Precancers or “actinic keratosis” is one of the most common diagnosis made in the field of dermatology. They are caused by chronic sun exposure, and typically appear as dry, flaky spots of skin. Because there is a risk that these findings can advance to certain skin cancers, it is important to have a conversation with your provider to properly address how to manage these changes in the skin once they are identified. There are many treatment options for precancers, ranging from freezing individual spots to using photodynamic therapy, also known as “light treatment” by many of our patients.
This past May, I found a new red, scaly growth on my chest. I decided to use Picato, a 2 day treatment for actinic keratosis. Similar to other topical precancer medications, Picato is proven to be highly effective in treating “fields” of skin such as the face, scalp, forearms, and in my case, the chest. I was curious to see what type of reaction I would have considering this was my first precancer. I was shocked with the results.
Here is a photo of my chest prior to using Picato. The pink spot on the left side of the photo is the area of concern.
I used the first tube on a Friday night. It is a gel, and I covered as much of my chest I could with the small tube. I was able to extend it from the outside corners of my clavicles, across the top of my chest, and down centrally to where a scoop neck shirt would lie. That night, my chest became very itchy. In fact, I recall waking up in the early morning and noticing the itch. I found using a damp, cool washcloth helped soothe my skin. The next morning I noticed redness starting to spread. See the photo 12 hours after my first application below:
The itchiness remained and grew on Saturday, especially with activity that raised my body temperature such as walking my dogs or working out at the gym. After showering on Saturday night, I applied my second dose. By Sunday I noticed small blisters develop on my chest. My skin was still itchy, but I found it to be more tolerable at this point. Day 2:
On Monday, the itch was completely gone and I noticed my skin healing. The blisters resolved and I was left with small, scabs. Day 3:
The scabs healed relatively quickly and by Tuesday (or day 4), I noticed a considerable improvement. Day 4:
The following Friday, my chest was completely cleared.
The following photo was taken 2 weeks after the first application. You can also appreciate how the red spot is much improved. Day 14:
Picato allowed me to see the extent of my sun damage while treating it at the same time. And I am happy knowing that it has peeled years of sun damage in the form of precancers off my chest. With continued sun protective habits, I am hopeful to prevent similar precancers and even more concerning skin cancers.
It is worth mentioning that Picato is not necessarily for everyone. It is also very important to note that each patient’s experience with Picato may be different. I have had patients experience much more exuberant reactions, and other than presence of more precancers on the skin, it can be hard to predict who will react more severely. Also, not every red, scaly spot is a precancer. Remember, if you find a new spot or have a spot that is changing, please make an appointment to see your dermatology provider. They will discuss a plan that makes sense for you.
By: Jessie Holland, MPAS, PA-C