Back in the early 1960s when I was a wee young thing, we didn't pay much if any attention to the long-term effects of sun exposure. By we, I mean my family, and many other families. Now, in 2015, I wish things had been different all those decades ago ...
TRIGGER WARNING: There are photos below the fold, showing skin reddening and blistering. Some readers may be sensitive to this sort of image.
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More after a short pause for a delicious orange croissant.
Last chance to bail out before unveiling a couple of nasty skin photos below. Well maybe they're not so bad, but some people don't like to see such things.
During my early years, our family owned a cottage in a little lake resort village about an hour's drive from home. In summers, I spent lots of time outdoors around the cottage and at the beach, much of it wearing little more than a bathing suit.
There's a price to be paid for that, and I'm paying it now.
Yes, there were sunscreens, or as we called it then, "suntan lotion". The emphasis was more on the promotion of browning, and prevention of burning was secondary. Bad move. Nobody had even heard of "SPF" until the 1970s. Serious discussion of the sun's role in relation to skin cancer didn't reach the public until the 1980s.
Coppertone, a well known brand, was famous for its ad campaign in the 1950s and 1960s featuring a little girl with her swimsuit bottom being pulled down by a dog:
The campaign featured the slogan "Don't be a paleface!". Yes, they actually said that. I can remember seeing a billboard-size version of that ad at the beach, close to a store that sold beachwear and that kind of stuff.
Meanwhile, some of us burned. Sunburn is a nasty thing, and I had lots of them back in those years. Redness, peeling skin, itchy, painful skin. The works. My arms suffered the brunt of it, but it also hit shoulders, forehead, nose, scalp, back of the neck, and ears. I'm a white guy. A particularly white guy. Not albino white, but noticeably white. When you hear talk of "fair complexion", that's me they are talking about. Sometimes I used to joke that I have two levels of suntan: ivory white, and lobster red. It's a really, really, bad joke, not funny at all in retrospect.
But you know, we all thought this would pass, each time we got burned. Nobody really talked about the fact that these sunburns were just the surface indication of long-term damage that was being inflicted, over and over. We didn't know.
A few years ago, I started to notice some random blotches on my arms, blotches with a slightly rough texture to the touch. I was referred to a dermatologist, who pretty much started the conversation with "did you have bad sunburns as a kid?" Yup. A biopsy was taken of one of the nastiest looking ones (it turned out negative). Basically, I was told, what was happening was that the long-term damage from decades earlier had started to make itself known on the surface. I was sprouting lesions, known as Actinic Keratosis. They are considered to be pre-cancerous, in that if left untreated, cancer can develop. Then you are in much more serious trouble.
The usual treatment for AK is a spray of liquid nitrogen. The dermatologist has a canister of liquid nitrogen, held at around -200C. This is sprayed, very targeted on the trouble spot, for a couple of seconds. If you're getting this treatment, you probably have several AK spots, and they can all be hit in one session, one at a time. The stuff is cold, really cold, but the sensation is more like burning. At that temperature, designed to freeze and kill the damaged cells, your nerves are hit with an overload that is pretty intense.
Within a few days, the sprayed sites will scab over. If you can keep from scratching, the scabs will eventually fall off, and the site will heal over pretty well. In the meantime, you look rather nasty.
So I had several spots on my arms sprayed on that first dermatology visit. I was told to expect that more spots would pop up over time, and indeed that has been the case. On my second visit, my forehead was included in the targeted spray. This week, I had my third visit to a dermatologist, this time a new doctor, having moved in the interim. Spray sites were on my arms, forehead, and my right ear. Oh shit, that was awful, having that spot on my ear sprayed.
About two years ago a new product appeared on the market to deal with AK. It's a gel with the brand name of Picato, an extract from an Australian milkweed plant.
My new dermatologist suggested a 2-pronged treatment this time around: spraying the most noticeable spots as usual, then applying the Picato, at home, to a slightly wider area.
If you think sunburns are nasty, wait, it gets worse. From some of the online message boards I've been reading in the last couple of days, this stuff has been described as "a chemical peel", "chemical surgery", and even "chemical torture".
I took the prescription to my regular pharmacy, and there was a brief huddle among the staff; none of them had any awareness of this product. They did find it listed in their computer, but needless to say didn't have it in stock. They were able to order it and have it in from their central supply later that day. This is what I received:
I put the quarter there just to illustrate the size. Two tiny tubes of gel. One tube is used entirely, on each of two successive days. Skin coverage per tube is about 2 square inches. My dermatologist recommended an application procedure to dot and spread it around, to increase the application area. My online research indicates that pretty much everybody using Picato is being instructed to do the same thing. That little box costs (are you sitting down?):
$480.
Four hundred and eighty dollars.
For what amounts to a few droplets of medication.
The Alberta government medical coverage pays 100% of the liquid nitrogen treatment, as it is considered an effective preventative measure against skin cancer. But they don't pay for this product. Fortunately, I am covered by my partner's employment-based medical plan that does pay for many add-on expenses beyond what the government pays for. And that plan pays for Picato, 100%. Hurrah.
From what I've read from the U.S., the cost there can be as much as $700 for the same package. Some users have medical insurance that pays for it, some have paid out of pocket, and some have had partial reimbursement in the form of a coupon from the manufacturer.
If it wasn't for the coverage we have, I'd have likely gone back to the dermatologist and told him to keep spraying. Along with the prescription, he gave me a brochure provided by the manufacturer of Picato. Among other things, the brochure says:
The most common side effects: local skin reactions at the treatment site. These include redness, flaking, scabbing and crusting, swelling, blister or ulcer, skin that becomes hard or thickened, and peeling skin. These reactions can start within one day of treatment and may get worse for up to one week after you have completed treatment with Picato Gel.
...
Common side effects: pain, itching, skin irritation, or infection at the treatment area, swelling around the eyes, and headache.
Oh, for the good old days of
Happy Fun Ball.
This stuff aims to destroy the damaged cells, and of course it's also going to eat some of your undamaged cells in proximity.
Today being Thursday, I'm only a couple of days into the process, but I've completed the courses of application of this medication. From here on it's just waiting, and wishing this damn thing would just go away. But everything I've read tells me that the peak irritation, redness, itching, and pain is still a few days ahead. Here's where we're at now:
I already want to just rip my arms off, and I haven't even reached the peak yet. For $480 (of somebody else's money), this tiny bit of gel had better do something wonderful. It is nothing if not intense. There are several message boards online, with varying horror and/or success stories. I'm cheering on the successes. The people putting this stuff on their face, even at a weaker formulation, seem to like the results, but not the couple of weeks of torture doing the process.
Of course, there are other medications available for the treatment of AK. What you have just read is based on my personal experience. And at its heart, what this treatment is all about is heading off cancer before it strikes. Without treatment, the possibility of skin cancer developing is significant. I'll put up with a lot to avoid that.
If there's a moral to the story, it's this: Kids, do whatever you need to do to avoid sunburn and/or long-term sun exposure. Parents, etc., etc.
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