DermHelpCentral

Actinic Keratosis: Decision Aid

Actinic Keratoses (AKs) are rough spots that are common on sun-exposed skin of light-skinned individuals.  Most AKs are not worrisome and treatment is often optional. They are frequently treated by a number of modalities by many dermatologists.  This decision aid may help you in deciding if and how you want your AKs treated.  You can also view (and print)) this decision aid as a PDF. Download Actinic Keratoses Decision Aid DF

About Blu light: cost of procedure, not always covered by insurance

Cost of 5FU cream or imiquimod if insurance does not cover.  GoodRx can save you money

The Cochrane Report on Interventions for Actinic Keratoses is worth reading.  Despite the marketing hype, there is little difference between the modalities.  An informed patient can make the choice of which modality suits her or his needs and expectations best.

There is no evidence that treating most actinic keratosis will prevent the development of dangerous squamous cell carcinomas.  The decision to treat rests on how much the keratoses bother the patient or worries a concerned dermatologist.  Treatment can allay some patients’ anxiety.  Treatment should not be done to make one’s physician feel better or get richer.  It is clear that in many cases, actinic keratosis are grossly over-treated.

What Matters To You?

If your care giver asks “What matters to you?” this is often better than if she or he just asks, What's the matter, today?"

Sosena Kebede, M.D., M.P.H. addresses this topic in short, but helpful, 2016 British Medical Journal essay.

We have devised a queationnaire to start you thinking about this topic.  You can access it at WMTM Form.

Why Are So Many People Popping Vitamin D?

By Gina Kolata, April 10, 2017

The frenzy for vitamin D began not in natural food stores but in medical journals. Millions of people are now popping supplements in the belief that vitamin D can help turn back depression, fatigue, muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.

“A lot of clinicians are acting like there is a pandemic” of vitamin D deficiency.” In point of fact, an institute of medicine committee concluded in 2010 that very few people were vitamin D deficient and noted that randomized trials had found no particular benefit for healthy people to have blood levels above 20 nanograms per milliliter.

Medical organizations have repeatedly found that there is no reason to assess vitamin D levels in healthy adults. Still, vitamin D has become “a religion,”

This is an important article that all sentient people should read.  Make sure your physician or care giver does not order a Vitamin D level without telling you why she is doing so.

Close to Half of American Adults Infected With HPV

A recent report from the CDC shows that more than 42 percent of Americans between the ages of 18 and 59 are infected with genital human papillomavirus.

FULL NY TIMES ARTICLE

The CDC report on Prevalence of HPV Infections in the U.S. (published April 2017) is an important resource that covers our present state of knowledge.

Two vaccines are effective in preventing sexually transmitted HPV infection, and researchers said the new data lend urgency to the drive to have adolescents vaccinated. [This will be used by the companies that produce the vaccines as a potent advertising tool]

HPV usually is spread through direct contact with infected genital skin or mucuous membranes during intercourse or oral sex. Over 90 percent of HPV infections are cleared by the body within two years.

Testing: There is no HPV test for men at all. A test for women is sometimes used in conjunction with a Pap screen for cervical cancer.

This is important information and the CDC report is the best information we have.  At least the CDC is not in the business of marketing vaccines or treatments.  The best we can do, at this time, is to immunize children.  Not all of the public will be able to afford the vaccine and in some areas it is not a covered benefit for men.  This may change.

A potential fall-out from the report is that it will foster health anxiety and promote cyberchondria.  It may cause a spike in "venereophobia."  Time will tell.