Actinic Keratoses

You have one or more spots on your sun-exposed skin called actinic keratoses. This means "sun spots," a problem which usually starts as small, red, scaly places on the sun-exposed skin areas. The importance of these spots is that they are known to be premalignant; that is, that a significant percentage of these lesions or spots will at some time turn into skin cancers. Because of this possibility, these spots need to be treated.

There are several techniques for removing these actinic keratoses. For a limited number of lesions, we usually use a technique called cryosurgery (surgery with cold). In this treatment, an application of super-cold liquid nitrogen to the spot causes some redness, swelling, and possibly slight blister formation in the area. Over 2-3 days, any blistering will subside and protective crusts form over the lesions. Subsequently, after 7-14 days, the lesions peel off, leaving smoother skin below. Sometimes this skin is slightly red for several weeks, but it will return to the near-normal or whitish coloration, usually without much trace that it was ever there.

The other excellent method of treatment for these spots is the application of a chemical to the skin of sun-exposed areas which destroys the precancerous cells themselves. The advantage of this technique is that it will destroy even those lesions or spots which are not yet visible to the eye, but which indeed are forming. The medicine is called 5-fluorouracil (Efudex), and needs to be put on and rubbed into the areas twice a day with the fingertips, unless we direct you to do otherwise. The fingers should be washed after each application, and the medicine should not be put into the eyes. The cream generates quite a bit of redness and irritation and sometimes frank weeping and soreness in the spots. Usually, the treatment is continued for two to three weeks, during which time you will have significant redness and crusting of the affected area. It is important you realize this, so that you're not too alarmed when it occurs. Tepid tap water compresses for 10-15 minutes twice daily for inf lammation will help a lot to decrease the soreness. If you have significant soreness, weeping, pus formation, or any problem which especially disturbs you about your skin during the course of the treatment, you should call the office right away for further advice.

Since there have been rare reports of topical skin allergy to Efudex, you should take special note of any blistering you develop in treated areas, and notify us should this occur. We have seen very few patients in whom allergy to Efudex has developed, but you must notify us if you see liquid-filled blisters so we may check you for this possibility.

You should also be aware that blue-eyed, red-haired, fair-skinned people of Scotch-Irish or Nordic descent have a tremendously greater sun sensitivity and predisposition toward the formation of actinic keratoses and skin cancers. It's for this reason that we advise you to avoid every bit of sunlight you can. In fact, you may go outside, but still not get the sun damage that would be expected. To do this, use two types of sunscreens - chemical and physical.

The physical sunscreen acts as a physical barrier between you and the sunlight. The best examples are broad-brimmed hats, long sleeves, and the old-fashioned parasol. These will very effectively prevent sunlight from reaching your skin; but remember that if you are around a swimming pool or white sand, you'll still get tremendous amounts of sunlight reflected onto your skin. Even grass reflects about 18 percent of the light which strikes it! Obviously, snow reflects the most sunlight, resulting in intense sun damage in skiers and during other winter activities. The message here? Don't forget your sunscreen in the summer or winter!

These sunscreening lotions contain substances which filter out the damaging rays of sunlight, but allow a very slow progressive tan to occur. We will circle appropriate agents for you to use at the end of this teaching sheet. You should be aware of a concept known as the Sun Protection Factor, or "SPF" number of sunscreens. These numbers, given on sunscreen bottles, indicate the amount of protection offered skin with the lotion, versus skin without the protective lotion. For example, if it takes you one-half hour to get a sunburn, and if you're using a sun lotion like PreSun 15 with a 15 SPF number, then you would have to stay out for over 7 hours, or 15 times your ordinary burn time to incur the same amount of redness. Be aware, however, that recent evidence shows that you are incurring damage when you are outside, even with the sunscreens on, so you should try to wear the highest SPF sunscreen you can find, and still avoid being out if you can, and wear physical sunscreens if you must be outside.

When you're in the sunlight, as you will be when you're on vacation or when you're working outside in your garden, apply sunscreen every four hours to all sun-exposed areas in order to prevent significant damage. Also, apply sunscreen one hour and again at one-half hour before swimming, and every four hours thereafter. This allows the lotion to soak into the stratum corneum, or dead layer of the skin, keeping it locked into the skin where it belongs. In recent tests, subjects used far too little sunscreen in their applications. It should be used liberally and frequently! Remember also that sun exposure and sun damage are cumulative. That is, they build up over one's entire life, from youth to old age. Sun produces progressive skin damage and more important, precancerous or cancerous changes in the skin. Many people are confused about having sun spots despite the fact that they are not in the sun any longer. This is old damage from over the years.

As a final word, please remember your lips when you're in the sun. Sunlight can sizzle a lip very quickly. Premalignant lesions and skin cancers of the lip can arise quite early. To prevent this type of damage, you should use an agent like Eclipse Lip Protectant, or Chap-Stick with 15 rated sunscreen. Lip sun damage is almost completely avoided by women who use an opaque lipstick. This is the main reason why women very rarely develop lip cancer! That very fact should emphasize to men how important it is to protect the lips, and how simple too!

Take good routine measures to shield your skin from the harmful effects of the sun's rays, and it'll last you a lifetime, looking younger in the process! As one very smart unwrinkled person said, "Before 30, you have the skin you were born with, but after 30 you have the skin you deserve!" And in regard to wrinkling, one last quote is in order from Dr. Albert M. Kligman, world-renowned dermatologist, researcher, and inventor of Retin-A (the marvelous new "anti-wrinkle cream") who has said in regard to sun damage, "The object of aesthetic dermatology is to die young, as late as possible!" Who could argue with that philosophy?

Postcryosurgical Information For Patients Who Have Had Freezing Treatments!

The spot we have frozen during your visit will show swelling and redness within a few minutes after the treatment is completed. This swelling will, in most cases and in most areas of the body, progress to blister formation. Sometimes there will be a drop of blood within the blister which can make it look blue-black.

If the swelling persists, keeping the treated part elevated above the level of your heart (raise an arm on pillows, elevate your leg on a chair, or sleep in a semi-sitting position with 3-4 pillows behind your back) will decrease the swelling. The blisters can last a varied length of time depending on the thickness of the skin, but should rupture on their own and leak a little fluid within the next one to three days.

Keep in mind that a blister is the body's protective covering and should not be disturbed. Blisters will break on their own. After the blisters break, the overlying skin should still not be removed, but you should watch carefully for redness surrounding the blister site which, if it occurs, should be reported to our office. This is to prevent a secondary infection from occurring. The blisters will crust over and will come off on their own within one to three weeks. You may wash over the area very gently after crusting occurs, but remember that wet blisters get very soggy and fragile and may break easier, depriving the healing site of its natural bandage. You should try not to irritate the site any more than is necessary.

Once the crusting occurs, you should still leave the lesions alone unless you are having increasing pain or excess redness around it. Please call us for any unusual signs that you notice or which exceed the above description.