Your Skin And The Effects Of The Sun

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An Overview Of Sun Damage

Your Skin And The Effects Of The Sun

Sun damage of the skin, also known as photo damage can be either acute, as in a sunburn or more commonly, chronic, seen as gradual changes in the skin caused by an accumulation of sun exposure throughout one's life. Chronic photo damage results in either a cosmetic change in the skin's appearance called photo aging, or changes that are of medical and health concerns such as pre-cancerous lesions and skin cancers. The evidence is very strong that ultra-violet light is the cause of most of the changes that we consider to be associated with aging of the skin.

Sunshine, although essential for health and well being, is certainly a hazard for the skin. For many people it feels good to spend time outdoors and this makes it difficult to avoid excessive exposure to the sun. Most of the sun exposure we accumulate throughout our lives, is thought to be the effect of multiple short periods of time outside. If the ozone depletion continues this may also increase our lifetime exposure.

Those living in sunny areas are clearly at risk for photo damage, as are those with occupations that require working outdoors. Activities such as skiing, sailing, and gardening can contribute to chronic photo damage. Even one-time sun exposure, causing a tan, results in damage to the skin. There is no such thing as a 'safe' tan.

Individuals with fair skin are clearly at greater risk although sun damage can occur in all skin types. Tanning studios are popular amongst many and this also adds to an accumulation of photo damage.

Smoking is another environmental factor that contributes to premature aging of the skin. Early recognition of sun damage will provide a better chance of reversal of the cosmetic appearance as well as reducing the number of skin cancers.

What Does Sun Damaged Skin Look Like?

The appearance of sun damaged skin is well recognized, and is different from changes seen with normal chronological aging. The very smooth, fine, pale wrinkling associated with aging seen in the sun protected areas of the skin such as the buttocks are different from those of sun damage.

Fine and coarse wrinkles are seen on sun damaged skin. There is a roughness to the skin and a laxity or looseness in advanced damage, patchy or mottled darker patches of increased pigmentation are seen also. Sometimes these patches become irregular and produce what are known as lentigos. In areas around the back of the neck a leathery texture and coarseness with deep lines is frequently seen, the skin may feel dry and scaly. Chronic sun exposure will in many produce a thickened layer in the upper dermis known as solar elastosis, which gives a yellowish chicken skin look.

Some individuals will develop more blood vessels, known as telangiectasias or broken blood vessels. If damage is severe, thinning of the skin and bruising may be seen particularly on the hands and forearms.

Pre-Cancerous Changes Of The Skin:

The most common indication of chronic sun exposure most often seen in fair skinned individuals is actinic or solar keratosis. These are usually small reddish, or reddish brown rough areas on the skin with a hard surface. Sometimes the smaller lesions can be felt more easily than they can be seen. As they progress, they often develop a thick rough whitish scale. This is seen most commonly on the face, ears, bald scalp, and on the backs of the hands, the lower legs of women are also risk areas.

Skin Cancer:

Basal cell carcinomas are the most common of skin cancers, which again are associated with chronic sun exposure. They are also more common at sites of burns, scars, and those with a history of arsenic ingestion. These are most often raised skin coloured bumps (papules). These may have a pearly appearance. They sometimes have telangiectasias (small blood vessels) over them. There is often a history of easy bleeding from the area. On the trunk or limbs, basal cell cancers can look like persistent well defined reddish, slightly scaly patches resembling psoriasis. They usually remain unchanged for many years if untreated and slowly grow.

Other basal cell carcinomas can be slightly pigmented, and the least common is the appearance of a scar like lesion that appears on the face without history of trauma, these are known as a morphea or fibrotic basal cell carcinoma. Most basal cell cancers occur on the face and neck, they are uncommon one the back of the hands, forearms, palms, soles, and scalp.

There are three rare genetic disorders that are associated with BCC. Squamous cell carcinoma, is the second most common type of skin cancer, there is an increased risk of squamous cell carcinoma developing from actinic keratosis (described above). This type of skin cancer can be aggressive at times, particularly those arising from the lips (actinic chielitis), these usually arise from skin that is clearly sun damaged.

Squamous cell cancers are most often red and scaly lesions. Occasionally these can present as ulcers or raised warty growths. They normally have a depth or thickness to them, which means that the surface or epidermis grows thicker and downwards into the dermis. There is often a low-grade inflammation that is the reaction from the immune system. It is rare to see these cancers arising from normal looking skin. Sundamage is clearly the biggest risk, although scars, physical burns, and stasis ulcers, which are chronic, are also a risk.

Malignant melanoma is the most threatening skin cancer. Most of the time, these cancers appear intensely pigmented. Dark brown or black lesions should be looked upon with suspicion and should be checked by a physician. The bigger lesions are more suspicious (over 6mm), but these cancers are best detected when they are very small. The best clue is the intense, dark pigmentation. Irregular pigmentation within the lesion as well as irregular borders is also of concern. Early detection and treatment of a melanoma is important as melanomas can be fast growing. About one half of them arise from moles, while the other half will develop from normal looking skin.

Treatment For Sun Damaged Skin

OTC Treatment:

There are a number of products and treatments available to try to reverse some of the signs of sun damage. These include preparations available over the counter, prescription medications and medical procedures.

The use of products containing alpha hydroxy acids such as glycolic acid and lactic acid may have a smoothing effect on the skin. We also know that vitamin C preparations will also have modest effects on reversing the appearance of sun damage.

These products will have benefit after they have been used for many months. They peel off the dead surface of the epidermis, which allows more ultraviolet light to penetrate so sun protection is most important when these products are used. These products can be used in conjunction with prescription vitamin A preparations.

Medical Treatments:

Tretinoin (creams and gels): Tretinoin creams and gels have been documented as reversing sun damage, smoothing of the skin may occur within a number of weeks. There is some thickening of the epidermis as well as the dermis. The increased pigmentation may be reduced by inhibiting epidermal melanin content. If this product is used over many month or years there can be a visible reduction in the wrinkling and fine lines.

Tazarotene: Tazarotene is the newest product shown to have advantages in reversing sun damage. It is also a retinoid or a vitamin A product that was initially used for the condition of psoriasis. It is also effective in the treatment of acne and has shown to be of significant benefit in reversing chronic sun damage or photo aging.

Chemical peels: Chemical Peels are procedures that remove the upper parts of the skin allowing recovery and re-growth of the surface. This relies on initially wounding the skin which stimulates growth of fresher, newer looking skin. The peels can either be superficial or quite deep into the dermis. Superficial peels include glycolic acid preparations. The deeper peels such as trichloroacetic acid and phenol are used less often. These produce more benefit but also carry an increased risk of pigmentary changes or possibly very superficial scarring. Recovery is quicker with the more superficial peels and may take weeks with the deeper procedures. The peels treat fine lines, age spots and uneven pigmentation.

Laser surgery: The use of dermabrasion has diminished. This was performed by mechanically peeling off the skin surface with a metallic rotating instrument and then supporting the skin as it healed. Laser brasion has been used over the last decade with quite significant results. The laser essentially vaporizes the skin away in very thin layers. The CO2 laser was first used and later the Erbium Yag laser became more popular as it produced less heat damage to the skin, which meant a more superficial layer of damage and a faster recovery.

The disadvantage of these procedures which essentially peel the surface of the skin allowing renewed growth of skin, which has less of a photo-damaged appearance, is the lengthy healing time. There is considerable redness for the first 10 days that usually requires time off work. The risk of prolonged redness and some whitening of the skin are also observed in some.

Non-Ablative Laser Surgery is a new development in the treatment of photo damage. These procedures involve the use of a broad-spectrum intense pulse light or laser, which is used repeatedly on the skin. This heats the dermis and encourages collagen production. It can also minimize some of the redness from broken blood vessels and diminish the hyper-pigmentation, which may be a consequence of photodamage.

Pulse Dye lasers that are used for red birthmarks or rosacea also have a benefit in photo damage in that they heat the skin, encouraging production of collagen with subsequent smoothing of the skin. These lasers also reduce the red vessels that often can be of cosmetic concern.

Skin fillers:

Skin fillers can be used for individuals with deep lines and wrinkles. These include collagen or hyaluronic acid. These are useful for lines that are seen in the resting phase. These have gained popularity. Collagen purified from the skin of cows is injected into skin wrinkles to fill in the depression. The benefit lasts for 3-6 months.It is usually used for correcting the naso-labial folds or deep smile lines or crows feet.

The treatment is usually well tolerated but there is usually some stinging or burning. Slight swelling and redness may be transient after treatment. It is essential that a small quantity of collagen be injected into a test area of skin weeks before the treatment to ensure that there is no allergy to the product.

Artecoll is collagen which has been impregnated with minute spheres of methylmethacrylate. This gives a long lasting effect to the injection. It appears that the injected collagen dissolves allowing the skins own collagen to grow on to these tiny beads. It is used for deeper lines, acne scars, smile lines as well as for enhancing lip fullness.

Hylaform and Restylane are injectable gels of Hyaluronic acid. This is part of the ground substance or material that collagen lies in within the dermis. Its production is diminished with age allowing the skin to wrinkle. These are introduced into the skin to fill in the defect that allows the wrinkling to occur. Allergy is not a concern with these. There may be some redness and swelling after the treatment but persistent redness is rare.

Botox:

Individuals with wrinkling in the glabella and on the forehead can benefit from this also. This is done by inactivating the muscles under the skin that produce lines and wrinkles. These are not the types of wrinkles that are the result of sun damage. There is no change the quality of sun-damaged skin.

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