Lorraine, a blonde and pale-skinned person, worked in the beauty industry for more than three decades and considered herself knowledgeable about skincare. However, she was unaware of actinic keratosis (AK), a pre-cancerous condition caused by long-term sun exposure. After an unexpected diagnosis, she embarked on a painful treatment journey using a 'chemo-cream' called Tolak, which left her face red and in constant pain.
For more than two years I ignored the small patch of scaly red skin at the top of my nose. It was easy to cover up and, though it occasionally itched, I assumed it would one day disappear.
At no point did I consider the tiny 1cm long mark could be cancer. After all, I thought, I am something of a skincare insider, having worked on glossy magazines for more than three decades, testing a variety of treatments in the name of beauty journalism.
And at the age of 57 I fully expect my skin to show the life I have lived: I am a Gen X mum-of-four with a love of open-water swimming, who grew up in the countryside and enjoyed the odd sunbed in my 20s. Today, I am at peace with my wrinkles, my sunspots, my rosacea and the inevitable loss of collagen that comes with being post-menopausal.
But as we mature, the C-word looms large, so I have my moles checked regularly, and as a blonde, pale-skinned person, I always wear SPF 50. I would consider myself knowledgeable when it comes to suncare – and yet I had never heard of actinic keratosis until I got diagnosed with it by accident three weeks ago.
I embarked on a painful treatment journey using a miracle cream to kill my potentially cancerous cells, which at one point left the skin on my face looking like I had blow-torched it. Earlier this month, after visiting my GP about a mark on my chest, I was referred to a dermatologist, and used our family health insurance to see one five days later.
While she was examining me, she told me the red mark on my nose was an ‘AK’, as actinic keratosis is lovingly known among the large online community of sufferers I have since discovered. Lorraine's actinic keratosis had to be treated with a 'chemo-cream' called Tolak to destroy the cancerous cells - but it left her face red and in constant pain After three weeks of using the cream Lorraine's face cleared up and left her skin looking healthier than ever before AKs are pre-cancerous cells caused by long-term exposure to the sun; they build up invisibly under the skin over many years until they harden and appear.
If you are fair and over the age of 40, you are more at risk of skin cancer. Your AKs can look innocuous, like my dry red mark, or like scabs and crusty warts, depending on factors such as your skin type, age, genes and environment. Hearing the word ‘cancer’ after the age of 50 is nothing surprising, sadly. My friends and I joke on our ‘Girls Aloud’ WhatsApp group that our midlife is the era of ‘constant probing’.
Last year I had two benign breast cysts removed by the amazing staff at Charing Cross Hospital, so I’d already been through the C-word emotional rollercoaster too recently to panic. But I also knew some of my friends’ diagnoses were not so positive, so my post-50 modus operandi is to keep calm and carry on. In any case, according to dermatologists, AKs don’t always become cancer, which is why this is such a confusing skin condition to explain.
Some can be left untreated; while the majority may be frozen off or surgically removed. Mine had to be treated with a course of what the internet has terrifyingly labelled ‘chemo-cream’. If you Google it you end up in a pit of fear, for this is the cream which makes your face light up like a fiery demon and burn like hell.
It also frightens the life out of anyone who comes across you in the queue at the chemist . This acute redness, caused by the treatment cream destroying the DNA of pre-cancerous cells, also worries your family who witness your inflamed face on a daily basis. About two days into the treatment, I began to regret ever going to the GP because it was so sore.
I found it impossible to imagine it ever healing, as small scabs formed and skin flaked off. I couldn’t shower, just gently dab it with a damp cloth and grit my teeth. I also had to stop going outside for a week. The only comfort I got was by watching the Gen X women of Instagram and TikTok and their ‘post-chemo cream’ selfies, where their skin was positively glowing.
I was prescribed seven days of Tolak cream applied at night alongside Calcipotriol cream. Tolak cream is thick and gooey and comes out of the tube as reluctantly as a teenager loading the dishwasher. You must wear gloves to apply it . Application is not as simple as it sounds.
You pop the cream on one area but it goes about its business overnight, seeking out any nearby pre-cancer damage too, which causes the redness. It turned out my pre-cancerous cells had spread to my cheeks and three days into my seven-day course I was in constant pain. But, as NHS psychodermatologist Dr Alia Ahmed explained to me later, the fact the cream found more cells on my face is a good thing.
In fact, those were not visible, just lurking.
‘If there is nothing to treat then this particular cream would not affect your skin at all,’ she said. Only Eucerin’s Aquaphor cream helped soothe it. On day six I had to record my podcast, Postcards From Midlife, on camera, so I headed to Space NK for advice on covering the redness.
A sympathetic beauty assistant covered the heavily moisturised area with Erborian redness Correct BB cream, a miracle product, and also recommended Eucerin’s Actinic Control SPF 100, which is specifically designed to help prevent actinic keratosis and is my daily suncream now. Who knew SPF 50 wasn’t high enough for women in midlife?
Read More Leanne suddenly had bald spots on her scalp but this £8 product saved her I had not expected the treatment to burn so much, and I wish I had researched it more before applying it in those first few days. With the benefit of hindsight, I would have cancelled things in my diary and bought the creams in advance to alleviate the soreness. I certainly should have asked more questions at the dermatologist’s office.
And I am also a bit peeved my GP didn’t point it out too, given it is estimated to affect up to 28 per cent of women over 40, according to a Google search . Treating AKs is preventative, and women should not be afraid to get it checked out.
‘Women often think, “Oh it’s just red skin I won’t bother anyone” but preventing skin cancer is high on our list of priorities as dermatologists,’ explains Dr Alia Ahmed, of St Bart’s Hospital. ‘Right now it is peak AK diagnosing season as the sun comes out and we notice our skin in more detail.
‘AKs are really showing what your skincare was like in your teens – it is a result of the sun exposure from then onwards, so we do take it extremely seriously in people over 40 who may not have been so knowledgeable about sun care in their youth. ‘It also affects older men in large numbers, especially on their scalps. We can all benefit from earlier treatment for skin cancer.
You do not have to avoid going in the sun following treatment, you just need to keep reapplying high SPFs and wear a hat in the sun. I always say aim to avoid getting a tan.
‘There are several ways to treat it under medical supervision. We’re trying to avoid skin patches becoming lumpy, scabby, itchy or bleeding, as then it may be a non-melanoma cancer, which would require more serious or invasive treatment. It isn’t something to panic about at the stage you had, but it is something to treat as early as possible. ’ Today, the skin where Tolak did its job looks brand new.
It’s soft and clear, there is no sign of the red patch on my nose at all, and I am happy to report it looks way better than it did before. I am just cross I ignored it for so long.
AK Actinic Keratosis Long-Term Sun Exposure Skin Cancer Understanding The Condition Difficulty In Diagnosing And Treating Compared To Breast Cysts Removal Finding Support In Online Communities
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