Sun damaged skin, also known as photoaging, is a biologic process that we all must endure.  The appearance of our skin is greatly influenced by genetics, age, and sun exposure. Unfortunately, the majority of sun damage is accumulated before the age of 20.  The skin takes 10 to 30 years to manifest the damage of our youth.  The damage is initially subtle with added blood vessels and pigmentation changes on the sun-exposed areas.  As we age, the changes become more pronounced with the appearance of wrinkles, brown spots and coarse dry areas.

Solar radiation, also known as ultraviolet radiation, consists of wave lengths of A, B, and C. Ultraviolet wavelength C is absorbed by the ozone layer before it reaches the earth’s surface.  Wavelengths A and B are abundant and are the major cause of sun damage. Ultraviolet light B (UVB) is blocked by glass such as a car window. Ultraviolet light A (UVA), however, readily passes through glass. 

The exact mechanism of sun damage is not completely understood.  As a consequence of ultraviolet radiation, tissue-damaging free radicals are generated. These radicals are essentially cellular oxygen molecules that have been “energized” or activated.  The result is a cascading effect that can damage millions of cells in a very short time. The effects seen visually are wrinkles, laxity of the skin, textural changes, and discoloration such as age spots. The effects not seen are cellular DNA damage and impairment of the skin’s immune system.  These factors are important, as they are influential in the development of skin cancer.

Recommendations:

Skin rejuvenation is accomplished through cellular regeneration and maintaining the health of sun-exposed skin.  The sun is very damaging and sun avoidance as well as protection with sunblock or sunscreen is essential to any maintenance regimen.

The three most widely used treatments for skin rejuvenation involve antioxidants, Vitamin A preparations, and exfoliating agents. 

Antioxidants:  Antioxidants are an emerging concept in skin health and maintenance.  The sun’s ultraviolet radiation produces free radicals that are absorbed by antioxidants.  The most common antioxidants are Vitamins A, C and E, along with beta-carotene.  These antioxidants are most effective when applied topically. Topical Vitamin C is the most widely used. In addition to its antioxidant activity, topical Vitamin C stimulates cell replication and collagen production.  The overall effect is thickening of the skin with reduction in the appearance of fine lines and wrinkles. 

Vitamin A:Vitamin A is available in common forms such as Retin-A® (tretinoin) or retinol. Retin-A® is prescription strength and is stronger than over-the-counter Vitamin A derivatives. Over-the-counter retinol, however, is very effective for sun damage. Over-the-counter preparations avoid many of the side effects of redness, irritation, and peeling associated with the prescription products. (See retinol)

Topical Vitamin A is also essential for skin health and maintenance.  The skin has receptors that specifically absorb Vitamin A, aiding in cellular growth and differentiation.  The results are impressive with a reduction of fine lines and wrinkles and a complexion that is smooth, supple and evenly pigmented.

Exfoliation:  Skin exfoliation is achieved by mild acid application to the skin.  The acids currently in use are alpha and beta hydroxy acids. (See hydroxy acids.)  Hydroxy acids are readily absorbed into the deeper layers of the epidermis.  Effects include superficial exfoliation and subsequent stimulation of both the epidermis and dermis.  The result is skin thickening with more uniform pigmentation and a reduction in the appearance of fine lines and wrinkles.

What treatment regimen is right for you?

Dermatologists uniformly agree that skin health and maintenance should be addressed twice daily. An excellent, yet simple, treatment regimen should be one product in the morning and another in the evening. Products can be combined, however, this may increase adverse effects such as redness, irritation and peeling.  If a simplified regimen is tolerated, products can always be added based on individual goals and preferences.

Remember, damaged skin is the result of many years of sun exposure. Improvement will occur gradually with a consistent program of skin care maintenance.