Prevention and Treatment of Sun Damaged Skin

There is bad news and good news about sun damaged skin. The bad news is that without proper protection from UV radiation and other free radicals, our skin will begin to show signs of damage after the age of 2! The good news is that our knowledge of how to protect our skin from further damage, and the technology to correct such damage has increased tremendously.

Daily environmental insults such as sun exposure, smoking, poor diet, air pollution and alcohol consumption contribute to the formation of oxygen free radicals. The most common source of free radicals comes from the exposure to the sun’s ultraviolet radiation. As these free radicals form in the skin they cause major changes including:

Collagen breakdown
Loss of skin elasticity
Uneven pigmentation

This process is commonly called photo-aging and results in: wrinkles,
hyperpigmentation (sun/age spots, melasma, etc), facial veins, rough
and uneven skin texture, and skin cancer.

UV radiation from the sun is the primary cause of this damage. There are two types of UV radiation known as type A and type B. UVB rays cause burning of the skin. While UVA rays cause photo-aging and skin cancers. UVA rays are 100X more plentiful than UVB rays. UVA rays are also present year-round and can penetrate clouds and the glass in our homes and cars. UVA rays are also able to penetrate 30-40X deeper into the skin.

Protection
The best way to minimize photo-aging is to:
Stop smoking
Eat a healthful diet rich in anti-oxidants
Drink alcohol in moderation
Avoid polluted environments when ever possible
Wear a sunblock of 30 spf or higher EVERY DAY
Apply a topical antioxidant to sun exposed skin every morning

Sunblocks vs. Sunscreens
Sunscreens will only protect the skin against UVB rays. Sunblocks will protect against both UVA and UVB rays for maximum protection from the sun. It is important to know that zinc oxide is the most effective ingredient in completely blocking both types of UV radiation. Zinc oxide is completely safe and non-irritating. Both zinc oxide and titanium dioxide are now available in a microfine form and can be made into a transparent formulation (i.e. no more white, greasy mess). A combination of titanium dioxide and avobenzone (Parsol 1789) also offers similar protection from UVA and UVB radiation. Even the best sunblock and the healthiest lifestyle can’t completely prevent free radical damage to our skin.

Topical Antioxidants
Antioxidants are free radial scavengers, and regardless of the source of the free radicals, antioxidants will neutralize them. Unfortunately, the antioxidants that we consume by mouth are primarily only able to act as free radical scavengers internally. Through advances in research there is now a formulation of topical vitamin C that has been proven to raise antioxidant levels in the skin. Topical vitamin C serum (l-ascorbic acid) has been shown to:
Neutralize free radicals
Prevent photo-aging
Stimulate collagen production
Act as an anti-inflammatory agent
Reduce skin redness
Clear sun/age spots by breaking up melanin and inhibiting the formation of new pigment
Reduce thymine dimmers; which are cellular mutations that are the precursors to many skin cancers (when paired with vitamin E)

Vitamin C serum should be of a 10% concentration or higher, and should be applied to dry skin after cleansing in the morning. Once vitamin C has absorbed into the skin it cannot be washed off. Sunblock can be applied after the vitamin C is absorbed into the skin.

Correction of Photo-aging
After beginning a preventive program that uses sunblocks and topical antioxidants, many people want to correct existing problems like hyperpigmentation, fine lines and wrinkles, and uneven skin texture. Below is a list of current procedures that are used to correct photo-damaged skin. We often times will use a combination of these procedures to obtain optimal results for patients.

Chemical peels
Glycolic acid is derived from sugar cane and is used for superficial chemical peels. When used with lactic acid they work to exfoliate dead skin cells; improve skin hydration, stimulate collagen production, and eliminate hyper-pigmentation. These superficial peels can be done over a lunch hour and cause minimal redness and irritation. It generally takes 5-10 peels to obtain optimal results. Deeper peels using other peeling agents to remove deeper layers of skin. Due to the depth of the peel there is more redness, peeling and irritation that can last up to 2 weeks.

Microdermabrasion
Microdermabrasion is an exfoliation process that involves aluminum oxide crystals and suction. The crystals exfoliate dead skin cells, and smooth rough skin texture. This can be very useful in elimination acne scarring. The suction removes the crystals and dead skin cells from the skin surface. The suction also increases blood flow the middle layer of the skin (dermis). This stimulates collagen and elastin fiber production, which leads to a smoothing of fine lines and wrinkles. Microdermabrasion is an excellent way to treat early signs of photo-aging, and when used in conjunction with glycolic/lactic acid peels offer excellent results with very little down time. Microdermabrasion is not recommended for those with rosacea, facial veins, or extremely lax skin.

IPL (Intense Pulse Light)
This non-invasive procedure is on of the best ways to eliminate the signs of sun damage. The IPL is able to smooth fine lines and wrinkles, clear sun/age spots, and eliminate red blotchy skin. There is minimal discomfort with IPL treatments, and the treatment generally takes 15-20minutes for an entire face. The most common side effect is mild redness that can last for 24-48 hours. The only limitation after having an IPL procedure is to remain out of the sun for 24-48 hours afterwards. IPL can also be paired with a topical medication called Levulan for dramatic improvement in fine lines & wrinkles, hyperpigmentation, and even pre-cancerous skin lesions (actinic keratoses). Depending on the amount of sun damage and the patient’s desired results, it takes 4-6 treatments to obtain optimal results. Treatments can be done on any area of the body with sun damage skin.

Laser Genesis
This is a non-ablative laser treatment that targets the deeper dermal layer of the skin where it stimulates the production of collagen. Laser genesis eliminates the redness, hyperpigmentation, and fine lines/wrinkles. This procedure is ideal for people who have fine lines and lax skin, but not severe enough to warrant surgical correction. A facial treatment takes 30 minutes to perform and should be done every 4-6 weeks for a minimum of 3 treatments. It is recommended that once the initial series has been completed and optimal results have been achieved, to have a maintenance laser genesis done every 3-4 months.

Skin Care Products
Regardless of what procedure a person decides upon it is imperative that they continue the corrective process with a home skin care prescription. We have found that the best results occur with the following skin care regimen:

Morning Skin Care
1. Cleanse with a cleanser that contains alpha hydroxyl acids (i.e. glycolic and lactic acids)
2. Apply 3-5 drops of vitamin C (l-ascorbic acid 10-20% concentration)
3. Hydrate skin
4. Apply sunblock with SPF 30 or higher every day. If you are going outside apply sunblock 30 minutes before heading outdoors. Reapply sunblock every 2 hours if you are outdoors for a prolonged period of time; or if you are swimming or perspiring heavily. And don’t forget to apply sunblock to children before they go outside to play!

Evening Skin Care
1. Cleanse
2. Apply vitamin A derivative product such as Retinol, Retin-A, etc. Vitamin A works very well to smooth fine lines and wrinkles. It has also shown in dermatologic studies to be very helpful in improving the fine lines underneath the eye area.
3. Hydrate skin 30 minutes after applying vitamin A product.