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Having Dark Pink Spots On Face. Like Scaly Patches. Treatment?

Posted on Wed, 23 Oct 2013

Question: Hello! For about the past 2 years I have started getting occasional dark pink spots on my face, irregular in shape, that sometimes sort of flare up into red, almost scaly patches. I had a PA tell me these were not precancerous in a skin check, whee she did also freeze a couple areas that were similar that she said WERE precancerous potentially. These things won't stop coming up and they almost form thin scabs before they go away and I find them very embarrassing, and wonder if anyone else might have any idea what behaves like this and if they can be controlled. Thank you.

Answered by Dr. Ilyas Patel (2 hours later)

Brief Answer:
It seems that you are having actinic keratosis.

Detailed Answer:
Hi,

After going through history and seeing photo, I feel that you are having actinic keratosis.

There may be reddish patches with white or yellow scales.

The lesions occur on sun exposed areas.

They occur after long time ..few years after exposures.

However,they are considered pre cancerous, but ,cancer occurs only in 5 to 10 percent patients...it may be squamous cell carcinoma.

Some time the lesions go away by themselves without treatment.

Biopsy may be done to confirm the diagnosis of actinic keratosis.

Seborrheic keratosis should be ruled out,which occurs anywhere on body and have no relationship with cancer.

Best treatment is prevention of AK... Sun exposure should be minimised...
And sun screen gel may be used.

Treatment methods of AK are simple and straightforward...

1) cryosurgery... Liquid nitrogen may be used to freez the lesions.
2)surgery...surgical excisions may be done under local anaesthesia.
3)5 fluorouracil cream may be used.. There are two strenght 1% and 5%. Apply cream on the lesions. The lesions may be removed after few applications.
4)Imiquimod..it is an immuno stimulant , there is a cream to apply on lesions.
5)IPL or laser may be used for photodynamic therapy.
6)diclofenac cream..a nonsteroidal anti inflammatory cream may be used on lesions.
The lesions may be cured with less irritation and inflammation.

You discuss with your dermatologist about mode of treatment and go ahead.
Do not worry,lesions of AK may be treated with any mode of treatment easily.

But remember, prevention is better than cure.

I hope you may be satisfied with my answer.

Still, if there is any query, you are welcome.

Thanks.

Wishing you good health.

Dr. Ilyas Patel MD

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ilyas Patel (18 minutes later)

Thank you! The lesions they froze they considered to be AK's. So the fact the "scabs" come and go but are always in the same place is common of these? The reason i ask is that i have been told they are nothing to worry about, which i found suspicious, since the lesions they identified as AK's looked the same as the areas which they said i could ignore, except the AK's were actively scabbing at the time (similar to the second photo i submitted) and the faint pink blotches were in what i would consider a dormant stage. One dermstologist thought it was random inflammation from overly irritated skin and gave me a perscription strength cortisone to use for a couple weeks. During that time everything settled down to just the very faint pink spots which stayed dormant for quite a few weeks, but they did subsequently flare up in the same places as before. Does that sound consistant with the AKs?

And one last part of that question - in the US, IPL is available without having to schedule through a dermatologist, and i have access to a center that provides it, but i know IPL has many types of settings for differnent circumstances. Is there a particular "setting" for the laser i would request if i wished to try to treat presumed AK's?

I thank you so very much. I have not had much confidence in being told by one doctor and one PA to baically ignore this condition as of course i want to keep looking for solutions if there is risk or even just to minimize my pesonal embarrassment.

By the way i will also menton that i can make the pale pink areas flare up and become scaly or scabby by washing my face too vigorously or applying foundation type make up or any strong anti-aging type of lotion or creme. They are just very sensitive and reactive.
With appreciation...

Answered by Dr. Ilyas Patel (11 hours later)

Brief Answer:
AK is a UV light induced lesion.

Detailed Answer:
Hi,

Welcome back.

I think you seem anxious for your skin disease.

Your skin lesions are treated and healed.

There is only discoloration. They are not active lesions.

So, I do not think that you should worry.

I recommend to prevent the recurrance of AK by avoiding sun exposure.

However, if they relapse. You apply creams as I suggested previously.

Recently , new molecule.. Ingenol mebutate gel is also used to heal the AK lesions.
You may try it on new lesions.

For laser, you consult expert who has experience of using it in such condition.

At last, I advise to use topical applications... If you develop new lesions.

Wishing you healthy life.

Thanks.

Dr. Ilyas Patel MD

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Shanthi.E