Long lazy youthful days spent lounging in the sun once appeared as a deep, bronze tan. But fast-forward by 20 years and evidence of those carefree and unprotected hours in the sun shows up on faces, chests, necks and arms. The signs appear as fine to medium wrinkles, loose or sagging skin, freckles, uneven pigmentation, liver or age spots, moles — and sometimes precancerous lesions or skin cancer.
In April, 2012, the New England Journal of Medicine published a photo and case study of a man who had driven a delivery truck for 28 years. The side of his face exposed to the sun on a daily basis showed the kind of damage and premature aging that solar rays can inflict on unprotected skin over a long period of time.
The first step in reversing sun damage is preventing further damage. “A good broad-spectrum sunscreen that reduces UVA and UVB exposure is the first and most important step for people to take,” says Azadeh Shirazi, MD, a dermatologist at Scripps Clinic in San Diego.
She also recommends a full-body cancer screening and mole check by a qualified dermatologist. Because Southern Californians are exposed to more intense sunlight more days of the year than people in more temperate climates, they should have a baseline examination by the age of 30.
Interventions for sun damage run a full gamut, from daily use topical creams and gels to chemical and mechanical skin peels and laser treatments. These treatments can temporarily fade uneven pigment, smooth roughened or wrinkled skin, tighten large pores and even restart collagen production.
“We typically see three kinds of sun damage in San Diego,” says Vic Ross, MD, director of laser and cosmetic dermatology at Scripps Clinic. “Melasma, which are tan or brown spots on the forehead and cheeks, is the most common. There are also red and brown age spots, broken blood vessels and finally — wrinkles and sagging.”
These compounds, chemically derived from vitamin A, encourage skin cells to slough off and renew themselves, improving skin cell turnover cycles. They also stimulate collagen production, lighten brown spots and reduce the size of pores.
Vitamin C and other anti-oxidants
These substances slow the skin’s degeneration due to the production of rogue chemicals (free radicals) that cause visible signs of damage. Antioxidants can slow the signs of aging, reduce ultraviolet damage to skin and help reduce the breakdown of collagen.
Sun damage slows the rate at which skin cells turn over, or replace themselves, causing dull, dry skin, uneven skin tone, and even blemishes and clogged pores. Chemical exfoliants like AHAs (alpha-hydroxy acids) and BHAs (beta-hydroxy acids) stimulate faster skin cell turnover.
Whitening or brightening cosmetics typically include hydroquinone, an ingredient with clinically proven skin-lightening properties. Used in conjunction with a retinoid, these can lighten but not completely remove superficial discoloration, uneven pigmentation and sunspots.
A chemical peel is a procedure performed by a dermatologist using various solutions to achieve a controlled treatment of the skin layers. The depth of treatment varies; it can be superficial, medium or deep depending on skin type and the cosmetic and therapeutic goal.
Peels encourage sloughing off the dead top layer of skin, which in many cases will take with it areas of uneven pigmentation, precancerous lesions and fine lines. Chemical peels can either be performed in a series or as a one-time treatment, depending on the peel depth.
“Downtime for superficial peels is minimal,” explains Dr. Shirazi. “You may experience redness and swelling with a deeper peel. Medium and deep peels require longer recovery time. After any chemical treatment, a strong sunscreen is a must.”
Several kinds of lasers can be used on nearly any body surface to reduce the appearance of sun damage. “Generally, the laser treatments produce the best results when we apply them to the whole face, hairline to jawline,” says Dr. Ross. “They typically take just 15 minutes, with varying downtime depending on laser type.”
Also referred to as photorejuvenation, these lasers can improve skin texture, redness, veins, blotchiness, and brown spots. “There is no better technology for blood vessels than a green light laser,” says Dr. Ross. “Creams and chemical peels just can’t physically affect them the way a laser can.”
These lasers create tiny thermal zones, or tiny wounds, deep in the skin. As it heals, the skin re-emerges with a smoother, tighter appearance. Fractionated lasers stimulate the natural healing process to create new collagen. They also treat brown spots and age growths, replacing them with fresh, healthy skin.
These are more aggressive, deeper lasers that vaporize the top layer of skin, and are appropriate for significant damage ranging from deeper pigmentation and growths to unevenness and deep lines and wrinkles. These lasers require a longer and more intense recovery period.
Dr. Ross emphasizes that keeping the visible signs of sun damage at bay is an ongoing process. “Unless they stop going outside during the day, most people will continue being exposed to skin-damaging solar rays,” he says. “Many of my patients find they need some kind of overall maintenance laser treatment once every year or two.”