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NancyL

dermatologist to treat AKs

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Who is the best dermatologist in Thailand to see for treatment of AKs (actinic keratosis AKA solar keratoses)? In the U.S. I saw a dermatologist every two years and he would prescribe a course of 2-3 weeks of Fluorouracil cream (carac cream) which "disclosed" the AKs on my upper back and then he'd burn them off with a laser.

I have very fair skin with many freckles. My back is a real disaster zone. I had one really, bad graphic, awful, sunburn to the upper back as a small child. Very severe sunburn to the back. It was really child abuse on the part of a teacher at a school outing. Now I'm paying for it. Anyway, once I reached age 40 in the U.S., I'd develop small sores on my upper back that never seemed to heal. The Carac/laser treatment every two years took care of that.

Now I've been here over six years since age 54 and the small sores are driving me crazy with the itching. I've been to dermatologists at CM Ram Chiang Mai and Bumrungrad and they tell me everything is OK. I'm just scratching and that's why they don't heal. They don't have Carac cream here. Don't worry.

All I could find here is Fluorouracil cream with another ingredient that's used for warts. Not appropriate for treatment of AKs.

Is that true? They really don't have Fluorouracil cream here? It isn't pleasant to use. It makes the AKs turn raw, and your skin into hamburger. It's counter-intuitive to continue to rub a cream into raw skin, but if it makes the AKs more visible to the dermatologist, I'm all for it.

If there really isn't anything better here, then what about Singapore? Is Fluorouracil cream available there?

I just had a friend who died of skin cancer. Hubby is concerned. I ask what he sees when he looks at my back and he says he has no clue. It's all freckles, scratches and red marks. He has no clue what he's looking at. He's an engineer, not a doctor.

Edited by NancyL

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Just found on the internet that Carac is know as Efudex in Australia if that helps anyone's understanding of the product I referenced in the previous post. I'd love to find it here in Thailand, at a reasonable price, since I need several large tubes for a multi-week course of treatment of my upper back.

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Dr Siri is the Dermatologist with he best reputation that I know of, at Sriphat or his clinic on the moat.

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Dr. Nyom at the Bumrungrad dermatology clinic is familiar with skin conditions affecting Westerners as conditions such as actinic keratosis is extremely rare under the local population and most local dermatologists are not really familiar with the treatment.

Efudex, according to MIMS Thailand, does not seem to be available but other forms of fluorouracil may be available from hospital pharmacies.

Other alternatives are Diclofenac (Voltaren Gel) which are freely available but cryotherapy may be the only solution for persistent lesions. Other treatment options at: http://www.skincancer.org/skin-cancer-information/actinic-keratosis/actinic-keratosis-treatment-options

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OP - I have used several different brands of Vitamin E topical creams over many years... While my skin condition was not as serious as yours sounds - it was a noticeable problem, I have found that all sorts of skin eruptions - somewhat similar to your description but fairly minor were subdued by consistent daily use of the creams. I have used it on the back of my neck where I had a persistent acne like problem with hard reddened nodules, on brown patches, skin tags (as some refer to them)... and had a overall reduction of the problem.

Also - a girlfriend of some 10 years in the states was very fair skinned and had crescent shaped sunburn scars under her eyes - quite noticeable. We were in Mexico on a vacation and went into a pharmacy shop and I found Retin-A. We bought it and she used it for several weeks daily ... the scars became only a faint impression easily covered by makeup - I thought it was quite dramatic.. I noticed the other day that my favorite Thai pharmacy has Retin-A on the shelf.

And - (Not necessarily for use by a female) but one time several years back I started taking a supplement that metabolized to testosterone in the body... I took it to boost my metabolism and it worked fairly well for that... I lost about 10 pounds in a month without really trying... Well - much to my surprise in about the beginning of the third week of use ALL my keloid scars on my hands and arms - completely disappeared and became slight white traces where the original minor cut had been. Keloid scaring 'runs' in my family - mother, sister, brother and myself. It works like this ... I got a small cut on my back on my hand or forearm... instead of just a normal amount of scar tissue forming as the cut heals - those susceptible to keloiding get a large - thick - rosey red mound of scar tissue - the Keloid. The keloid scar remains slightly inflamed and tender and hurts if I bump it on something - not to mention how bad they look. I cannot really express the full nature of my surprise that this happened..

Just passing these happenings on OP ... do with them what you may...

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I have seen (and in the past bought, though many years ago ) Efudex in Phnom Penh at Pharmacie de la Gare.

It will take some patience but you could try calling them to see if they have any now (if so, you would have to go there to get it). You'll need to ask to talk to the head pharmacist. He speaks some English but more French. +855 23 430 205

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Oh Sheryl, thank you. Hubby and I "won" a trip to Siem Reap recently and are going at the end of this month. I hate to sound like a bad sport, but my the time we paid the airport taxes on the "free" airline tickets, decided to stay a couple extra days, gifts for the cat sitter, buy re-entry permits -- it's not such a free holiday. I'm really not big on looking at old ruins in hot climates. I'll spend my time prowling around the pharmacies looking for Efudex!

I wonder what will happen if I use it for a few weeks and then go back to the same doctor who said I have nothing to worry about, those sores on my backs aren't healing just because I scratch them all the time? Will she then, finally be ready to get out the laser?

Edited by NancyL

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Doubt you will find it in Siem Reap, in fact would be surprised if you did. Not the same range of meds as in Phnom Penh which is where all the main importers and distributors are based and also of course the largest expat population lives.

So you may need to go to PP.

BTW there is a good, Western-trained Khmer dermatologist there, Dr. Mey Sitach Tel: 012 947 458, also a good German one at SOS (very expensive though) Dr. Christoph Bendick tel 023 216 911. Neither have lasers but they might be a source of Efudex if you don't find it in a pharmacy.

Lastly there is a very good Western trained Khmer derm there specializing in cosmetic issues, last time I went to him he did not have a laser but that may have changed as it more than a year ago and he was just setting up his own clinic. He speaks excellent English - Dr. Sreng Reasey tel 023-888-848

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Sheryl -- are you saying Efudex is definitely not available in Thailand?

Also -- just so I'm clear -- the docs you recommended in Cambodia -- those all are in PP?

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1. Yes, not available here. The only preparation available for AK that I am aware of here is Aldara (imiquimob) ( See http://www.aafp.org/afp/2007/0901/p667.html ). While and diclofenac 3% gel also works, I haven't seen any diclofenac gels in that strength here, they all seem to be 1% and intended for muscle aches etc.

2. Yes, all in PP.

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