Skin Discoloration

Actinic Keratosis

Actinic keratosis is a term derived from the Greek roots: actinic, meaning light; and keratosis, meaning a thickening or roughness of the skin’s outer surface. These appear as small persistent reddish-brown or gray, rough, scaly spots. Sometimes it may be easier to feel them than to see them. Sometimes the lesion will sting or burn, and sun exposure may heighten these symptoms.

Other signs of prolonged sun damage, including variable degrees of skin wrinkling, thinning, yellowing, reddening, and scaling, are usually also present to some degree. What causes actinic Keratosis?

Chronic repeated sun exposure is the major cause of these growths, and people with fair complexions are at highest risk. This is because their skin has less melanin, our natural pigment, which filters out ultraviolet rays of the sun. In the United States, Arizona has the highest incidence of actinic keratosis and skin cancer because here the exposure to the sun”s ultraviolet spectrum is greatest during the course of the year. Treatment

Actinic Keratosis are not skin cancers. However, they always require medical treatment because they are pre-cancerous (prone to become malignant). If treated at an early stage, these pre-cancers are highly curable. Depending on the size, location, and depth of the lesion, treatment may be freezing, using a cold substance called liquid nitrogen; or it may be application of a “burning” cream called 5-fluorouracil (5-FU), particularly for multiple extensive actinic Keratosis; or in some cases surgical removal.

Prevention

Develop a lifetime habit of sun sense. Avoid excessive sun exposure. Follow the few simple steps for sensible sun protection:

1. Watch the time. The sun’s rays are most potent between 10:00 a.m. and 2:00 p.m., when the sun is almost directly overhead. Try to schedule outdoor activities for early morning or late afternoon.
2. Cover up for comfort and protection; use a sun hat and tight-weave, light-colored clothing.
3. Use a sunscreen with a sun protection factor (SPF) of at least 15. Use a sunscreen lipstick protectant balm for the lips.
4. Avoid tanning salons and booths, sun reflectors, and lamps.
5. Outdoor activities, fresh air, and exercise are important. With proper protection, following the simple steps listed above, and using common sense and moderation, we can now enjoy the outdoors without sustaining sun injury to the skin.

Follow-up

Remember that sun damage to the skin accumulates year after year, and the “fertile soil” for the development of additional precancerous Keratosis and/or cancerous skin lesions is already laid. Therefore, not unexpectedly, new lesions will develop, but this should not be reason for discouragement. The problem will certainly be lessened with good sun protection, and it can always be controlled with regular checkup visits.

Seborrheic Keratosis

A seborrheic keratosis is a common warty skin growth seen most often in the middle-aged and elderly. It is benign and completely harmless. It does not become malignant.

What do seborrheic Keratosis look like?

Coming in all sizes and shapes, seborrheic Keratosis may be any color from flesh to tan to jet-black. They appear to be “stuck on” the skin and have a characteristic pitted surface. In their early stages, they are flat but with time they can slowly grow into large, raised, waxy, and warty skin growths. They frequently occur in large numbers and are most often seen on the back, chest, face, scalp, and body folds such as underarms and groin. They can be quite itchy.

The term seborrheic is really a misnomer because these lesions have nothing to do with oil glands. The term seborrheic refers only to their sometimes greasy appearance and to the fact that they frequently occur in areas where there are many oil glands.

What causes seborrheic Keratosis?

The cause of this benign localized proliferation of the outermost skin or epidermis is unknown. The occurrence of large numbers of seborrheic Keratosis however may be familial.

Treatment

No treatment for seborrheic Keratosis is necessary unless they are cosmetically bothersome or they are frequently rubbed or irritated, or if they itch severely.

Generally, they are easily treated in the office with application of liquid nitrogen, without any need for anesthesia.

Melasma or Chloasma

Melasma or chloasma is a brownish discoloration of the face that occurs most often in women. Men can also develop this problem. The brown color often fades in winter and gets worse in the summer.

What causes it?

Pregnancy (mask of pregnancy) is the most common cause of melasma. Women who are taking oral contraceptives are at risk of developing melasma. Sunlight is a major factor in the development of melasma.

How do I treat it?

A strong sunscreen such as Elta Block, Ombrelle, and Shade Lotion SPF 45, etc., should be applied to the face each morning. Hydroquinone 4% cream (available by prescription) applied to the face twice a day (in the morning before applying sun screen and later in the day) is the main treatment for melasma. Retin‑A cream applied to the entire face each night before bed has been shown to be an effective treatment for melasma. Dr. Guccione and Anne Carlisle, FNP, can also prescribe a combination of prescription medications that may be effective in treating your melasma. Most importantly, however, avoid intense sunlight! This brings out more brown discoloration. It is your body’s natural protection response from the sun.

Tinea Versicolor

Tinea versicolor is a chronic skin condition caused by a yeast living on normal skin of all people. In most people, the presence of this yeast on the skin is not visible. In some people, for unknown reasons, the yeast grows more actively and causes an itchy scaling rash.

What causes it?

Tinea versicolor is caused by a yeast called Pityrosporon orbiculare. People who have tinea versicolor are genetically predisposed to developing a rash when this germ is present on the skin. When the yeast grows on untanned skin, the rash is pink to brown. When the yeast grows on tanned skin, the rash looks white because the yeast blocks out the sunlight and the skin where the yeast is growing does not tan. When growing on Asian or African-American skin, the rash can look darker or lighter than the surrounding skin depending on the patient.

Can it be cured?

There is no permanent cure for tinea versicolor, but there are some medicines that may be used to keep the problem under control. Resistant cases can be treated with an antifungal cream applied directly to the skin.

The uneven pigmentation that can develop from this condition can be improved with daily alpha hydroxy acid lotion (MD Forte) application to the involved areas for several months.