Actinic keratoses or (AKs) are rough-textured, dry, scaly patches on the skin that are often caused by too much exposure to ultraviolet light from the sun and tanning beds. Often patients can feel these more than they can see them, and sometimes describe a sensitivity in the precancerous area. These most commonly show up on the face, scalp, and ears. They can vary in color. Sometimes skin toned to reddish brown and can vary in all different shapes and sizes.
Actinic Keratoses develop over time. Each exposure to UV light without sunscreen lends you to have the risk to develop AKs. They usually appear after the age of 40. Your risk of developing AKs increases if you have one or more of the following risk factors: a history of cumulative sun exposure, fair skin, blonde or red hair (in particular if combined with blue, hazel or green eyes), a tendency to freckle or burn after sun exposure, and a weakened immune system.
So why do we care? AKs have the potential to turn into squamous cell carcinoma; a type of skin cancer. Repeated skin checks are important for early detection and prevention. Actinic keratoses can be treated with liquid nitrogen for individual lesions. If field therapy is needed, patients can be treated with photodynamic light therapy, also mown as BLU-U.
Photodynamic therapy (PDT) is a treatment that uses certain medications called photosensitizing agents. In our office we use Amulez, in combination with a blue light to destroy the precancerous cells on the surface of the skin.
When you come in to receive your PDT, one of our providers will use an instrument to “rough” up the skin, allowing the Amulez to penetrate more efficiently. The Amulez will then be applied to the treatment area. Next you’ll have to wait the recommended time in order to allow the solution to penetrate the targeted cells. This usually is anywhere from 1-2 hours.
After that waiting period, you will return for a second part of the treatment which includes illuminating your treated lesions with the Blu-U blue light. During this blue light treatment you may experience some stinging or burning, but this is normal.
After your PDT it is very important that you avoid sunlight and any other bright lights for at least 48 hours. This makes winter the perfect time to do a treatment. Sunscreens with a physical blocker such as zinc oxide or titanium dioxide are necessary to protect against photosensitivity reactions caused by visible light during this time.
Common side effects may occur during and after your PDT. These side effects include burning and/or stinging, which may last up to 24 hours after your Blu-U treatment. Redness and swelling may also occur, as well as scaling and crusting. Moisturizers should help provide some relief during this time.
Who should see my rash? An Allergist? A dermatologist? Or both?
Many patients wondering who they should see for a rash which is suspect to an allergen.
There are two most common allergic reactions. Type I (immediate type hypersensitivity) and Type IV (delayed type hypersensitivity).
Type I hypersensitivity occurs over a rapid time period (usually minutes). These are typically reactions to inhaled or ingested environmental allergens such as pollens, grasses, dust mites, certain foods, and venoms (such as bee stings). Upon exposure to the allergen, there are blood cells that produce substances, including histamine, which rapidly elicit the symptoms of type I hypersensitivity which may include skin swelling (hives or angioedema), runny nose, and eye itching. Antihistamines are usually effective in controlling these symptoms. Hives, the most common skin symptom, may come and go but a hive rarely lasts in one specific skin location for more than 24 hours. People that have these types of allergies may benefit from prick testing, which is typically performed in an allergist’s office to attempt to determine the cause of their rash. The skin is gently pricked with a panel of allergens and, since the reaction is usually immediate, the skin test site is read in approximately 20 minutes to determine if there are allergies present.
In contrast, type IV hypersensitivity occurs over a more delayed time period (usually occurring greater than 24 hours after exposure and lasting at least many days or weeks). These are usually reactions to things the directly touch the skin and cause rash at the sites of contact. These rashes are generally referred to as allergyc contact dermatitis. Potential causes include preservatives from creams/lotions, fragrances, rubber additives, industrial chemicals, steroids, plants, and metals. Certain cells known as T-cells are recruited to the site of the allergen. This promotes a skin rash characterized by skin redness, scale, and itch. People with this type of allergy may benefit from patch testing which is typically performed in a dermatologist’s office to attempt to determine the cause of the rash. With patch testing, a panel of allergens is taped to the patient’s back and the patient typically returns to the office in 48 hours, at which time the dermatologist removes the patches and looks to see what (if any) substances the patient is allergic to.
Patients can often benefit seeing both an allergist and dermatologist. Especially with the following conditions:
Atopic dermatitis or Eczema: Eczema is linked to both genetic and environmental factors. It is connected to asthma, food allergies, and seasonal allergies. Some things can make eczema flare up, such as certain foods, stress, soaps and lotions, or cold and dry air. Both prick testing by an allergist and patch testing can be helpful.
Urticaria, or hives, are raised bumps on the skin that form because of an allergic reaction. A person may get hives after eating a food they’re allergic to or taking a medication they are allergic to, or even a bug bite.
Angioedema is swelling deep in the skin. It often happens on places like the eyelids, lips, and throat, and often happens together with hives.
All of these conditions can be diagnosed by both a dermatologist or allergist and often treated by one or both. The team work approach between an allergist and dermatologist can be beneficial. We are happy to be able to have an allergist on staff that can help diagnosis and treat our patients.