PS from the PA – December 2022

Hamilton DermatologyNews

Do you ever get those rough, dry patches on your face that just don’t seem to go away? Or chronic irritation around the borders of your lips? Well, that may be a sign of chronic sun damage and precancers, also known as actinic keratosis (AKs). It is a very common diagnosis, especially in patients ages 30 and up. They show up most commonly on sun exposed areas of the face, chest, neck, and hands. I always like to say to my patients that the skin remembers everything! So, all the UV exposure that occurred in adolescence will eventually catch up to us. It is recommended to treat AKs as some of them will go on to become skin cancers such as basal cell or squamous cell carcinoma. The winter months, like all other treatments that require downtime and limited sun exposure, is the perfect time to do field therapy treatment!

Many of our patients know the dreaded liquid nitrogen canister. That cold, stinging, burning sensation is hard to forget! We use that to treat the discrete AKs we see on exam in the office. However, when there are greater than 15 AKs in one body area or there is significant sun damage, we recommend treating the entire area, calling it field therapy. I would like to highlight a few of our favorite options that can be done both in the office and at home!

The two that we do at our office include TCA chemical peels and PDTs. A LOT can be said about the mechanisms of both, but I will just cover the basics. Trichloroacetic acid (TCA) is a chemical that gets applied to the skin. During the procedure, patients will feel burning and stinging, then have a week of peeling. Typically, this treatment is covered under insurance with the added cosmetic benefit of helping with skin texture. Photodynamic therapy (PDT) utilizes ameluz, a chemical that targets sun damaged areas. After application, either done at home the night before or in the office, the treatment area gets activated by red light. There can be the addition of lasers for an additional cost. Recovery on this one is probably the worst as there is pain and swelling. Also 48 hours of zero light exposure at all. However, the results are often the prettiest cosmetically.

Home options include a compound of fluorouracil, a topical chemotherapy agent, and calcipotriene, vitamin D. The typical regimen for this is applying the cream twice a day for four days, then sometimes repeating it in a month. The fluorouracil will target precancerous areas, activating them to become red and crusty. The calcipotriene allows the medication to penetrate deeper and be a more effective treatment during a shorter period. Downtime is typically about a week, but the benefit of doing home therapy is doing the treatment on your own schedule.

All the options can be overwhelming, but Dr. Hamilton and I are happy to help with the decision-making during body checks. Call the office to schedule yours today! We are doing our yearly Christmas product sale, so all Hamilton Dermascience products are 20% during the month of December. Give the gift of fabulous skincare this holiday season!

As a reminder, our office will be closed for the holidays from December 24 until the 3rd of January.

Happy Holidays from everyone at Hamilton Dermatology!

Madison Hamilton, MMS, PA-C

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