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What Causes Actinic Keratosis (AK)?

A scaly, crusty growth that develops due to damage from exposure to ultraviolet (UV) rays is known as actinic keratosis (AK), or solar keratosis.

AKs are the most commonly occurring type of precancerous skin lesion. They usually develop on skin that has undergone frequent sun exposure or exposure to artificial sources of UV radiation, such as tanning machines.

Extensive exposure to x-rays can also cause AKs in rare cases. They usually appear on sun-exposed areas of the body such as the bald scalp, face, neck, shoulders, ears, and back of the hands and forearms.

Suncoast Skin Solutions, led by board certified dermatologist Dr. Christopher Ewanowski, provides advanced dermatology treatments to patients in Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Central Florida, Florida, and surrounding communities.

Key Causes

Sun Exposure

The primary cause for the development of almost all Actinic Keratoses is chronic sun exposure. Sun exposure leads to cumulative damage to the skin. Therefore, even short durations of sun exposure can add up over a lifetime.

Cloudy days are also unsafe as 70 to 80 percent of the sun’s UV radiation can penetrate through the clouds. These damaging rays can also be reflected off sand and snow, leading to extra exposure.

The probability of developing one or more AKs is proportional to the time spent in the sun. For this reason, elderly people and outdoor workers experience a higher risk of AK development.

The incidence of AK development is marginally higher in males as they tend to spend more time outdoors and use less sun protection compared to females.

While AKs affect some people as young as in their 20s, they occur more commonly in individuals above the age of 50. According to some experts, almost everyone over the age of 80 years has AKs.

Geographical Location

The possibility of developing AKs increases with the individual’s geographical proximity to the equator.

Other Causes

The UV rays emitted by the lamps in a tanning salon can be more concentrated and damaging than sunlight. Therefore, dermatologists advise against indoor tanning. The chances of developing AKs increase in proportion to indoor tanning.

Sometimes, AKs may also develop due to significant exposure to X-rays or various industrial chemicals.

Who is at Most Risk?

Individuals with fair skin, freckles, red or blonde hair, and green, blue or gray eyes are most susceptible to sun damage. They have a high probability of AK development if they spend time in the sun and live long enough.

Asians, African Americans, Hispanics, and people from other ethnicities with darker skin are not as vulnerable, but anyone can develop skin cancers. Skin cancers in Hispanics and African Americans usually tend to be detected at a later stage than those found in Caucasians partly due to late diagnosis.

People with weakened immune systems due to AIDS, cancer chemotherapy, organ transplantation, or other reasons are less able to ward off the harmful effects of UV rays and are more susceptible to developing AKs. In fact, extensive UV radiation exposure itself suppresses the immune system and reduces its ability to repair damage due to UV rays.

In general, AKs develop gradually and reach a size from an eighth to a quarter of an inch. Initially, they may disappear only to resurface later on. AKs can lead to itching or create a tender or pricking sensation. They may become swollen and surrounded by redness. Although rare, AKs can sometimes even bleed.

Dr. Christopher Ewanowski’s skin care clinic receives patients from Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Central Florida, Florida, and nearby areas for advanced skin treatments.

SunCoast Skin Solutions Dermatology offices are located in Tampa / Hillsborough, St. Petersburg / Pinellas County, Brandon, Lutz (2 locations), Winter Haven, Largo, Riverview, Brooksville, Ocala, Largo at Bardmoor, Daytona Beach, Sarasota, and Palm Harbor, Florida. Contact us at 1-844-786-3376 or click here.

Treatments For Actinic Keratosis (AK)

Prompt and early treatment can address almost all actinic keratoses (AKs) before they turn into skin cancer.

If a physician suspects an AK to be a precancer, they may remove some tissue for a biopsy by shaving off a part of the AK with a scalpel or scraping the lesion with a curette, which is a surgical tool with a sharp ring-shaped tip.

The doctor may also use the curette to scrape off the base of the lesion. They will stop the bleeding using an electrocautery needle, or by applying trichloroacetic acid (TCA). The patient will require local anesthesia for this procedure.

Treatment Options

There are various treatment options available for the treatment of Actinic Keratosis, depending on the patient’s age and medical condition as well as the nature of the growth. These include:

Surgical Procedures

Cryosurgery: The doctor will apply liquid nitrogen to the AK in order to freeze the tissue. Subsequently, the lesion, as well as the surrounding frozen skin, may blister or become crusty and fall off.
Curettage and desiccation: The doctor will scrape or shave off a portion or the complete lesion. They will then apply heat or a chemical agent to stop the bleeding and potentially eliminate any remaining AK cells.
Laser surgery: The doctor will use a strong light to vaporize the AK tissue.

Topical Treatments

For patients with multiple or widespread AKs, the doctor may prescribe a topical gel, cream, or solution. These can address visible as well as invisible lesions with minimal risk of scarring. This therapy is also known as “field therapy” as the topical treatments can cover a wide field of skin in comparison to a targeting single lesion.

5-fluorouracil (Carac, Efudex, Fluoroplex): A type of topical chemotherapy
Chemical peel: These peels are renowned for reversing signs of photoaging. However, chemical peels can also effectively remove some superficial AKs on the face, specifically when other techniques have been ineffective. In this procedure, the doctor applies trichloroacetic acid and/or similar agents to the face. This causes the superficial skin layers to slough off.
Diclofenac (Solaraze) and hyaluronic acid: A combination topical therapy.
Imiquimod (Aldara, Zyclara): This is a type of topical immunotherapy which prompts the immune system to create interferon, which is a chemical that fights cancerous and precancerous cells.
Ingenol mebutate (Picato): This is a quick-acting topical therapy developed from plants. An immunologic mechanism of action has been proposed.

Photodynamic Therapy

Photodynamic therapy (PDT) is quite effective for widespread lesions on the scalp and face. The doctor applies a light-sensitizing topical agent to the lesion. They then use a strong light to activate the topical agent. This helps eliminate the AKs without harming the surrounding normal tissue.

Some doctors in Europe follow the application of the light-sensitizing agent with sunlight exposure rather than exposure to artificial light. This is called daylight PDT. It is believed to be a more gentle treatment compared to standard PDT.

Combination Therapy

For AK treatment, physicians may also combine treatments for a period of time. In general, treatment regimens combine cryosurgery with PDT or a topical agent such as diclofenac, imiquimod, 5-fluorouracil (5-FU), or ingenol mebutate.

The topical meds and PDT may also be prescribed alternately every three months, six months, or one year, as determined by the doctor at follow-up skin exams.

What is Actinic Keratosis (AK) – A Potential Skin Cancer?

An actinic keratosis (AK), or solar keratosis, refers to a scaly, crusty growth which occurs due to damage from ultraviolet (UV) radiation exposure. AKs seldom develop as only one. Therefore, the plural, “keratoses,” is commonly used.

Pre-Cancer

Actinic Keratosis is believed to be a pre-cancer because if left untreated, it could develop into skin cancer. It usually progresses to the second most common form of skin cancer known as squamous cell carcinoma (SCC). Over 419,000 cases of skin cancer in the United States annually are linked to indoor tanning, including around 168,000 SCCs.

AKs are the most commonly occurring type of precancerous skin lesion. They appear on skin that has frequently experienced exposure to the sun or artificial UV light sources, such as tanning beds. In some rare cases, extensive x-ray exposure can also lead to the development of AKs.

AKs typically appear on sun-exposed body areas such as the bald scalp, face, neck, shoulders, ears, back of the hands and forearms, and neck.

They are usually raised, rough-textured, and resemble warts. Most AKs are red, but they can also be white, pink, dark or light tan, or skin-toned. They may occur in a combination of these colors as well.

At the outset, AKs are usually so tiny that they can only be recognized by touch rather than sight. Upon running a finger over them, the sensation is similar to touching sandpaper. In comparison to lesions apparent on the surface of the skin, patients may have many times more subclinical (invisible) lesions.

AKs often develop gradually and attain a size ranging from an eighth to a quarter of an inch. Initially, they may vanish only to reappear later on. Sometimes they may be itchy or produce a tender or pricking sensation. They can also become swollen or surrounded by redness. AKs may also bleed in rare cases.

Why You should be Concerned

While most AKs remain harmless, they reveal that the patient has experienced sun damage and is susceptible to the development of any type of skin cancer, most often the second most common form of the disease, SCC.

If a person has a single Actinic Keratosis, they may develop more in the future. Untreated and older AK lesions increase the probability that one or more may develop into an SCC.

Some scientists consider AK as the earliest type of SCC. In rare cases, AKs may also develop into the most common type of skin cancer, known as basal cell carcinoma.

If an SCC remains untreated, it may become invasive and even life-threatening. Another variant of AK, called actinic cheilitis, is an aggressive form of pre-cancer on the lower lips that has a high probability of developing into an invasive SCC.

When cancer arising from actinic cheilitis penetrates the outer lip layer (mucosa, mucous membranes) skin, it may bleed, develop a sore that does not heal, become infected, and even spread to internal organs.

At most, around ten percent of Actinic Keratoses develop into cancers. A majority of SCC start as AKs. However, there is no way to determine beforehand which AKs are precursors of SCC. Fortunately, there are effective AK treatments available to patients today.

SunCoast Skin Solutions Dermatology offices are located in Tampa / Hillsborough, St. Pete/ Pinellas County , Brandon, Lutz, Winter Haven, Largo, Riverview, Brooksville, Ocala, and Daytona Beach, Sarasota, Florida. Contact us at 1-844-786-3376 or click here.

Types of Melanoma Skin Cancer

Melanomas are categorized into four categories. Three types of melanomas initiate in situ, which means that they affect only the uppermost skin layers and sometimes become invasive.

The fourth type of melanoma is invasive from the beginning. Invasive melanomas are a more serious condition as they have penetrated deeper within the skin and may have spread to other body areas as well.

Superficial Spreading Melanoma

This form of melanoma is the most common and accounts for nearly 70 percent of all cases. It usually occurs in young people. As the name indicates, this melanoma develops along the upper layer of skin for some time prior to penetrating more deeply.

The initial symptom is the appearance of a flat or slightly elevated discolored patch that has uneven borders and is relatively unsymmetrical in form. The color may vary between black, brown, tan, blue, white, or red.

This form of melanoma can develop in a previously non-cancerous mole or as a new lesion. It can develop in any area of the body but most often occurs on the trunk in males, the legs in females, and the upper back in both genders.

Lentigo Maligna

This form of melanoma is similar to the superficial spreading type. It also develops close to the surface of the skin, and typically appears as flat or slightly raised mottled brown, dark brown or tan discoloration.

This type of in-situ melanoma usually develops in the elderly due to chronically sun-exposed, compromised skin on the ears, face, upper trunk, and arms. Lentigo maligna is the most commonly occurring type of cancer in Hawaii. This cancer is known as lentigo maligna melanoma when it becomes invasive.

Acral Lentiginous Melanoma

Acral Lentiginous melanoma also spreads superficially prior to penetrating more deeply. It is distinct from other forms as it typically appears as brown or black discoloration beneath the nails or on the soles of the feet or palms of the hands.

This form of melanoma sometimes develops in dark complexioned people and tends to advance more often than superficial spreading melanoma and lentigo maligna as it is diagnosed at a later stage. It develops most often in Asians and African-Americans and least commonly in Caucasians.

Nodular Melanoma

Nodular melanoma is typically invasive when it is initially diagnosed. However, the malignancy is detected when it develops into a bump. It is typically black but can also be gray, blue, brown, red, white, or skin tone.

This type of melanoma usually develops on the legs, arms, and trunk of older adults and the scalp in men. Nodular melanoma is the most aggressive form of the melanomas and is detected in 10 t0 15 percent of cases.

Surgery for Melanoma

The initial step in the treatment of melanoma is excising the primary melanoma tumor. This is usually done by surgical excision, or cutting it out. In the past decade, there have been significant advancements in surgical procedures.

Today much less tissue is eliminated than in the past. Patients usually heal well after the lesser surgery which is easier to tolerate and creates a smaller scar. Surgical excision is also known as resection, and the borders of the entire region excised are called the margins.

Kybella – Remove Your Double Chin Without Surgery

The presence of a double chin can adversely affect the facial contours and appearance of a person.

Double chins do not have serious health implications, but many people are unhappy about the appearance of a double chin, especially in pictures taken from a profile perspective.

Kybella is an effective aesthetic dermatology solution for individuals seeking to mitigate the appearance of their double chin.

A Key Note

Kybella injections work in a similar manner to the natural fat absorption process of the body. Therefore, the patient can substitute it for liposuction.

Kybella is a man-made form of deoxycholic acid, which is a substance that is naturally found in the body and helps absorb fat cells. Kybella destroys the fat cells contributing to a double chin and eliminates it quickly and efficiently.

Suncoast Skin Solutions, led by board certified dermatologist Dr. Christopher Ewanowski, provides Kybella injectable treatments to patients in Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Central Florida, Florida, and surrounding communities.

What is Kybella?

Kybella is the first and only injectable treatment to be approved by the FDA to improve the appearance of fat underneath the chin by actually destructing fat cells.

This innovative medical spa procedure melts away extra fat that makes up double chins. The substance comprises a man-made form of deoxycholic acid, which is a naturally occurring material that enables the body to absorb fat cells. Double chins can be a persistent issue. However, Kybella can destruct the fat cells that contribute to the unattractive chin appearance.

Sometimes even with every conceivable exercise and diet plan, it is still difficult to remove stubborn neck and chin fat. Most people who consume a balanced diet and exercise routinely do not have problems in toning their legs, arms, and abdomen area.

However, they may find it challenging to eliminate the fat in their submental (under chin) area. This fleshy, low-hanging area is commonly called a “double chin.”

Kybella can help patients address submental fat without the need for liposuction and other fat-reduction procedures. The treatment involves a series of Kybella injections which mimic the natural fat absorption process of the body and produces a sleeker, slimmer chin area that is picture-perfect.

Kybella Benefits

No requirement of anesthesia or surgery
Kybella is FDA-approved
Fat cells are eliminated for good
Quick and efficient treatments

How does Kybella work?

Kybella, formerly called ATX-101, is a synthetic version of the molecule deoxycholic acid, which is found naturally in the body. The human body produces this substance in the intestines to help disintegrate and absorb dietary fats.

This revolutionary treatment has been at the center of a global program which involves over 20 clinical studies with more than 2,600 patients. Upon being injected into the subcutaneous (underneath the skin) fat in the under chin area, Kybella destroys the membranes of the fat cells in this region.

These cells can no longer store fat once they are destroyed. The decimation of these fat cells is followed by the body’s natural process of elimination and healing. This process is slow but effectively removes fat in the area within four to six weeks of undergoing Kybella injections.

Which body areas can be treated using Kybella?

At present, Kybella is only approved for use in the submental area. It has been proven to be most successful in smaller areas of fat.

While it is currently not a viable treatment for problems such as muffin tops and love handles, the FDA is researching its possible benefits for these sites. After Kybells kills the fat cells, they are gone for good. This injectable procedure offers permanent benefits.

How long does Juvederm Voluma XC last?

A person may experience thinning of skin in the mid-face and facial volume loss over time due to a variety of reasons such as aging, genetics, sun damage, illness, and other factors.

Juvederm Voluma XC is one of the most effective non-surgical treatments in cosmetic dermatology to restore facial volume.

The FDA has given its approval to this procedure exclusively for adding volume to depleted cheeks. During the initial consultation, the treatment provider will discuss the potential benefits and limitations of Voluma XC, including the sustainability of its results.

Suncoast Skin Solutions, led by board certified dermatologist Dr. Christopher Ewanowski, provides dermal filler treatments to patients in Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Central Florida, Florida, and surrounding communities.

Longevity of Outcomes

The main active ingredient in Juvederm Voluma XC is hyaluronic acid (HA), which is a biocompatible substance. Many dermal fillers contain HA. However, the concentration of HA is much higher in Juvederm Voluma gel.

Additionally, the molecules are cross-linked more robustly in this filler, which enables it to provide more sustainable results to patients in comparison to other HA-based fillers.

Juvederm Voluma XC can last for up to two years, even more in some cases. This period is comparatively much longer than the average longevity of many other filler injectables, which usually last for six months to a year.

In a primary research study to establish the sustainability and effectiveness of Voluma XC, patients were injected with six syringes of this dermal filler. After two years, their outcomes were assessed. A majority of patients still found the results satisfactory.

Variability of Outcomes

Juvederm Voluma medical spa injectable treatment has estimated longevity of two years which has been proven over time. However, patients should be cognizant that individual outcomes may differ, similar to any other cosmetic dermatology procedure. Various factors will have an impact on the actual longevity of the outcomes in each case.

Factors such as the patient’s metabolism and activity level as well as the depth and location of the injection may differ in each case. Some patients may experience significant cheek volume loss and may need more units of the filler gel. The treatment gel administered in each case may differ.

In almost every case, Juvederm Voluma is likely to produce aesthetically appealing and sustainable outcomes. A majority of patients will be able to enjoy the results on the injectable treatment from anywhere between one to two years. The longevity of the treatment depends on various factors, including how the patient’s body responds to the procedure.

Robust Cross-Linking

HA is a standard substance used in many dermal fillers. However, the sustainability of the outcomes depends on how the material is prepared. Some experts use two balls of yarn, approximately the same size, to explain the strength of Voluma XC.

If one ball is wound tightly while the other is rather loosely wound, the ball that is wound more tightly will naturally take a longer period to come undone. Similarly, Voluma contains tightly cross-linked HA molecules, which enables them to stick together and sustain for longer.

Juvederm Voluma XC Before and After Photos

The FDA-approved dermal filler Juvederm Voluma XC is designed to add fullness to depleted cheeks. For people who wish to add volume to their cheeks in a non-surgical manner, this is an effective procedure.

Voluma XC has a specific application. Therefore, patients need to understand what this cosmetic dermatology treatment can and cannot do for them.

Starting Off Right

An experienced injection provider may like to present the patient with Juvederm Voluma XC before and after images during the initial consultation. Doing so can help patients understand the potential outcomes of Voluma in a better manner.

The main goal of a responsible treatment provider will be to inform the patient about the advantages and limitations of Juvederm Voluma XC dermal filler and help them make an enlightened choice on the procedure.

What are Juvederm Voluma XC Before and After Pictures?

Juvederm Voluma XC dermal filler ‘before and after photos’ refer to a pair or group of images of previous patients who have received the same filler treatment with successful outcomes.

The pictures are taken prior to the injections and after the injections when the post-treatment inflammation and redness has subsided and the complete effects of the dermal filler treatment are apparent.

The medical spa treatment provider will make sure that the images are taken with the patient’s express consent and show them to new patients in a judicious and discreet way.

The identity of the patient will remain hidden according to standard norm. The sole purpose of the provider in displaying these images is to use them as a visual tool to explain to the new patient about the potential outcomes of Juvederm Voluma XC.

Treatment Benefits

People seeking to reduce facial signs of aging by eliminating lines and folds will have various cosmetic options to choose from. This can sometimes make it challenging to select the most appropriate treatment for one’s requirements.

While some patients may need only limited correction to add fullness to the cheeks with Juvederm Voluma XC, others may need more extensive treatment.

Sometimes, the provider may recommend combining Voluma XC with Botox or another soft tissue filler treatment. Regardless of the case, the patient can make a more judicious choice after viewing Juvederm Voluma XC before and after images.

Maintaining Realistic Expectations

It is important for the patient to have clarity about the potential benefits and limitations of any cosmetic procedure. For this reason, the treatment provider may choose to display Juvederm Voluma XC before and after images to the patient at the time of the initial consultation itself. Dr. Ewanowski does his best to put any patient at ease. He knows transparency is key in these situations – for any elective surgery.

This is done to build a bridge between the surgeon and the patient – showing them these images. This enables the patient to understand precisely what to expect and what not to expect from this surgery and helps minimize any future disappointments at a stage where the results may be difficult to reverse.

This will enable the patient to make a decision that is totally suited to them and allow them to be comfortable with either door they choose to open – either signing up for the surgery or declining it.

The Consultation is Vital

The dermatologist may display Juvederm Voluma XC before and after images on their website under a section titled “Photo Gallery” but in this case, for this particular surgery, this has not occurred though this does not mean these pictures cannot be a part of the website in the future. Juvederm Voluma XC injections – these types of images will have to be seen during the consultation.

How much does Juvederm Voluma XC Cost?

The FDA-approved dermal filler treatment Juvederm Voluma XC has been specifically developed to add fullness to depleted facial areas and create a fuller, rounder face.

This innovative cosmetic dermatology procedure has been approved by the FDA to add fullness to the cheek and mid-face area.

At the time of the initial consultation, the injection provider will explain the benefits and limitation of Juvederm Voluma to the patient and discuss its estimated costs to enable the patient to make an enlightened decision.

Cost Comparison

Juvederm Voluma XC dermal filler treatment is more cost-effective in comparison to many other facial anti-aging treatments based on RF, laser, and ultrasound technologies. The time taken to complete the Voluma injectable treatment is only around 30 minutes.

Juvederm Voluma XC already contains lidocaine. Therefore, the medical spa procedure does not involve general or local anesthesia. The treatment can be undertaken in-office. Voluma is based on hyaluronic acid (HA), which is a natural substance that is found in the body.

Therefore, no prior testing is necessary before administering Juvederm Voluma. This will reduce the monetary amount of the procedure even more. Most patients will not need to incur any expenses on prescription medications and other post-treatment costs.

The patient can resume their routine activities right after the filler injections. This is another favorable financial implication for working professionals.

Cost-effectiveness

In comparison to various other HA-based dermal fillers, Voluma XC has a higher concentration of HA. For this reason, Voluma offers more sustainable and longer lasting results.

Most HA-based fillers offer outcomes that sustain for between six months to one year. Juvederm Voluma XC outcomes can last for up to 18 months, even two years in some cases. The patient should compare Voluma costs relative to its sustainability and the effectiveness of outcomes.

Cost Factors

The costs of Juvederm Voluma XC typically vary between practices and even between patients. The geographical location of the practice has an impact on the procedure costs.

Prime urban centers and busy metropolitan cities usually have higher overhead and living costs. This affects the costs of all products and services, including the cost of cosmetic procedures such as Voluma XC.

Apart from this, the credentials, skills, and experience of the treatment provide also impacts the costs as different practices may offer different quality standards to patients.

Extent of Treatment

The cost of Juvederm Voluma is usually determined on a per syringe basis. However, some providers may charge on an hourly basis. The actual injection costs may vary marginally between patients, depending on their cheek and mid-face volumizing needs and the extent of treatment necessary.

The costs of treating larger surface areas will be higher. Some patients may require regular monitoring and follow-up treatments to meet their aesthetic goals. Certain patients may also choose to undergo Juvederm Voluma with Botox or another facial treatment. The financial implications of the procedure will differ in each case.

Insurance and Finance

Juvederm Voluma XC is usually performed as an elective cosmetic treatment. This means that the patient will likely not receive insurance coverage for this procedure.

But patients can choose to pay for the treatment using a variety of payment options such as private loans, credit cards, bank loans, and financing through third-party medical care finance firms.