SKIN CONCERNS BY AGE 41 – 60

ACTINIC KERATOSIS

Actinic keratosis is characterized by single or multiple, dry, rough like sandpaper, adherent scaly areas on the skin. Actinic keratoses are caused by sun exposure and are commonly found in  areas with more sun exposure such as the face, ears, neck, scalp, chest, forearms, and hands.

Actinic keratosis can progress to squamous cell carcinoma, which is a type of nonmelanoma skin cancer.

WHAT CAUSES ACTINIC KERATOSIS?

Risk factors for actinic keratosis include sunlight, ultraviolet radiation, and human papillomavirus in fair-skinned individuals (light colored hair, eyes, and skin). It is more common in men, outdoor workers, and sportspersons.

TREATING ACTINIC KERATOSIS

Treatments may include treating individual actinic keratosis with cryotherapy or cryosurgery or treating early actinic keratosis that are not visible to the naked eye with topical cream. The best method of prevention is to apply UVB/UVA sunscreens with SPF 50+.

 

REFERENCES

  • Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol 2000;
    42:4.
  • Flohil SC, van der Leest RJ, Dowlatshahi EA, et al. Prevalence of actinic keratosis and its risk factors in the
    general population: the Rotterdam Study. J Invest Dermatol 2013; 133:1971.
  • Duncan KO, Geisse JK, Leffell DJ. Epithelial precancerous lesions. In: Fitzpatrick’s Dermatology in General
    Medicine, 7th ed, Wolff K, Goldsmith LA, Katz SI, et al. (Eds), McGraw-Hill, New York 2008. Vol 1, p.1007
  • ALOPECIA (HAIR LOSS)
  • Alopecia, or hair loss, can occur on the scalp or other parts of the body. Depending on the
  • cause, hair loss can be temporary, permanent, or associated with another underlying disease.

 

 

 

WHAT CAUSES ALOPECIA?

There are many different causes of hair loss that include:

  • Genetics: Inherited from mother and/or father.
  • Hormones: A group of hormones called androgens act on hair follicles of the scalp
  • Injury: Excessive hair pulling, excessive brushing, or surgery
  • Autoimmune or other systemic disease
  • Child-bearing
  • Medications
  • Infections

 

TREATING ALOPECIA

The progression of alopecia gradually occurs over years to decades. Depending on the underlying cause of the hair loss, treatment options include topical and oral medications to reduce the rate of hair loss or stimulate hair follicle growth. Unfortunately, hair loss may be difficult to treat.

REFERENCES

  • Breitkopf T, Leung G, Yu M, et al. The basic science of hair biology: what are the causal mechanisms for the disordered hair follicle? Dermatol Clin 2013; 31:1.
    Price VH. Treatment of hair loss. N Engl J Med 1999; 341:964.
  • Otberg N, Shapiro J. Hair growth disorders. In: Fitzpatrick’s Dermatology in General Medicine, 8th
  • ed, Goldsmith LA, Katz SI, Gilchrest BA, et al (Eds), McGraw-Hill, New York 2012. Vol 1, p.979.

 

 

 

SKIN CANCER

Two types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Risk factors include fair skin, light hair and eye color, red hair, older age, northern European ancestry, smoking, and increased number of previous sunburns. Commonly found on the face, chest, and back. The diagnosis of skin cancer is made while examining the skin and is confirmed with a skin biopsy. The primary method of preventing non-melanoma skin cancers is sun protection.

 

WHAT CAUSES SKIN CANCER?

There are many different causes of skin cancer that include:

  • Genetics
  • Ultraviolet radiation in sunlight
  • Chronic arsenic exposure
  • Radiation therapy
  • Long-term immunosuppressive therapy

 

TREATING SKIN CANCER

Treatment options include surgical excision or Mohs micrographic surgery to ensure the complete removal of the skin cancer while preserving the overall cosmetic appearance. After treatment, close follow-up and regular skin examinations are recommended to prevent new and recurrent skin cancers.

 

REFERENCES

  • Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol 2018; 78:237.
  • de Vries E, Trakatelli M, Kalabalikis D, et al. Known and potential new risk factors for skin cancer in European populations: a multicentre case-control study. Br J Dermatol 2012; 167 Suppl 2:1.
  • Stratigos A, Garbe C, Lebbe C, et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer 2015; 51:1989.

 

 

 

MELANOMA

Melanoma is the most serious type of skin cancer. It is the fifth most common skin cancer in the United States. Melanoma develops in melanocytes, or the cells that produce the pigment that gives your skin its color. The etiology is unclear; however, the known risk factors include fair skin, history of severe sunburns, tanning beds, family history of melanoma, immunodeficiency, or having multiple moles on the body.

 

WHAT CAUSES MELANOMA?

Melanoma is the result of an uncontrolled growth of melanocytes found in the skin. Melanoma can form in normal skin, moles, freckles, eyes, nails, or mucous membranes (nose, mouth, esophagus, anus, urinary tract, and vagina). The first sign of a melanoma may be a freckle or mole that is initially flat and becomes thickened, raised, or itchy with associated tenderness, bleeding, or crusting. Melanoma is diagnosed with a skin biopsy and histopathology examination.

 

TREATING MELANOMA

If detected early, melanoma can be treated successfully. Treatment options for melanoma include surgical excision, immunotherapy, chemotherapy, and radiation. In addition to routine skin examinations by a clinician, we recommend performing self-skin checks monthly at home by checking for the following signs (ABCDE): asymmetry, border irregularities, color variations, diameter > 6 mm, evolution, or any changes in size, shape, or color.

 

REFERENCES

  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69:7.
  • American Academy of Dermatology Ad Hoc Task Force for the ABCDEs of Melanoma, Tsao H, Olazagasti JM, et al. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015; 72:717.
  • Levit EK, Kagen MH, Scher RK, et al. The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol 2000; 42:269.
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