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Crusts that do not go away
Rough crusts that come and go on sun-exposed areas: why they should be examined.
These are the small rough areas that appear on the forehead, temples, nose, ears, scalp where hair thins, and on the backs of the hands and forearms. They are felt more than seen: to the touch they are like sandpaper. They form a small crust, it comes away, and a few weeks later it returns in the same place.
They are not age spots or dry skin. They are the effect of sun accumulated over decades on the same areas, which is why they appear exactly where the skin has been most exposed and generally after the age of fifty — earlier in those who have worked outdoors or have fair skin. The damage does not come from last summer: it comes from all the summers before.
The reason they are worth examining is that some of these lesions can evolve over time into squamous cell carcinoma. Not all of them, and not quickly — most remain what they are — but appearance cannot establish which will. This makes them different from a simple blemish: they are lesions to keep under review, not to ignore until they cause trouble.
There is then something those who have them notice for themselves: they are rarely single. In heavily exposed areas the skin around the visible lesions is also damaged, even where it looks normal. Assessment therefore looks at the area, not the individual spot — which is why treating one crust and ignoring the rest achieves little.
The signal is that it keeps returning to the same spot
A crust that comes away and never returns is almost always nothing. One that comes away and reappears in the very same place, for months, is saying something else: that area of skin is not repairing as it should. This is why it is worth having it examined even when it does not hurt or bother you — persistence is the information, not discomfort.
How it shows
- Small rough areas, felt before they are seen
- A dry crust that comes away and returns in the same place
- Pink, yellowish or skin-coloured, sometimes on a reddened base
- Typical sites: forehead, temples, nose, ears, scalp, backs of the hands
- Several lesions in the same area, often of different ages
- Generally appearing after the age of fifty, earlier in fair skin
How we proceed
- 1Dermatological visit: examination of the exposed areas, not only the reported lesion
- 2Dermatoscopic diagnosis when distinction from other lesions is needed
- 3Assessment of the whole photo-exposed area, not the single element
- 4Definition of treatment based on number, site and extent of damage
- 5Scheduled follow-up over time and guidance on sun protection
Available treatments
- Dermatology visit
- Dermatoscopic diagnosis
- Cryotherapy with liquid nitrogen
- Photodynamic therapy
- Dermatological surgery
- Scheduled follow-up
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Frequently asked questions
Are they dangerous?+
Taken individually, most remain what they are. Some, however, can evolve over time into squamous cell carcinoma, and appearance cannot establish which. This is what makes them something to monitor rather than ignore: not urgency, but the fact that surveillance changes the outcome and waiting does not.
Can I remove them with any cream?+
Moisturisers or exfoliants make no difference: the lesion is not dry skin to be softened, it is an area where the skin grows abnormally because of accumulated sun damage. Specific treatments exist, and the choice depends on how many there are, where they are and how extensive the surrounding damage is. It is an assessment made by looking at the area, not the single crust.
Why do they find more than I had noticed?+
Because they are felt before they are seen. To the touch they are rough as sandpaper even when barely visible, and the dermatologist finds them by running a hand over the exposed areas. Moreover, in heavily exposed areas the surrounding skin is damaged even where it looks healthy: assessment therefore concerns the area, not the spot that prompted the appointment.
If I have them removed, do they come back?+
New ones can appear, yes, because the accumulated sun damage concerns the whole area and not only the treated lesions. This is not treatment failure: it is why the pathway includes follow-up over time and serious sun protection. Protecting exposed areas from now on does not undo the damage already done, but it reduces what is added.
Related reading
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