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Sun Damage

Freckles, actinic keratosis and solar lentigo.


What is it?

Freckles (ephilides) are most often seen in fair-skinned individuals, particularly those with red hair. They are a result of melanin (dark skin pigment) build-up within keratinocytes (skin cells). In winter, freckles fade as the keratinocytes are replaced by new cells. Freckles usually become less noticeable with age. They can indicate that the skin is more susceptible to sun damage. Freckles do not need to be treated.

Actinic keratosis

What is it?

Actinic keratoses (AK) are areas of sun-damaged skin. They are scaly spots that are mostly found on the parts of the skin that are frequently exposed to sun, such as the backs of hands, forearms, face and ears. They are usually harmless but can be unsightly. There is however a small risk of some AKs turning into a type of skin cancer called squamous cell carcinoma (SCC).

AK more commonly occurs in individuals that are older and fair-skinned. A tendency to burn rather than tan also predisposes a person to AKs.

How is it diagnosed?

AK is usually diagnosed on appearance of the lesion alone. However, AKs can look like a SCC so there may be some doubt. In this case, a biopsy (sample) or excision can be performed, which allows more exact assessment under a microscope.

How is it treated?

AK can be prevented by strict sun protection. Once already present there are some options.

AKs can regress by themselves and are usually not concerning. If they are flat and not causing symptoms then observation by a dermatologist may suffice. Alternatively creams such as imiquimod or 5-fluorouracil can be effective.

If on the other hand they are painful, enlarging, thickened or ulcerated then they should be treated. Treatment in this scenario usually involves removal of the defective skin cells. Options include: cryotherapy (freezing the lesion off with liquid nitrogen), photodynamic treatment (shining a red light after applying a cream that allows the skin to absorb it), curettage (scraping with a sharp instrument) and excision.

Solar lentigo

What is it?

A lentigo is an area of skin that has more skin pigment than normal parts of the skin and thus looks darker. Solar lentigenes are due to damage from the sun or sunbeds and are usually age-related. They are found on the most sun-exposed areas of the skin, which tend to be the backs of hands, face and lower legs. They can be yellow, light or dark brown in colour. Solar lentigenes are harmless.

How is it diagnosed?

A solar lentigo can usually be identified from its appearance and the way it looks using a magnifying tool called a dermatoscope.

How is it treated?

Solar lentigenes can be prevented by very vigilant sun protection. Once present, they usually don’t need to be treated. However, they may pose a cosmetic nuisance. Treatment options include cryotherapy (freezing with liquid nitrogen), hydroquinone containing creams and lasers.

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