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                              Sun Damage Treatments
 
What is Photoaging? 
Excessive exposure to the sun early in life can make a person look older than he/she really is. Premature wrinkling and skin damage from sun exposure is also called photoaging. Photoaging, unlike natural aging, results in coarse, dry skin, freckling, skin discoloration, leathery skin, and deep wrinkles. 


Treatment for Sun-Damaged skin:
 

Sun damaged skin
Condition
Sun damaged skin has wrinkles, texture alterations, pigmentation abnormalities with melasma and Lentigines yellowing or sallow appearance, thinning, fine telengiectasias and mottling. Sun damaged skin can have pre-malignant changes such as solar keratoses (actinic keratoses), basal cell carcinoma and squamous cell carcinoma.


Sun damaged skin is predisposed to the development of malignant skin tumors, the most common of which can be found around the periocular area and face being the basal cell carcinoma. People with skin number  1 and 2 skin type (red or blonde haired individuals) are more prone to both sun damage and skin tumors. 

Skin tumors caused by sun also include squamous cell carcinoma and malignant melanoma, fortunately more rare, but more serious.


In particular, sun damaged skin looks older because of the dehydration, pigment changes, thinning and wrinkles. Deep lines occur in the periorbital area and face partly because of sun damage but more due to muscle action from the muscles of facial expression which cause deep lines in an already thin and aged skin.


The treatment of sun damaged skin with all its associated features is combination therapy which  includes proper skin care, specific skin treatments, chemical peels , botulinum toxin A (e.g. Botox®), laser resurfacing and fillers (e.g. Restylane,Juvederm). 


Examination
First, the patient will be asked what aspect of their sun damaged skin concerns them.


Examination of patients with sun damaged skin will involve taking a full history concerning sun exposure when younger, whether they have lived abroad or worked outside, habitual sunscreen use and skin care. Any family history of malignant skin cancer such as basal cell carcinoma,melanoma, or squamous cell carcinoma should be given. 


The periorbital area and face is assessed for fine wrinkles and deep lines, skin elasticity, skin quality including the presence of dyspigmentation with melasma and lentigines. Other aging features such as brow or eyelid ptosis, mid-face descent, malar bags and baggy eyes are assessed.


The patient will be asked on smoking habits, drug allergies and current medications.


Photographs of the sun damaged areas will normally be taken. You should bring along photographs of your face when younger as this helps plan treatment.


Treatment
Sun damaged skin can be greatly improved with treatment. 

Treatment:



Daily skin care with paraben free and perfume free moisturize and cleanser(Cetaphil)
Sun damage protection with sun blocker cream which has a very high, broad and stable UVA/B protection, such as Bull Frog, Blue Lizard or Cetaphil 50 which contain titanium and zinc oxide which are physical blockers.

Tretinoin treatment. Tretinoin, commonly known as Retin-A, is a topical cream or gel to treat photo-aging skin with fine wrinkles and dyspigmentation.

The most commonly used strengths around the periorbital area and face are tretinoin 0.05% and 0.025%. Tretinoin will produce a rosy glow to the skin with a fine translucence and healthier appearance. It does reduce fine wrinkles, surface roughness and may help prevent adverse effects of ultraviolet light by increasing the amount of collagen in the skin. 

Tretinoin is available by prescription, e.g. as Differin ®, Airol ®. Tretinoin is applied lightly to the perioibital areas and face, neck and backs of hands at least three times a week at night. Once the patient has accustomed to it, it can be applied daily. It is imperative that patients using tretinoin treatments wear a strong factor (50+) sunblock during the day. It can take between two and six months of application before noticeable improvement of skin quality. Its use can be continued over years.
Higher strength tretinoin cream 0.1% combined with hydroquinone and a small amount of steroid can be prescribed for larger melasmas (flat, brown patches), but their use has to be monitored closely by the cosmetic dermatologist.

Chemical peels (e.g. TCA). TCA 20-30% is used to provide a superficial depth epithelial peel and can reverse solar lentigines, improve solar keratoses, improve skin texture and slightly improve fine wrinkles. Its effect is to tighten the skin by correcting some of the epidermal atrophy and helping to lay down new collagen. The peel represents superficial layers of the epidermis exfoliating and then there is re-epithelization with fresher looking skin.

Peeling involves producing the effect equal to a moderate sunburn with redness, some discomfort and irritation occurring before the peel. 

To minimize the effects of photoaging, several treatment options are available for aging skin. Specific treatment for sun-damaged skin will be determined by Dr. Gary based on: 


your age, overall health, and medical history 
severity of the skin damage 
type of skin damage 
your tolerance for specific medications, procedures, or therapies 
your opinion or preference 
Treatment may include: 


BOTOX®

 
An injection of botulinum toxin BOTOX® (a complex type of protein) or 
into specific muscles will immobilize those muscles, preventing them from forming wrinkles and furrows. The use of botulinum will also soften existing wrinkles. 
chemical peels 

Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
 
 
Juvederm Injections 

Juvederm is injected beneath the skin to replace the body's natural volume loss. Injectable Juvederm is generally used to treat wrinkles, scars, and facial lines.

Dermabrasion 

Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher. 

A gentler version of dermabrasion, called microdermabrasion, uses small particles passed through a vacuum tube to remove aging skin and stimulate new skin growth. This procedure works best on mild to moderate skin damage and may require several treatments. 

Intense pulsed light (IPL) therapy 

Intense pulsed light (IPL) therapy is different from laser therapy in that it delivers multiple wavelengths of light with each pulse (lasers deliver only one wavelength). IPL is a type of non-ablative therapy. 
laser skin resurfacing 

Laser skin resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars. A newer treatment option is called non-ablative resurfacing, which also uses a laser as well as electrical energy without damaging the top layers of skin. 
tretinoin treatment 
Tretinoin treatment, a prescription topical cream, can reduce wrinkles, rough skin, and discolored skin. 

However, prevention is the key to retaining a youthful appearance. Practicing safe sun exposure habits, such as using sunscreens correctly, staying out of the sun as much as possible, and wearing protective clothing and hats, are essential to keeping the skin healthy. In addition, practicing sun safety may prevent the development of skin cancer later in life.