Sunburns, revisited

Barc'a beach: just down the way were some very brown grandmas bathing in the nude. Impressive. I wonder about their skin.

Barc’a beach: just down the way were some very brown grandmas bathing in the nude. Impressive. I wonder about their skin.

Back in March, Matt and I took a jaunt to Barcelona to visit my friend J.  We walked down to the beach on Saturday morning, and while Matt went for a run, I sat at an outdoor cafe on the boardwalk and drank coffee in the sun.  I wasn’t sitting there long, but it was long enough to get a wee bit burned on my face and chest.

I confess I was a bit pleased about it — winter in Sweden is long and dark and I am very very white, and sun feels really lovely in the spring.

But it also reminded my skin of sunburns past.  I grew up in California before sunscreen and Gothic white skin was cool.  I burned myself to a crisp at least once every summer as a kid, to the point that I could peel sheets of skin off my back.  My nose was always peeling.

So after some sun in Barcelona, a small sore erupted on my nose that alarmed me: a small white blob that was not a zit, surrounded by raw flesh and not healing quickly. I realized I had the same sore before while we were in Australia last year, in high sunny summer.

I made an appointment to see a dermatologist soon after we got home from Spain.  He looked me over with a backlit magnifying glass, checking everything all over my body and paying particular attention to the sore on my nose. He found “senile” (in Swedish) “cherry spots” (in English), small scars, age spots, and yes, a problem with the spot on my nose.  An actinic keratosis, or a precursor to squamous basal cell carcinoma, at the lowest level of skin cancer and eminently fixable –but still, worth fixing right away, as the blood vessels feeding it would keep it slowly growing for years, smack dab in the middle of my nose.

The skin doctor gave me a referral to a skin clinic (Hudvårdcentral). A few days later, they called to arrange an appointment for me on a Sunday morning, and I got a text message the next day to confirm (a Sunday morning, on the day of the time change here, so it felt a wee bit early, even though it was at a reasonable hour!).

Another doctor did a second check on the spot on my nose. She gave me two options:  She could zap the offending growth with liquid nitrogen, freezing it — and most of the skin around it, leaving a crater to heal, with the chance of scarring or leaving a big pit in its wake.  Or she could give me a chemical treatment that would require a prescription, and about two weeks of hideousness while the skin on my nose went though a massive inflammation to kill off the keratosis.

I recalled immediately the liquid nitrogen treatments I’d had before on my feet for plantar’s warts. They left pits and massive scars on the soles of my feet that still bug me sometimes. I asked for the chemical therapy — or chemotherapy.

That word raises flags so fast. But it sounded so easy when the doctor described it:  dab a bit on, sleep with it on overnight, and let your skin do the rest.  Apply no makeup, no other applications, nothing.  The doctor gave me the prescription, and even called me later that day from her own cell phone to check with me to see if I understood the process.

After a day or two of worrying about it, and reading some abstracts in PubMed, I went and bought the tiny packet of Picato. Three small tubes, one for each day’s application, lined up in a small cardboard box. I got the instructions in English from the US National Institutes of Health — which was good, as the doctor (too worried) and the pharmacist (a little too relaxed) were not quite precise in their instructions (plus they made me worried I would do it wrong).

After the first application, my nose blistered; the next day, it oozed a tiny bit, and the next — the third and last day — the blister outright burst, leaving a sore the size of a quarter on my nose. And then my nose started to heal, almost immediately.  Every morning, Matt has been peering at my nose, scrutinizing the skin, and every time, he says, “Looks good.” The scab that formed slowly flaked a bit, leaving the inflamed new pinkish skin beneath, and a tiny black spot where the keratosis once was.

I’m still watching it, and I don’t want to speak too soon, but the treatment seems to have worked.  And the amazing thing to me is this: the drug was approved by the US Food and Drug Administration in 2012, less than two years ago. Papers were still being published on its effectiveness in 2013, just last year. And here I am, in Sweden in 2014, getting a prescription for a crazy drug that kills cancerous cells from a doctor whom I most likely will never see again.

I don’t think I could have gotten this drug treatment from my HMO in the US.  From past experience, a new drug or treatment would have been considered way too experimental even five years after its general acceptance by the medical research community. From this one experience, the doctors seem to trust that the system works, well enough.  I applaud caution in many cases, but in this one, I’m so far pleased to be an early adopter.

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