Prevalence of actinic keratoses and associated factors in a representative sample of the Italian adult population: Results from the Prevalence of Actinic Keratoses Italian Study, 2003-2004.

OBJECTIVE The Prevalence of Actinic Keratoses Italian Study (PraKtis) was designed to estimate the point prevalence of actinic keratoses (AKs) and associated factors in a representative sample of the Italian adult population. DESIGN A representative sample of people 45 years or older was selected from the electoral rolls according to a stratified random sampling design. SETTING A total of 180 specifically trained interviewers contacted the sampled subjects and conducted face-to-face, computer-assisted interviews and skin assessments. PARTICIPANTS A total of 12,483 subjects contacted and interviewed from March 1, 2003, through April 30, 2004. MAIN OUTCOME MEASURES History of AKs and evidence of AKs at the interview. RESULTS Overall, an estimated 34% of the Italian population reported ever having undergone a dermatological examination. A history of AKs was reported by 0.3% of the total sample. Topical therapy was the most popular treatment according to 39% of subjects, whereas 25% reported that they did not receive therapy. Based on the interviewer's judgment, the point prevalence of AKs was 1.4% (95% confidence interval, 1.2%-1.8%). Forty-two percent of people with AKs were unaware of their condition. The prevalence was higher among men than women and increased steadily with age. The prevalence increased with lighter phenotype and with more severe facial wrinkling. It also increased with the reported number of hours spent in the sun during the week and on holidays. No clear variation was observed according to the reported use of sunscreens. Lesions were usually multiple (median number, 4). There was a strong association between a history of nonmelanoma skin cancers and the presence of AKs (odds ratio, 4.5; 95% confidence interval, 1.8-11.0). CONCLUSIONS The prevalence of AKs in our study was remarkably lower than expected based on data from the United States and Australia; in Italy, AKs seem to be underdiagnosed and undertreated.