • 5-fluorouracil cream is effective and popular. This take up to 21 days to be effective.
  • Faster treatment is by ingenol mebutate, effective in 3 days.
  • Chemical peel
  • Laser ablation
  • Cryosurgery



Sandpaper Skin

Sandpaper Skin: Cryosurgery is Using Liquid Nitrogen Gas to Spray on the Lesson to Freeze it and then Drop Off. It Is Painless and is Very Useful for Sensitive Area Skin.


Sandpaper Skin: UV radiation is the culprit 

Sandpaper Skin is mostly caused by the damaging UV radiation of the sun rays.

The UV ray induces mutation of the keratinocyte cell and eventually cancer.

Cumulative sun exposure causes the AK. SPF 17 or more can significantly reduce incidence of AK.

Any history of sunburn is bad news. Even a single episode of sunburn can increase risk. Six or more times of sunburn can significantly increase incidence of AK. Balding is one of the main cause of AK on the scalp.

Sandpaper Skin: Prevention

Sandpaper Skin can be prevented by the following ways;

  • Limit sun exposure
  • Use sunblock, at least SPF 30 and above.
  • Sun protection clothing

Sandpaper Skin: Treatment

Sandpaper Skin may be treated by several methods:

  • Surgical treatment
  • Excision is rarely necessary
  • Shave excision can be used effectively, frequently followed by electro-desiccation.