These scaly patches of skin are the result of a lifetime of sun exposure. They are typically 1-2 mm in length and up to 1 cm in diameter, although their roughness makes them easier to feel than to see.
The lesions on your scalp have been classified as actinic keratosis, also known as solar keratosis, based on the prescribed therapies.
Although these patches may be ugly, the primary reason to treat them is that 5 to 10 percent of them grow into squamous cell carcinomas, which are malignant.
This kind of skin cancer often affects the sun-exposed parts of the skin.
Fortunately, squamous cell carcinoma is rarely fatal, although it can spread to other parts of the body and can be disfiguring.
Efudix is a chemotherapeutic treatment that eliminates the precancerous cells that grow in actinic keratosis by inducing inflammation while leaving the underlying healthy tissue unharmed (though it must be used with care).
Some people require a second round of treatment to entirely remove the lesion; otherwise, it will grow again.
5% of 32 studies of four different therapies were evaluated as superior in a review. 5-fluorouracil, the medicine you had (its brand name is Efudix), was deemed the most effective.
One study involving 624 patients with five or more actinic keratosis lesions on their heads (in one continuous area measuring 25 cm2 to 100 cm2) found that 12 months after the initial treatment, 75% of patients experienced at least a 75% reduction in the number of skin lesions — a success rate significantly higher than with the other three treatments.
Solacutan is a gel formulation of the non-steroidal anti-inflammatory medication diclofenac, which may decrease inflammation. It is applied twice daily for two to three months, however, its effectiveness is inferior to that of 5-fluorouracil. According to research, it heals actinic keratosis in 40% of patients.
In your extended letter, you state that you are back on Efudix and ready to see your dermatologist once more.
Be assured that the risk of malignant alteration is low and that you are currently receiving specialized care; however, it may take several months for your skin to clean up. However, eventually, you will notice a significant improvement.
My left knee needs replacement and my left foot has osteoarthritis. Both causes of pain are continuous and at times unbearable. My doctors do not advocate surgery in light of my medical history. Is there a drug that could assist alleviate the pain in my feet, and will a brace benefit my knee?
Gary Jones, resident of Ammanford.
Given your medical history, it is understandable that the orthopedic specialist is hesitant to perform surgery, as both a general anesthetic and a regional anesthetic pose dangers.
Your extended letter adds that you’ve had two heart attacks and that you have stents in the blood vessels surrounding your heart and in the artery supplying your left leg, probably due to fatty buildup.
This means that the blood flow to your left leg is not optimal (and if the left leg is impacted, likely, the right leg will also be affected), increasing the chance of surgical complications.
But there are more choices to assist you to regain as much movement as possible.
The greatest contribution you can make to alleviating your pain is to lose weight (you mention that you’ve gained 3 st since last summer). When patients with hip, knee, or ankle pain lose weight, I am always astounded by the extraordinary improvement they experience.
I would recommend consulting with a dietician who can take a comprehensive medical history and recommend a diet.
I would propose a diet low in carbohydrates.
Without knowing more about the state of your left foot, I am unable to provide precise recommendations. However, a podiatrist may be able to prescribe orthotics that may adjust the strains within your foot when bearing weight.
Your primary care physician should be able to send you to a dietician and a podiatrist, and I recommend that you begin a low-carbohydrate diet immediately.
