Sun Damage

When I refer to 'sun damage', I'm not talking about sunburn or the peeling skin that occurs after too much time at the beach. I'm referring to the hidden alterations in your skin cells caused by ultraviolet radiation from the sun, known as UVA and UVB rays. This occurs whenever you are exposed to the sun - even on cloudy days, even indoors and even when you're wearing sunscreen! This phenomenon is often called photoaging or 'dermatoheliosis'.

Treatments:

Chemical Peels

Microneedling

Skin boosters

FAQ - SUN DAMAGE

What is sun damage?

Sun damage is the primary factor that speeds up the skin's natural aging process. When it becomes more severe, it leads to symptoms that resemble normal aging but aren't.

Essentially, there are three levels of sun damage:

• Stage one - minor damage that accelerates the natural aging process, making your skin appear older sooner.

• Stage two - extended exposure leading to symptoms that differ from normal aging.

• Stage three - significant damage that includes the above and also increases the risk of skin cancer.

  
  

Stage One – accelerating the aging process

One aspect of sun damage is collagen degradation. Even minimal UV exposure raises levels of an enzyme called matrix metalloproteinase-1 (MMP-1), a key player in collagen breakdown. The aging process is typically marked by symptoms linked to collagen breakdown and sun exposure hastens the onset of older-looking skin. That's why skincare experts emphasize protecting your skin from UV light.

Sun damage also leads to a decrease in glycosaminoglycans (GAGs), which include hyaluronic acid. These molecules keep your skin hydrated and work with collagen and elastin to maintain skin firmness. Skin that ages without sun exposure has low GAG levels. UV exposure accelerates this process.

Lastly, sun damage can manifest as thread veins, or telangiectasia, which are clusters of veins near the skin's surface. As collagen and GAG levels decrease, skin becomes thinner and loses elasticity. Thin skin reveals subdermal veins more easily. Inelastic skin struggles to compress enlarged veins back to normal size. Thread veins become more prominent with age, regardless of sun exposure, but UV exposure accelerates the process.

Stage Two – prolonged exposure leading to distinct symptoms

With limited stage-one exposure, damage isn't distinct from normal aging. In stage two, prolonged UV exposure symptoms become apparent.

• Discolored skin patches, darker than surrounding tissue - known as solar lentigines or ‘age spots’.

• Solar comedones - larger, more noticeable blocked pores, either open (blackheads) or closed (whiteheads).

• Localised thickening of the epidermis - actinic keratosis, small scaly skin areas, roughly 1–2cm in diameter.

• General thickening of the dermis - solar elastosis, where skin becomes thicker, leathery and deeply wrinkled.

  
  

‘Age spot’ is a common term in dermatology, but it's misleading. The correct term is solar lentigo, which implies UV exposure is necessary. That's why they appear on sun-exposed areas like the face and hands. They usually appear after age 60, often mistakenly attributed to aging. (If you notice hyperpigmentation spots elsewhere or at a young age, it could be something else. Consult a doctor if unsure.)

Solar comedones appear later in life (60–80 years old) and are more common in men. They're linked to UV exposure and often occur with thick, yellow skin typical of solar elastosis, this combination is known as Favre-Racouchot syndrome.

Actinic keratosis form after years of sun exposure. They can be mistaken for dry skin or scabs but indicate sun damage. If you find one, start protecting your skin from the sun. If one is lumpy, tender, or bleeding, see a doctor immediately as some actinic keratosis can develop into skin cancer called ‘squamous cell carcinoma’ and these symptoms could be early signs.

Solar elastosis is a sign of advanced photoaging. Prolonged exposure disrupts elastin fibers in the dermis, causing skin to thicken and become leathery. The dermis, beneath the epidermis, is where fibers bunch up, leading to thick, leathery, and yellow-tinged skin, similar to long-term smokers, with deep wrinkles more noticeable than those from normal aging.

Why do I have sun damage?

You don't need to spend hours outside without sunscreen to experience sun damage. Sitting by a window, shopping on a cloudy day or driving all contribute. In short, living on Earth exposes you to sun damage. Unfortunately, everyday exposure leads to premature skin aging without active management.

It's not all bad news, as your skin is adept at repairing itself. However, sun damage is inevitable unless you're nocturnal or live underground, accumulating faster than your body can handle. Precautionary measures are essential. Sunscreen won't block all damage but reduces UV radiation to manageable levels.

What does sun damage look like on the skin?

Beyond the obvious red burn and peeling from overexposure, long-term UV symptoms are often linked to aging. Common signs include:

• Telangiectasia - known as thread or spider veins

• Solar lentigines - often called age spots

• Solar comedones - large, blocked pores

• Actinic keratoses - small patches of dry, rough skin

• Solar elastosis - thickening of the dermis, leading to deep wrinkles and a leathery appearance

How can I prevent sun damage?

The best way to prevent sun damage is avoiding the sun. While impractical, it's the only foolproof method. However, avoid unnecessary sun exposure when possible.

Covering exposed skin with clothing is more practical. Opt for long sleeves and wide-brimmed hats, with dark colours being most effective.

Otherwise, use sunscreen. Many believe sunscreen is only for holidays or the beach, especially in places like the UK with limited sunshine. In reality, sunscreen should be worn daily. Even on cloudy days, uncovered skin receives UVA and UVB rays, contributing to photoaging.

What sunscreen should I wear?

Sunscreen blocks harmful UV radiation, which includes UVA and UVB rays. The sun emits these in varying strengths throughout the day, so constant protection is necessary.

SPF is useful but misunderstood. It only measures UVB protection, ignoring a significant portion of the sun's radiation. Look for sunscreen that explicitly states UVA protection or says ‘broad spectrum.’ UVA damages collagen, crucial for combating photoaging. Most sunscreens have a standard UVA to UVB ratio, but it's worth checking.

SPF values vary, with a common misconception that SPF30 is twice as effective as SPF15. SPF15 filters about 93% of UVB rays, SPF30 about 97% and SPF50 about 98%. Protection increase isn't proportional to SPF value. Aim for at least SPF30.

How often should I apply sunscreen?

Apply every two hours and immediately after showering or swimming. UVA rays penetrate glass, so use sunscreen indoors as well.

Can I get rid of sun damage?

It depends. Systemic effects of UV radiation on collagen and glycosaminoglycan levels can't be "removed" like acne. However, you can slow systemic photoaging with good skincare and treatments. With dedication, you might even halt it temporarily. Unfortunately, reversing time isn't possible.

For symptoms from prolonged exposure, like thread veins, solar lentigines (hyperpigmentation spots), actinic keratoses (dry patches), and solar elastosis (leathery skin), treatments can noticeably reverse damage.

How do I treat sun damage?

Since UV rays penetrate deep into the skin, treatments are effective against sun damage. Here's a list of common symptoms and helpful treatments:

• Collagen depletion - microneedling. A favorite for stimulating collagen production. A needle-tipped machine creates tiny holes in the skin, triggering collagen production through a wound healing response.

  
  

• Hyaluronic acid/glucosaminoglycan depletion - injectable moisturisers. Skincare with hyaluronic acid may not reach UV-damaged areas. Injectable moisturisers, composed of specially formulated hyaluronic acid are injected where needed, improving hydration. As part of glycosaminoglycans, hyaluronic acid aids collagen and elastin production.

• Thread veins - IPL, laser, microwave treatment, and microneedling. IPL and laser break up red hemoglobin pigment, allowing the body to eliminate it, reducing thread veins' appearance. Microwave treatment shrinks thread veins instantly. Microneedling enhances collagen and elastin, reducing thread veins' visibility.

  
  

• Solar lentigines - IPL and laser break up pigmentation for lymphatic drainage. Skin peels even out irregularities. Microneedling stimulates collagen and skin resurfacing, clearing pigmented skin, though less directly than laser or peels.

  
  

• Solar comedones - start with a prescription retinoid, but consult a professional for extraction, as these comedones are too deep for home treatment.

  
  

• Actinic keratosis - ensure they're not pre-cancerous before cosmetic treatment. Laser skin resurfacing and chemical peels can address them. Severe cases may need dermatological surgery or cryotherapy.

  
  

• Solar elastosis - damage to deeper skin layers. Consult an experienced practitioner for the best approach. Start with prescription retinoic acid or proceed to laser treatment or a chemical peel for repair.

Does skincare help to undo sun damage?

Your skin constantly tries to repair UV damage, so effective skincare is beneficial. Here are the products that help most:

• Sunscreen. Applying broad-spectrum UV protection in the morning and reapplying during the day prevents worsening sun damage and guards against future harm.

• Vitamin C serum or other antioxidant serum. Helps skin protect against environmental damage. Not a sunscreen replacement, but a supportive role. Well-formulated vitamin C products encourage collagen production and reduce age spots, brightening skin. Apply after cleansing, before sunscreen.

• Hyaluronic acid. This moisturising molecule holds water, hydrating outer skin layers, improving skin function, and strengthening the skin barrier. Apply hyaluronic acid serum or cream after vitamin C or antioxidant, before sunscreen.

• Retinol. Retinol improves skin functions, from boosting collagen to reducing pigmentation and revitalizing old skin cells. Introduce it gradually to let your skin adjust.

  
  

In terms of prescription skincare:

• Retinoic acid: more effective than retinol, a dermatologist's prescription for retinoic acid regenerates skin renewal, reduces pigmentation, and softens sun damage-induced wrinkles. Use cautiously as your skin adapts.

• Hydroquinone: the gold-standard pigment-reducing ingredient, available only by prescription, can be combined with retinol to reduce pigmentation marks.