SUN PROTECTION AND TREATMENT OF SUN-DAMAGED SKIN

Being out in the sun is great for one’s health – it fosters physical activity, lessens stress, and is a natural way to boost Vitamin D levels, which enhances the health of our bones and muscles. However, extended periods of sun exposure can also be the source of numerous skin problems, and can contribute to accelerated aging of the skin (photoaging). This is why it is best to know how to protect our skin from the harmful effects of the sun and its ultraviolet rays (UV rays).

What is healthy sun exposure?

Studies have found that being out in the sun for 10-15 minutes twice a week is sufficient enough to obtain adequate amounts of Vitamin D.

How do I protect my skin from the sun?

Protecting our skin from the sun (photoprotection) is essential to maintain healthy skin. This can help prevent, slow down, and sometimes reverse signs of sun damage.

• Limit your time under the sun and avoid direct sun exposure from 10:00 AM to 4:00 PM.
• Seek shade from trees, or use an umbrella if outside trips are unavoidable.
• Wear long-sleeved shirts and pants to cover up your skin. Dark colors are more protective compared to light colors. You can also check the ultraviolet protection factor (UPF) of your clothing. A UPF of at least 30 is recommended for better protection from the sun’s UV rays.
• Accessories such as wide-brimmed hats and sunglasses can help protect the head, eyes, ears, and neck. Closed shoes also offer more sun protection for the feet compared to open-toed shoes, sandals, or flip-flops.
• Use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. For those with sensitive skin, look for sunscreens containing zinc oxide and titanium dioxide. These are less likely to cause irritation. Make sure you use the right amount of sunscreen, and reapply your sunscreen every 2 hours. Reapply more often if you are sweating or swimming.
• Check the UV index (UVI). This measures the level of ultraviolet radiation in your area. The higher the UVI, the greater the chances for sun damage to the skin. A UV index of 8 or more means that there is a very high risk of damage from sun exposure, especially if no photoprotective measures are taken.
• Avoid tanning beds. Frequent tanning increases the risk for melanoma.
• Visit your trusted dermatologist. The earlier a skin problem is detected, the better the chances of treating it.

What are the skin conditions caused by sun damage?

Excessive sun exposure can cause a variety of skin conditions:

1. Freckles (Ephelides)

Prolonged and constant sun exposure (approximately 20 minutes) can cause immediate redness and darkening of the skin, and can lead to the appearance of small, light brown spots on sun-exposed areas such as the face.

2. Melasma

Melasma is more common in women and appears as acquired light-brown to dark-brown patches on the face, usually found on the cheeks, forehead, nose, and upper lip.

3. Sunburn

Within a few hours of exposure to the sun, the skin can get red and painful, sometimes accompanied with blisters. Constant sunbathing and sunburn increases the risk for skin cancer, especially in Caucasian skin.

4. Wrinkles and loose skin

Excessive sun exposure can induce damage in all the skin layers – the epidermis, the dermis, and even until the subcutaneous fat (fat under the skin). This is why a person with sun-damaged skin may notice changes such as appearance of wrinkles and loose skin, dry skin, and a darker or ruddy complexion.

5. Skin cancer

UV exposure from sunlight can cause damage to the DNA in the skin and can lead to production of abnormal, cancerous skin cells.

What are the treatment options for sun-damaged skin?

There are varied ways of treating sun-damaged skin. This all depends on what specific skin conditions you have. A visit to the dermatologist can help detect your skin problems and can point you to the right kind of treatment or management needed. A board-certified dermatologist will most likely use not just one, but a combination of 2 or 3 types of treatment modalities. Some of the most common treatment options include:

Retinoids

Retinoids are frequently prescribed by dermatologists to treat a variety of skin conditions. It can help reduce wrinkles, address pigmentation, fine lines, and rough skin. Retinoids increase collagen production and cell turnover, which helps in the treatment of damaged skin cells.

Hydroquinone

Hydroquinone is another commonly prescribed medication as it helps reduce the development of melanin (pigment). It is used to lighten dark patches of skin.

Chemical peels

Chemical peels are done to remove the top layer of the skin. When a chemical is applied to the skin, it causes irritation and inflammation, and signals for new skin to regenerate. This improves the skin’s appearance, as the sun-damaged, pigmented top layer of the skin is shed off. However, improvement can only be seen after undergoing multiple sessions.

Tranexamic acid

Tranexamic acid inhibits the formation of melanin. Numerous studies show evidence of its ability to improve facial skin tone and dark spots.

Lasers

A variety of lasers may be used to treat hyperpigmentation and sun-damaged skin. Laser therapy can lighten sun spots and dark marks. It can also minimize wrinkles, tighten skin, and improve fine scars.

Botulinum Toxin type A (Botox)

Muscles that constantly move, such as the forehead muscles or the eye muscles, are the most common sites of wrinkles and fine lines. Botox type A is injected into these specific muscles to block nerve signals and restrict muscle movement, which can lessen wrinkles, and improve the skin’s appearance.

Filler injections (Derma Fillers)

Sun-damaged, photoaged skin can cause facial lines and wrinkles due to volume loss. This is mostly due to the deterioration of natural collagen in the skin. A derma filler can be injected in order to replace the lost collagen and improve the appearance of fine lines, scars, and wrinkles.

Take-Home Messages

The best way to avoid photoaging and sun-damaged skin is prevention. Actively following the different ways to protect your skin from the sun’s UV rays will help prevent skin problems in the future. Advances in dermatology and skin care have resulted in the development of a wide range of treatment options to address pigmentation, fine lines, wrinkles, and loose skin. However, sun-damaged skin may still be difficult to treat. It is recommended to consult with a board-certified dermatologist to get the best, personalized treatment regimen for you.

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References:

• Kang, S. (2018). Fitzpatrick’s Dermatology, Ninth Edition, 2-Volume Set (EBOOK). McGraw Hill Professional.
• Lee, Jin Young, et al. “Loss of Elastic Fibers Causes Skin Wrinkles in Sun-Damaged Human Skin.” Journal of Dermatological Science, no. 2, Elsevier BV, May 2008, pp. 99–107. Crossref, doi:10.1016/j.jdermsci.2007.11.010.
• da Silva Souza, I. D., Lampe, L., & Winn, D. (2020). New topical tranexamic acid derivative for the improvement of hyperpigmentation and inflammation in the sun‐damaged skin. Journal of Cosmetic Dermatology, 2, 561–565. https://doi.org/10.1111/jocd.13545
• Bello, J. S. (2008). Treatment Options for Sun-Damaged Skin. Plastic Surgical Nursing, 3, 123–128. https://doi.org/10.1097/01.psn.0000335810.39047.ec
• Sun Protection - The Skin Cancer Foundation. (n.d.). The Skin Cancer Foundation. Retrieved March 17, 2022, from https://www.skincancer.org/skin-cancer-prevention/sun-protection/
• Sun Protective Clothing - The Skin Cancer Foundation. (n.d.). The Skin Cancer Foundation. Retrieved March 17, 2022, from https://www.skincancer.org/skin-cancer-prevention/sun-protection/sun-protective-clothing
• What to wear to protect your skin from the sun. (n.d.). American Academy of Dermatology. Retrieved March 17, 2022, from https://www.aad.org/public/everyday-care/sun-protection/what-to-wear-protect-skin-from-sun
• Sunscreen: How to Help Protect Your Skin from the Sun | FDA. (n.d.). U.S. Food and Drug Administration; FDA. Retrieved March 17, 2022, from https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun
• Sun Safety | Skin Cancer | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved March 17, 2022, from https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm
• Radiation: The ultraviolet (UV) index. (n.d.). WHO | World Health Organization. Retrieved March 17, 2022, from https://www.who.int/news-room/questions-and-answers/item/radiation-the-ultraviolet-(uv)-index
• Treating Aged or Sun-Damaged Skin -  Health Encyclopedia - University of Rochester Medical Center. (n.d.). Welcome to URMC - Rochester, NY - University of Rochester Medical Center. Retrieved March 17, 2022, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00323

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