Sun damaged (a Carac experience)

Having grown up in Kimberley, South Africa, I was exposed to the dry heat and sun for most of my youth.  I spent many blissful sunny days at the Karen Muir Public swimming pool (named after the 12 year old Kimberley girl who set the still unbroken world backstroke record at a junior national event in the UK in 1965) with my childhood friend and his brothers soaking up the sun.   We were of course always out and about on bicycles or walking with our faces exposed to the sun - I think that Kimberley had something like 350 sunny days a year!  Unlike the USA, there was no culture of children wearing the almost ubiquitous baseball cap so we had tanned faces almost all year round.

Sun screen had been around when I was young and I do remember the Coppertone Girl billboards when I was a teenager - but even so, I had managed to get myself burned badly enough to blister several times in my life.  We certainly didn't know about the connection between sunburn and cancer until much later.  I think the sun products were all about how to get even tans and how to avoid the acute sunburn experience rather than long term protection.

A couple of years ago this all caught up with me when a squamous cell carcinoma was discovered high on my forehead.  This cancer is not dangerous if discovered early and is the second most common form of skin cancer.  It shouldn't be treated lightly though - it is a cancer and there is concern if it isn't treated in good time.  Fatalities are tied to not treating these early and the pictures that you see on the Internet can be quite disturbing.  Mine was very small and unassuming but gave me a bit of a wake up call to pay attention to the marks on my skin.


As a follow up, this year I scheduled an appointment with a dermatologist.  In America (or perhaps just in this part of the US) these things require planning and patience.  You need a referral and have to wait several months for an opening for the screening which basically involves inspecting you from head to toe for signs of growths or moles that might be problematic.

The condition that I have, caused by sun-damaged skin, is called Actinic Keratosis and is essentially scaly rough patches that you get on your face as you age.  These are fairly easy to spot in the "before" photograph of me in the series below - slightly darker than the rest of my skin.

The presence of these are evidence of sustained sun damage and the likelihood of developing any of the skin cancers (including the very aggressive melanoma) is greatly increased by this condition.  In fact many believe that actinic keratosis is an early stage of squamous cell carcinoma.  Apparently about 10% of these patches are likely to develop into cancer.

One suggested preventative treatment is to use a cream that attacks the cells on the skin that have the potential to develop into cancer.  The cream is made from a chemotherapy drug called fluorouracil which is most quickly absorbed into cells that are dividing rapidly and inhibits their ability to synthesize DNA which essentially kills the cell.

The cream apparently affects people differently and the treatment time can vary from two to four weeks.  I was told that I'd have to use the cream for about two weeks and was warned that I would be astonished at how much of my face would react to the cream and that it would end up being increasingly irritated and red as the treatment progressed.

After a few days of use, I was not showing too many signs of redness - perhaps just enough to prompt me to create an image in black and white using the red filter in Lightroom to accentuate all the red places.  I called the image Leopard Face because of how it made me look.

The truth is, that my face was beginning to look pretty grim.  The raised spots were not quite painful, but certainly noticeable - I guess a little like how you feel a few days after you have had a bad graze, the tight not-quite-itchy slightly painful feeling you get as you are recovering.

I had to apply the cream once a day - I did it before going to bed each night - and after a few days of treatment I had a borderline headache by the end of the day and was pretty aware of all the irritated areas around my face.  It was entirely bearable, but fairly unpleasant.

As you can see from the second picture, the irritated area was enough to be noticeable but not that obvious - my colleagues at work told me that I was being over-sensitive to how obvious it was.

So here is a collage of my face before, after a few days and after 2 weeks to show how the effect increased over time.   You can click on these pictures to see them in closer detail.  Because there were areas in my beard that began to react to the cream I ended up shaving my beard  - much to the alarm of the rest of my family - to give me better access to those areas.  The dermatologist had said that I didn't have to shave, but I felt more comfortable treating the skin with the beard off.

On the last day of the two week treatment I was told to use Vaseline to help the healing process.  Like a glaze, it makes the red areas appear even worse than before.  I was quite fortunate to be able to work from home during this process, because the bright red patches on my face are very distracting and it takes some getting used to.

I am told that it will take several days for the redness to back off and all of the dead skin will have to peel off my face.  Apparently after two weeks I will look at least like I did before the treatment and four weeks after the treatment my skin will be markedly better than it has been.  There may be a few persistent patches of actinic keratosis that will still have to be treated separately.

Most people who have this condition are able to treat each developing lesion by burning them off individually with liquid nitrogen.  This was an option that the dermatologist suggested to me as an alternative.  Considering though, how much of my face proved to be susceptible to this cream I am pleased to have used this more aggressive treatment despite the unpleasant view that I treated my family to as my face deteriorated over the course of the treatment.

Don't underestimate the importance of your appearance to people's impression of you.  It is an interesting experience going out looking like this.  I think that strangers assume that you have some facial pigmentation like port wine stains so you do get some looks - but mostly people ignore it.  We went out to lunch and had the waitress focus all of her attention on my wife for taking the order and checking on how we were enjoying the meal.  It is hard to ignore if you are face to face with a colleague or a customer so I would really recommend figuring out how to work from home if you can during the 2nd and 3rd weeks of treatment.

I have read on some of the forums for cancer treatment (I was prescribed Carac) that an option often exercised is to treat different parts of the face at different times.  Since some people end up having to have this treatment over 4 weeks it is hard to imagine avoiding going to work for that long.  From what I read these are for severe cases and also where the skin doesn't react as quickly as mine did.  I suppose fair people burn more easily and respond more readily to this treatment.  Either way, the longer treatments might only get unsightly after a much longer period.

A week on (6 nights after I stopped the treatment) my skin is looking a lot less angry.  My face is showing some peeling and the vaseline that I have to use to help the healing does make it look more pronounced but it is bearable.  I assume that I'll have a lot less to show for this in another week.

After 4 weeks there is still some evidence of the red below my eyes and some of the darker spots that were more inflamed than others, but overall I think that the skin on my face is quite a bit better than it was before I even started the treatment.  I have to say that I haven't noticed peeling excepting in some of the very badly affected areas.  I suspect that the peeling has not been very noticeable on my forehead for example where the skin looks very much better.








---- Feb 2012 update
I have been asked to add a photograph as an update 15 months later.  I am a little overdue for a checkup on my skin.  There are still a few noticeable sun damaged spots on the top of my forehead but as I said before these will be treated when they begin to transform.   Other than that, just more white in my beard :-)

Nov 2012 Update

One of the people who followed this Blog sent images of how he looked at the end of treatment.  Hopefully we'll also see an image in a few weeks as your skin returns to normal.  Thanks, Jim!

One week later...