Ted Rosen, MD discusses highlights from his lecture on All About AKs at the 2021 Elevate-Derm Conference.
In this video
In this rapid-fire interview, Dr. Rosen runs through several of the updates from his talk. He points to a recent paper showing very good response rates for basal cell, squamous cell, and keratoacanthoma using undiluted 5-FU injected straight into the lesion \1980— an approach he reserves for patients where surgery is contraindicated or who have "surgical fatigue" and simply don't want another procedure. On spironolactone for acne, his advice on lab testing is blunt: "Don't, end of story." He explains that despite the potassium-sparing mechanism, no one has had significant hyperkalemia from it, so he skips serum potassium checks entirely — not even a baseline.
He also flags an Egyptian study of a thousand young men that found smokers were far more likely to show advanced androgenetic alopecia than non-smokers, giving providers one more reason to counsel patients with a strong family history to quit. He closes with "speed bumps," a phenomenon seen in incarcerated males who insert bits of metal, plastic, or glass to create round scars.
- Undiluted intralesional 5-FU injected directly into basal cell, squamous cell, and keratoacanthoma lesions offers very good response rates — useful when surgery is contraindicated or the patient has "surgical fatigue."
- Don't order serum potassium labs for patients on spironolactone for acne — no one has had significant hyperkalemia from it, and Dr. Rosen skips even the baseline.
- Smoking is linked to a higher likelihood of advanced androgenetic alopecia, so counsel patients with a strong family history of pattern hair loss to avoid or stop smoking.
- "Speed bumps" are round scars from foreign objects inserted under the skin, seen in incarcerated males.
