Sun Damage

UV radiation is a form of electromagnetic radiation that mainly comes from the sun. There are three types of UV rays: UVA, UVB and UVC rays. UVA rays are the weakest, but they cause skin cells to age faster. UVB rays are a little stronger, and can cause sunburns and skin cancer. UVC rays from the sun react with the ozone and do not reach the ground.

Sunlight is main source of UV radiation and this radiation is at its strongest between 10  a.m. and 4 p.m.,  nearer the equator, at altitude, and may be increased or decreased by clouds and surface reflections. UV radiation from the sun can be blocked with clothes, hats, and sunscreen. Lip balm with SPF and sunglasses protect the lips and eyes from UV rays. In locations with strong sunlight, sunscreen should be applied regularly.

UV light interacts with a natural chemical in the skin called melanin. Melanin is your first line of protection and absorbs UV rays in order to shield your skin against sun damage; this chemical reaction is what gives skin a tan. When the amount of UV rays you’re exposed to exceeds the protection provided by melanin, however, you get a sunburn.

Man-made sources of UV radiation, such as tanning beds, have also been linked to cancer. Tanning beds are particularly damaging if used before the age of 20.

UV light causes many other undesirable effects that are not cancerous and repeated overexposure to UV rays can lead to various forms of skin damage including fine lines, wrinkles, age spots, freckles, and other discolorations. The skin becomes tougher, more leathery and dry scaly patches can appear (called actinic keratosis and thought to be the beginnings of skin cancer).  Furthermore facial skin can become redder and new blood vessels can develop and become prominent.

Prevention and restoration:

At Dermatology Matters we aim to address all aspects of sun damaged skin both medical and cosmetic and where possible to combine treatments so as to provide optimal care.

Daily sun protection using a high quality sun block is an essential part of any skin care regimen and should be used daily. This is adequate for minimal exposure but SPF should be reapplied every 2-3 hours if exposed to more intense sunlight.

Modalities used to correct or repair aged skin target more specific problems. Firstly the skin is examined for any skin cancer or precancerous changes and these are treated accordingly with cryosurgery, photodynamic therapy, topical chemotherapy or surgery . Then the skin is examined for evidence of non-cancerous sun damage such as sun spots, thread veins and laxity. These blemishes can also be treated using a combination of therapies including IPL, Nd-Yag laser, Fraxel , Active FX and Photodynamic therapy. Topical therapies can also be used although they are most effective at maintaining the improvements achieved with more potent therapy.

Liquid nitrogen is sprayed at specific lesions and freezes a localised patch of the skin to -70C. This causes a freeze burn at the treatment site. This burn causes the upper layer of skin to separate from the lower layer and effectively removes sun damaged tissue (actinic keratosis). The underlying collagen is unaffected by freezing and therefore the burn heals without scarring. Pigmented cells are also susceptible to cold and liquid nitrogen can be used to treat sun spots and pigmented actinic keratosis also. Extra care must be taken when liquid nitrogen is used to treat pigmented skin types as it can leave areas of loss of pigment.

Liquid nitrogen is quick and easy but uncomfortable. Following treatment a blister will usually develop at the treatment site. This blister will usually heal in 6-10 days. Usually the blisters do not require treatment, but larger blisters can be burst using a sterile needle and then an antibiotic or antiseptic cream should be applied 2-3 times daily.

Cryosurgery is an excellent treatment for individual or small numbers of lesions. For more extensive areas of sun damage an alternative approach is needed.

Topical chemotherapy is an excellent treatment particularly when combined with an immune stimulant. The combination of topical 5 fluorouracil (Efudix) and the immune stimulant calcipitriol (Dovonex) mixed and applied together 2 daily for a week gives excellent results but is very harsh and the recovery time is in the order of 2 – 3 weeks.

This is a light activated chemotherapy. The photosensitizing drug is applied to the treatments site where it is preferentially absorbed by sun damaged or precancerous cells. The cream is then removed and the skin is exposed to a red LED light that activates the drugs and kills the abnormal cells

PDT has many advantages over alternate treatments. The treatment is carried out in the office and is safe and well tolerated and only mildly uncomfortable. It treats individual lesions and back round sun damage. It reduces the subsequent risk of developing skin cancer in the treated area and also results in an improved appearance to the skin. Following treatment the skin is very light sensitive for 48 hours: patients need to stay indoors. Patients usually get a sun burn like reaction that can be mild moderate or severe. Even severe cases resolve completely but these cases sometimes need to take antibiotics and antiviral medication.

Correction and repair for aesthetic purposes

We at Dermatology Matters strive to address all aspects of aging skin both to reduce age related skin diseases and cancers and where possible to combine treatments so as to also produce a more youthful and fresh appearance.

Prevention

Ultraviolet sun light is one of the major causes of skin aging and skin cancer. Daily sun protection using a high quality sun block is an essential part of any skin care regimen and should be used daily. This is adequate for minimal exposure but SPF should be reapplied every 2-3 hours if exposed to more intense sunlight.

Repair

After the skin has been examined for any skin cancer or precancerous changes and after these have treated the skin is examined for evidence of non-cancerous sun damage such as sun spots, thread veins and laxity. These blemishes can be treated using a combination of therapies including IPL, Nd-Yag laser, Fraxel , Active FX and Photodynamic therapy. Topical therapies can also be used although they are most effective at maintaining the improvements achieved with more potent therapy.

Fraxel is a non-invasive laser treatment that makes hundreds of thousands of microscopic holes in the skin. This softens and elevates scars and wrinkles and as the skin heals it tightens due to the production of new collagen and elastin within the dermis or deeper layer of the skin. Basically it smooths wrinkles and scars, fades brown spots, and resurfaces your entire skin tone. Unlike ablative lasers, Fraxel is a fractional skin resurfacing treatment, which means it only targets a fraction of the skin at a time. This means that after treatment the skin appears a little red and puffy but there is no real downtime.The number of sessions required vary but usually 3-6 sessions are required. Active FX is a more aggressive therapy, similar to Fraxel but using a CO2 laser as opposed to an Erbium glass laser. Active FX gives better results but is associated with greater post procedure downtime which typically lasts 3-4 days

Skin laxity and collagen loss can be reversed using a combination of different modalities; IPL and Fraxel operate at a superficial level and are suitable for fine lines and wrinkles on the face whereas the Nd-Yag Laser and bipolar radiofrequency (Viora reaction) operate at a deeper level and are more suited to the neck, forehead and deeper wrinkles.