Dr. Sherry Ingraham of Advanced Dermatology Speaks About Actinic Keratoses Treatments

Dr. Sherry Ingraham of Advanced Dermatology speaks about Actinic Keratoses, or precancerous skin lesions, and the proper treatments for patients affected by it. She offers explanations to the following questions: What are the challenges of Actinic Keratoses? When do you prescribe Fluorouracil cream to patients? What is "treat the field"? Why use Fluorouracil cream to treat Actinic Keratoses? Why use Fluorouracil cream instead of Liquid Nitrogen? What is the importance of patient education materials? Listen for informative answers given by a board certified dermatologist.


Dr. Sherry Ingraham: Typically, when a patient presents with extensive actinic damage, they'll present with characteristic areas on the face and scalp that are erythematous. They often have lentigines, dark and light areas of sun damage. Sometimes, they'll have solar elastosis where they have yellow areas in papular areas, and these can extend over the scalp, forehead, face, ears, neck, chest, and even the forearms and dorsal hands.

Dr. Sherry Ingraham: For example, this patient who presented to my clinic was a 63-year-old male who had a previous history of skin cancer in multiple locations as well as actinic keratosis. In this photograph, you can see his forehead has modeled pigmentation as well as areas that were previously treated with liquid nitrogen, which are seen as lighter areas.

Dr. Sherry Ingraham: Oftentimes, we can see precancerous change or sun damage in a patient manifest as wrinkling, hyperpigmentation, scaling in erythematous areas, but also they can manifest as lesions that you only notice by palpating or touching them. This is a challenge we as dermatologists face because the patients themselves don't appreciate the lesions. However, we do when we examine them and touch their skin.

Dr. Sherry Ingraham: A patient that I would typically prescribe 5FU4 presents with extensive actinic damage on the face, arms, chest and neck, and often these men or women may have been treated with liquid nitrogen before and may not want to further sustain some of the hypopigmentation or scarring, especially women in the chest area I find using a cream is ideal in those circumstances.

Dr. Sherry Ingraham: The current thought in dermatology is to treat the field. We want to treat the lesions that we see, but we also know, as I tell my patients, the same sun that got you here, got you here and here, and though you may see an AK today here, they're actually probably going to occur in the similar area soon. So, we want to treat what we see and what we don't see possibly with the topical cream that will get all of those lesions.

Dr. Sherry Ingraham: The reason I often choose using a topical 5FU or fluorouracil cream is because I feel like it's our duty as physicians not only to treat lesions, but to prevent lesions. Typically, an ideal medication would both treat a problem and help prevent that problem in four years. So, it offers us that alternative. Classically, we would just treat the lesions with something like liquid nitrogen. However, now, we have an alternative, and that is to prevent the lesions as well.

Dr. Sherry Ingraham: Lifestyle is very important when choosing a treatment for a patient. I often have patients who are traveling to meetings that they have personal events, and they don't want to have a mark on their face where they were just treated with liquid nitrogen. So, in those cases, I'll give them a prescription for Fluoroplex and tell them, "After your event in a week, begin this cream." I often have patients who travel abroad for work as well, and I will tell them to use the cream after their meeting or use the cream after their personal event, and maybe repeat that cream again six months later until they're able to come back and see me in the office.

Dr. Sherry Ingraham: The reason I choose Fluoroplex for my patients is because of ease of use. It's a 1% cream, and I find that it's very well tolerated, and now even more importantly it's affordable. Patients are able to purchase this cream with the coupon for only $10, which makes it a very viable option for almost every treatment.

Dr. Sherry Ingraham: Use of a topical five FU is associated with a characteristic reaction pattern that you want for maximum efficacy of treatment. As they continue to use the cream, the area will become more erythematous. It'll also become crusted often and then mature into an eroded and necrotic appearance. This patient in particular, you see on his scalp, he's been applying the cream for approximately four weeks, and he looks exactly like we want them to look. He has modeled erythema, and we're talking about a very, very red, sometimes beefy red erythema, and you need that end point to get that inflammation associated with clearance of the actinic keratosis.

Dr. Sherry Ingraham: It's crucial to have patient education materials to give the patients. They need to see not only what patients look like that are treated, but also what patients look like during and after treatment. They need to see the erythema and the expected end point of treatment, so they knew to continue their treatment, even though they may be uncomfortable or erythematous.

Dr. Sherry Ingraham: As a dermatologist, it's wonderful to have a therapy available like Fluoroplex that I can give to my patients to treat their actinic keratosis. Beyond the treatment of actinic keratosis, it's great to be able to prevent the progression of their pre-malignant lesions into invasive skin cancer.