So summer is almost over… and we are left with glowing tans and bikini lines that we could show off for maybe a few weeks after that awesome beach trip. But after getting out of the sun, we are also left with some deep sunburns and the dreaded “photo-damage” or chronic sun damage. This is basically accelerated skin aging due to that ubiquitous UV radiation. In reality, our skin is exposed to environmental damage from the sun 365 days of the year and giving our skin some TLC should not be limited to the summer months.
Photoaging is due in part, to DNA damage from exposure to the sun’s UV rays. DNA is altered by UVB and UVA stimulates the release of reactive oxygen species that cause lipid oxidation, causes dyspigmentation (brown spots) and induces carcinogenesis (skin cancer). Solar radiation affects the skin’s structural matrix and targets proteins in the middle layer of skin (the dermis) such as collagen, elastic fibers, glycoproteins and glycosaminoglycans (GAGs). Sun exposure results in various changes in the skin, from wrinkles, freckles, brown spots, pre-cancerous growths (actinic keratosis) to skin cancer.
Sun damage accumulates over time and it is never too late to start a regimen to protect and repair the skin. Here are some tips:
1. Prevention is key! Avoidance of direct sun exposure, especially at midday between 10AM and 3PM, and generous use of sunscreen cannot be stressed enough. Use sunscreens with SPF 15-30 or higher everyday. They help absorb or reflect UV radiation from the skin, thus preventing interaction with other molecules in the skin. Reapplication every 2-3 hours or after exposure to water is recommended. In addition, use of hats, tightly woven clothing and sunglasses help protect against UVA and UVB rays.
2. Retinoids are natural and synthetic compounds that derive from all-trans-retinol, more commonly known as Vitamin A. Topical retinoids act by increasing collagen production, inducing skin maturation and decreasing atypical cell forms. Improvements in wrinkling, blotchy coloring (dyspigmentation), and surface roughness can be seen after 3-6 months of treatment and the greatest response occurs during the first 6-9 months. Tretinoin and tazarotene are available forms of topical retinoids prescribed by dermatologists. Retinol is available over the counter without a prescription.
3. “Cosmeceuticals” are nonprescription topical compounds that contain antioxidants, vitamins, hydroxyacids and plant extracts that may influence and improve the biologic function of the skin. They can be used in conjunction with topical retinoids. However, these products are not subject to rigorous testing and regulation by the FDA, so advice from your dermatologist should be sought before use. Here are some examples of cosmeceuticals that may help repair sun damage to the skin:
- Vitamin C (Ascorbic acid) – neutralizes reactive oxygen species (ROS) caused by UVA irradiation
- Vitamin E (α-tocopherol) – scavenger of free radicals and reduces UV-induced redness
- Ubiquinone (Coenzyme Q10) – inhibits lipid peroxidation and quenches free radicals in the skin; suppresses UVA-induced damaging enzymes like collagenase
- α-Hydroxyacids (AHAs) – organic acids derived from dairy products, fruit or sugar cane; they reduce skin pH, increase exfoliation and improves skin hydration
- Plant extracts (Green tea polyphenolic epitechins, Soy isoflavones, Grape seeds, Coffee berry, Ginkgo biloba, Ginseng) – have antioxidant and anti-inflammatory properties
4. Chemical peels work by damaging the top skin layers with subsequent skin regeneration to tighten the skin and promote uniform color (melanin) distribution. These may improve photoaging but should be used with caution. It is important to balance your own values and preferences with the guidance and advice from your dermatologist.
5. Promising studies are ongoing regarding agents that accelerate DNA repair, reverse oxidative stress and reverse skin cancer development such as platelet activating factor and serotonin (5-HT) receptor agonists. Inducing melanin production using investigational enzymes and hormone analogues are also being explored.
Go and get yourself armed and ready! A tube of SPF 15-30 sunscreen, water for hydration, a pair of sunglasses, a hat, and expert advice from your dermatologist—jump into 365 days of summer!
References and Resources:
Image sourced from VisualDx. www.visualdx.com
Antoniou C, Kosmadaki MG, Stratigos AJ, Katsambas AD. Photoaging: prevention and topical treatments.
Am J Clin Dermatol. 2010;11(2):95–102.
Antoniou C, Kosmadaki MG, Stratigos AJ, Katsambas AD. Photoaging: prevention and topical treatments. Am J Clin Dermatol. 2010;11(2):95–102.
Sreevidya CS, Fukunaga A, Khaskhely NM, Masaki T, Ono R, Nishigori C, et al. Agents that reverse UV-Induced immune suppression and photocarcinogenesis affect DNA repair. J Invest Dermatol. 2010 May;130(5):1428–37.
Habif TP. Clinical dermatology: a color guide to diagnosis and therapy. [Edinburgh]: Mosby; 2010.
Chien, AL, Kang, S. Photoaging. In: UpToDate, Basow, DS (Ed), UpToDate,
Waltham, MA, 2013.