Topical Vitamin C for Supplemental Treatment and Prevention of Actinic Keratoses

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Dermatologists are finding that topical vitamin C is a new tool for the treatment and prevention of sun damage and actinic keratoses. Robin Fleck, MD, board certified dermatologist at Southwest Skin & Cancer Institute in Prescott, Arizona, was a pioneer in the use of topically applied vitamin C in patients with chronic sun damage over a decade ago. Her unique approach to combining topical vitamin C with standard treatments for actinic keratoses over the past decade has resulted in striking improvements in her patients’ skin.

Chronic sun damage with field AK

"Patients with chronic sun damage are pleasantly surprised when they observe the improvement in their skin's appearance as well as the reduction in AK from consistent application of freshly activated vitamin C,” observes Dr. Fleck.

Actinic keratoses (AK) are pre-malignant lesions that occur on sun-damaged skin. DNA mutations from ultraviolet light are believed to be the cause of AK, and occasionally these lesions can progress to skin cancer. Most treatments for AK are expensive, cause significant side effects and most do not prevent recurrent AK on the sun damaged skin. The topical use of the ascorbic acid form of vitamin C is inexpensive with no side effects and can improve the appearance of sun damaged skin. Over the past decade, Robin Fleck, MD, board certified dermatologist in Prescott, Arizona, has observed a significant reduction of the number of AK when patients use topical vitamin C, resulting in remarkable improvement of her patients’ skin.

Dr. Fleck explains, “I treat large and/or painful AK first with liquid nitrogen cryotherapy and then recommend patients apply topical ascorbic acid to the entire field of sun damage for several months or longer.”

Vitamin C has the added benefit that it appears to reduce pain and swelling from the cryotherapy treatment and results in more rapid healing afterwards.

“Most of the patients I treat have had recurrent AK for years and have undergone treatments with cryotherapy, topical chemotherapeutic and immunotherapeutic agents. They are pleasantly surprised when they observe the improvement in their skin's appearance as well as the reduction in AK from consistent application of freshly activated vitamin C,” observes Dr. Fleck.

These results are noticeable in as little as 4-6 weeks.

Topical vitamin C was shown to protect against ultraviolet B radiation damage in laboratory animals over two decades ago by researchers at Duke University. No human studies have been performed and this treatment is not FDA approved for this and related claims.

Dr. Fleck cautions that vitamin C is unstable in solution, and potency of the vitamin is reduced to insignificance by 4 weeks after mixing unless stored in a refrigerator. The beneficial results are therefore dependent on using freshly activated, pharmaceutical grade 12% topical ascorbic acid, which ensures the necessary potency. This material is commercially available. Preparations of vitamin C that are pre-mixed in a lotion or cream have not demonstrated the stability to consistently deliver 12% ascorbic acid.

Patients with AK are also counseled to avoid sun exposure, wear sunscreen and protective clothing and follow up at least every 3-6 months with their dermatologist since AK can be associated with other skin cancers such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Robin Fleck, M.D., is a double board certified dermatologist and internist, recognized by the American Board of Dermatology and the American Board of Internal Medicine. She is founder and medical director of Southwest Skin and Cancer Institute and Vitalité Med Spa. Dr. Fleck is also the director of Vein Specialties in Prescott, Arizona, where she treats chronic venous insufficiency, spider veins, and varicose veins.

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Robin Fleck, MD

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