Actinic Keratosis and Other Precancers

THE MOST COMMON PRECANCER :  More Than Ten Million

This figure is generally accepted as the best current estimate of the number of Americans with actinic keratosis (AK). People with a fair complexion, blond or red hair, and blue, green or grey eyes (Identify Your Skin Type) have a high likelihood of developing one or more of these common precancers if they spend time in the sun and live long enough. Location makes a difference: The closer to the equator you live, the more likely you are to have actinic keratoses.

The incidence is slightly higher in men, because they tend to spend more time in the sun and use less sun protection than women do. African-
Americans, Hispanics, Asians and others with darker skin are not as susceptible as Caucasians (Skin Cancer and Skin of Color).

Is There Cause for Concern?

Actinic keratosis can be the first step leading to squamous cell carcinoma and is therefore known as a “precancer.” Although the vast majority of actinic keratoses remain benign, some studies report that up to ten percent may advance to squamous cell carcinoma. This percentage does not sound very large, but it has a large impact. When it comes to squamous cell carcinomas, 40-60 percent begin as untreated actinic keratoses and may advance to invade the surrounding tissues. About 2 to 10 percent of these squamous cell carcinomas spread to the internal organs and are life-threatening.

Another form of actinic keratosis, actinic cheilitis, develops on the lips and may evolve into squamous cell carcinoma.

The more keratoses you have, the greater the chance that one or more may turn into skin cancer. In fact, some scientists interpret actinic keratosis as the earliest form of squamous cell carcinoma.

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

Actinic keratosis on the back of the hand. These precancers commonly occur on the face and the back of the hands.

A closeup shows elevation, roughness, and crusting. Some keratoses, like this one, are quite discrete and difficult to distinguish clinically from squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly.

Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

Skin Rashes - Where Do They Come From?

A skin rash shows up as an area of inflammation or change in the texture, and/ or color of your skin. It can be caused by a number of different things including irritation, disease, or allergic/ non-allergic reactions to foods, chemicals, plants, animals, insects or other environmental factors.

So many rashes appear because the skin is an active player in the immune system. Antigens are things like viruses or proteins that we react to. These antigens need to be presented to our immune system in a very controlled way; otherwise we would react to too many things. The skin is the site at which antigen presenting cells introduce the antigens to lymphocytes. These lymphocytes are in a sense the paratroopers of our body. A complicated process of making sure that we are not overreacting takes place. All of this occurs in the skin once these lymphocytes have been activated they produce many chemicals that cause inflammation. When we become allergic to an antibiotic or other drug, the action takes place mainly in the skin as well as in the lymph glands. Viral infections also frequently produce rashes as viral particles are presented to our immune system in the epidermis. In a sense the skin is like the schoolyard which is where many of the fights occur.

Rashes can appear on your entire body or be limited to a specific area, and what it looks like and how it feels can vary depending on the cause and type of rash. Some common types of rashes include:

* eczema (also called atopic dermatitis), which is commonly seen in children. It can cause dry, chapped, bumpy areas around your elbows and knees, and can be very itchy. It can sometimes become very serious causing red, scaly and swollen skin all over your body. (Visit Eczema Guide.ca for more information)
* irritant contact dermatitis, which is caused by your skin coming into contact with something that irritates it, such as a chemical, soap or detergent. This type of rash can be red, swollen and itchy.
* allergic contact dermatitis is caused by your skin coming into contact with something you’re allergic to, such as rubber, hair dye or nickel (which is a metal that is found in some jewelry). A nickel allergy can show up as a red, scaly, crusty rash wherever the jewelry touched your skin. Urushiol, which is an oil or resin that’s found in poison ivy, oak and sumac, can also cause this kind of rash.

If you develop a rash, don’t scratch it! If you do, the rash can take longer to heal and you might develop an infection or scar. There are a wide range of over-the-counter products available to treat rashes, but it’s important to see your doctor first and determine what’s causing the rash and the most effective treatment.

* If the rash is caused by an allergy, then treatment will focus on identifying and avoiding the allergen.
* It it’s caused by eczema, your doctor may suggest special moisturizers (emollients) to help retain the water in your skin; not only will this help to keep your skin soft and smooth, it will help reduce the itching. Short, cool showers are also a good idea because hot showers and baths can dry out your skin more. Also use a mild soap (read more on Mild Cleanser.ca ) and be sure to apply more emollients after you’ve showered.
* For poison ivy, cool showers and calamine lotion often help and if the rash is severe, your doctor may prescribe an antihistamine to reduce the itching and redness.

It’s important to try to find out what’s causing the rash because the best way to prevent it is to avoid the problem food, substance, medicine or insect. If a poison plant is your problem, learn what it looks like and avoid it. It may also help to wear long sleeves and pants when you go camping or hiking. If insect bites are causing your rash, then consider applying insect repellant before going outside. For eczema, stay away from harsh soaps that may dry out your skin, and make an effort to moisturize with creams or lotions.

By SkinCareGuide.ca

Benzoyl Peroxide and Tretinoin

When applying antiacne drugs to the skin, people should be careful not to get the medicine in the eyes, mouth, or inside the nose. They should not put the medicine on skin that is wind burned, sunburned, or irritated, and not apply it to open wounds.

Because antiacne drugs such as benzoyl peroxide and tretinoin irritate the skin slightly, users should avoid doing anything that might cause further irritation. They should wash the face with mild soap and water only two or three times a day, unless the physician says to wash it more often. They should also avoid using abrasive soaps or cleansers and products that might dry the skin or make it peel, such as medicated cosmetics, cleansers that contain alcohol, or other acne products that contain resorcinol, sulfur, or salicylic acid.

If benzoyl peroxide or tretinoin make the skin too red or too dry or cause too much peeling, the user should check with a physician. Using the medicine less often or using a weaker strength may be necessary. Benzoyl peroxide can irritate the skin of people with skin of color and cause darkened spots called hyperpigmentation on the skin. Benzoyl peroxide may discolor hair or colored fabrics.

ORAL DRUGS. Oral antibiotics are taken daily for two to four months. The drugs used include tetracycline, erythromycin, minocycline (Minocin), doxycycline, clindamycin (Cleocin), and trimethoprim-sulfamethoxazole (Bactrim, Septra). Possible side effects include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. One effective treatment is topical tretinoin, used along with a topical or oral antibiotic. A combination of topical benzoyl peroxide and erythromycin is also very effective. Improvement is normally seen within four to six weeks, but treatment is maintained for at least two to four months.

Special Conditions

People who have certain medical conditions or who are taking certain other medicines may have problems if they use antiacne drugs. Before using these products, the physician should be informed about any of the following conditions.

ALLERGIES. Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let the physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Teens who are pregnant or who may become pregnant should check with a physician before using tretinoin or benzoyl peroxide. Isotretinoin causes birth defects in humans and must not be used during pregnancy.

OTHER MEDICAL CONDITIONS. Before using antiacne drugs applied to the skin, people with any of these medical problems should make sure their physicians are aware of their conditions:
•    Eczema. Antiacne drugs that are applied to the skin may make this condition worse.
•    Sunburn or raw skin. Antiacne drugs that are applied to the skin may increase the pain and irritation of these conditions.

In people with certain medical conditions, isotretinoin may increase the amount of triglyceride (a fatty-substance) in the blood. This may lead to heart or blood vessel problems. Before using isotretinoin, adolescents with any of the following medical problems should make sure their physicians are aware of their conditions:

•    alcoholism or heavy drinking, currently or in the past
•    diabetes or family history of diabetes (Isotretinoin may change blood sugar levels.)
•    family history of high triglyceride levels in the blood
•    severe weight problems

Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Natural Acne Scar Treatments

Hormonal changes and overly active sebaceous (oil) glands that commonly occur in adolescence usually cause acne, however acne can still affect adults as well. Zits, pimples, acne, cystic skin eruptions, blackheads and white heads all fit into the acne skin malady category.

The temptation to squeeze the spots and remove the infected matter, albeit tempting, will not reform your skin to its natural radiance. In fact, secondary infection by bacteria being pushed back into the deeper layers of the skin can cause more pain, inflammation and most likely future scaring. Once the bacteria have been released, it can re-infect the surrounding skin. The facial scars are actually remnants of the bacterial infection caused by ‘procedure.’

The unfair fact is that adult acne will affect 25 percent of men and 50 percent of women in their adult lives. We know that identifying hormonal changes as the main cause of adult acne aren’t entirely proven. There isn’t just one cause. Acne in adult women can be linked to cosmetic use, some hair products and can frequently be brought on by the hormonal fluctuations associated with pregnancy. Certain types of prescription medications can also cause adult acne. Some strains of acne, such as Acne vulgaris, don’t typically show up in adults until midlife. Adult acne also forms differently, whereas adolescent acne begins on the forehead and cheek area, adult acne tends to show more on the chin, jaw line and neck.

With all this new adult acne erupting (pardon the pun) more than before, natural acne and scar treatments are gaining more acceptance as consumers want to make healthier more sustainable choices for their skincare.

Your skin has an amazing natural ability to regenerate itself and a new layer of skin growth will generally cover any scarring, but in the rare cases where this does not occur then a more advanced scar treatment is in order. Always consult with your doctor or dermatologist before beginning any facial treatments to be sure you are not causing further damage.

A healthy, well-balanced diet plays a large role in helping your body and skin to regenerate itself to its optimal condition. Many dermatologists recommend a diet high in natural minerals. These minerals are to maintain the health of the skin cells, which in turn should prevent a further outbreak of acne and repair damaged tissue. Diets, which include plenty of green vegetables, un-cooked vegetables such as carrots, spinach and cucumbers, have also helped many to maintain smooth, blemish-free skin. The idea is to try to create a new fresh layer of skin so that the scars reduced or eradicated.

Are you drinking enough water?

By consuming a regular amount of water daily, you can improve the look of your skin. The average human body is comprised of 60 percent water. Drinking more water, instead of sugar-laden sodas or energy drinks will keep the skin moist and smooth; it will also clear away the dead skin cells, flush toxins and aid in the regeneration of new skin cells. Mixing water with natural ingredients like citrus, fruit or vegetable juices, can also be helpful to exfoliate the skin.

With a proper nutritious diet, vitamins and plenty of water, most see results within a few months. It can take up to a year for acne scars to heal completely. Acne scars do not show up overnight and removing them can take the same amount of time if not more. It takes patience, but with the proper motivation for beautiful, glowing skin, it will be well worth the wait.

Of course, some scars may be so deep as to require dermalogical treatments such as lasers or painful acid peels. Try the natural methods first, as theses procedures can be quite costly. Any effort you make to regenerate your skin naturally will only help the dermatologist’s treatments even further.

Always remember to gently cleanse and moisturize your skin everyday as well. Applying harsh, drying chemicals to your acne will usually cause further inflammation and breakouts. One natural treatment that had shown good results is to mix pure sandalwood oil with rose water, apply it to your scar(s) and leave on the skin overnight. Cleanse face as usual in the morning.

Protecting Your Skin From The Sun

Higher altitude means increased levels of harmful UV exposure compared to sea level areas. UV exposure increases 8-10 percent with every 1,000 feet above sea level.  At an altitude of 9-10,000 feet, UV may be 45-50 percent more intense than at sea level. In addition, snow reflects about 80 percent of the UV light from the sun, meaning that you are often hit by the same rays twice. This only contributes to the problem, further increasing the risk for skin cancer.

The combination of higher altitude and ultraviolet (UV) rays reflected by the snow puts skiers and snowboarders at an increased risk of sun damage and ultimately, skin cancer. More than 90 percent of all skin cancers are caused by sun exposure. It’s easy to associate winter with frostbite and windburn, but most people are unaware that UV rays can be even more damaging on the slopes than on the beach,it’s important to take proper precautions while on the slopes.

Both snow and strong wind can wear away sunscreen and reduce its effectiveness, so you have to take extra precautions. To protect your skin from the bitter cold, heavy winds and winter sun, follow these important sun protection tips:
•    Use a broad-spectrum sunscreen with an SPF of 15 or higher whenever you spend time outdoors. Apply 30 minutes before hitting the slopes.Be aware that the sun’s reflection off the snow is strong even on cloudy days.
•    Apply sunscreen liberally and evenly to all exposed skin - most skiers and snowboarders do not use enough sunscreen and therefore do not get the maximum protection.
•    Use a more moisturizing sunscreen. Winter conditions can be particularly harsh on the skin.
•    Be sure to cover often-missed spots: lips, ears, around eyes, neck, underside of chin, scalp and hands.
•    Always wear a lip balm with an SPF 15 or higher. Lips are even more sensitive than most parts of the skin.
•    Reapply at least every two hours, and more often after sweating or exposure to wind and snow.
•    Carry a travel-sized sunscreen and lip balm with you on the slopes. Reapply on the chairlift, especially after a long, snow-blown run.

Cover up.
•    Wear items like ski masks, which will cover most of the skin, leaving very little exposed to the wind and sun.
•    UV-blocking sunglasses or goggles that offer 100% UV protection and have wraparound or large frames protect your eyelids and the sensitive skin around your eyes, common sites for skin cancer and sun-induced aging. The sun’s rays and glare can impair your vision, so it’s important to wear sunglasses or goggles to clearly see the terrain. Plus, it will increase your enjoyment and performance while skiing.
Be mindful of time spent in the sun, regardless of the season.
•    Keep track of the time you spend in full sunlight. If possible, ski early in the morning and later on in the day, before 10AM and after 4PM. This helps avoid long lines and decreases the amount of time spent outdoors in the most intense hours of sunlight.
•    If you are on the slopes for most of the day, take a few breaks indoors to reapply sunscreen.
•    Drink plenty of water to avoid dehydration from the sun.
Enjoy the winter season, but be sure to take care of your skin to avoid the damage the cold season can cause. The first organization in the U.S committed to educating the public and medical professionals about sun safety, The Skin Cancer Foundation is still the only global organization solely devoted to the prevention, detection and treatment of skin cancer. The mission of the Foundation is to decrease the incidence of skin cancer through public and professional education and research.