Catch-Up Time for AK Treatment
Autumn is my favorite time of year. I love the colors of the leaves, cool brisk evenings, baking with pumpkins and Sunday soup making. Fall also just happens to be a favorite season of mine in the office, too. I call it "catch-up time" for a number of reasons.
First and foremost, this is an excellent opportunity to discuss with patients the use of Efudex for the treatment of actinic keratosis (AK). Many patients decline liquid nitrogen for AKs in the summer, since it's the height of wedding season and family vacations. September and October Efudex applications will be resolved and clear just in time for the holiday season. The weather is typically less sunny and the winter sport season doesn't gear up until the first few snowfalls. I notice a higher compliance when the hot days and great desire to be outside are lessened.
I prefer to have patients apply Efudex cream twice daily to their scalp for 3 weeks and once daily for 4 weeks to more delicate areas such as the face and chest. In addition to a prescription, I like to see them after 10 to 14 days of initial usage to ensure the treatment is being tolerated well. Efudex is a powerful medication and it can be scary for first-time users. Patients are usually more than happy to return to the clinic.
Often times I will give triamcinolone cream 0.025% if extreme irritation is noted or a patient reports tenderness.
I instruct patients to apply CeraVe cream twice daily for 2 weeks following their treatment and then come into the office for evaluation.
Treatment of AKs is especially important for the prevention of squamous cell carcinomas. SCCs are the second most common form of skin cancer and represent 20% of all primary skin malignancies. The two photos I've included in this post show two cases of squamous cell carcinoma. In the photo on the right, the purple outline is SCC and the lesion to the left is an AK. Rarely do we get to see them presented side by side.