Sun Damage to the Skin Can Be Treated With Medical and Surgical Methods

October 20, 2000

New York (MedscapeWire) Oct 20 - The healthy glow from a suntan can have dangerous repercussions. Photo aging, the premature wrinkling and damage done to the skin by the sun, affects millions of Americans and is the impetus behind the search for new ways to recreate and retain a youthful appearance.

At the American Academy of Dermatology's Derm Update 2000, dermatologist Wilma Bergfeld, MD, Professor, Dermatology and Pathology, The Cleveland Clinic in Ohio, discussed the surgical, medical, and cosmetic treatments of photo aging.

"Today, patients are more sensitive to their appearance as they age. They also have a greater understanding of the types of treatments available for aging skin," said Dr. Bergfeld. "Dermatologists can create a customized treatment plan that will address a patient's specific concerns and optimize the benefits for their skin."

Natural aging is commonly characterized by a thinning of the skin and a deepening of the normal facial expression lines. As the skin ages, it becomes more fragile and crinkles (thin fine wrinkles) appear. Unlike natural aging, photo aging is distinguished by coarse wrinkles, dry and rough skin, abundant freckling, loss of firmness and skin discoloration. Habitual tanning or unprotected outdoor activity severely damages the elastic fibers below the surface of the skin, causing it to appear tight and leathery. At the same time, the skin loses its ability to bounce back from stretching and deep, dry wrinkles develop.

"The best prevention for photo aging is a comprehensive sun safety program that includes the use of sunscreens, wearing protective clothing and hats, and seeking shade whenever possible," said Dr. Bergfeld. "However, there are also several medical and surgical treatments that can help individuals turn back the hands of time."

Currently, the only prescription topical treatment for skin manifestations of photo aging is tretinoin emollient cream. Tretinoin has been shown to reduce the fine wrinkles, splotchy pigmentation, and skin roughness associated with chronic sun exposure. Other over-the-counter cosmetic moisturizing products include retinol or antioxidants in their ingredients, which also reduce the appearance of fine lines and wrinkles.

In addition, the last decade has seen a marked increase in the cosmetic industry's use of alpha hydroxy acids (AHAs). Glycolic and lactic acids are the most common of these compounds, which are derived from fruit and dairy products. "Although there have been limited studies regarding AHAs, dermatologists and patients have been impressed with the impact these agents have on photo aging," said Dr. Bergfeld. "The use of cosmetics with retinoids or AHAs, combined with gentle skin cleansing, a broad spectrum sunscreen and a retinoid treatment at night, can mildly improve skin damaged by photo aging."

Patients are more often combining medical treatments with noninvasive surgical techniques to reverse the signs of aging. Many patients, who want the results of facial rejuvenation without extended recovery time, are taking advantage of new "lunch-time" techniques including acid peels, microderm abrasion, and superficial laser peels. Facial resurfacing procedures such as these physically remove the upper layer of the skin and new, younger-looking skin replaces damaged skin, reducing wrinkles and fading pigment spots. "Though these techniques may have less recovery time, often allowing patients to go back to work immediately, the results are not as long-lasting," said Dr. Bergfeld.

There are also several soft tissue augmentation procedures that can smooth out wrinkles making them less noticeable. One of the most popular forms of this technique is the use of botulinum toxin, which when injected into frown lines, crow's feet, or other wrinkles, paralyzes the muscle creating those lines. Not only does botulinum toxin dramatically soften existing wrinkles, it decreases the patient's ability to frown or squint which prevents additional damage.

Laser skin resurfacing is also a popular option for treating photo aging. These high energy lasers work by emitting a beam of light that is absorbed by the water in the skin cells. CO2 lasers continue to be extremely effective for treating patients with deep wrinkles and severe sun damage. Erbium or combination lasers provide a more superficial treatment of wrinkles, sun damage or irregular pigmentation.

"Lasers require a slightly longer healing time with minimal patient discomfort and are effective for facial rejuvenation," said Dr. Bergfeld. "They offer a relatively painless procedure and improved results over traditional cosmetic surgery."

Dr. Bergfeld added, "With so many options for the treatment of photo aging, dermatologists and patients can try a combination of medical, surgical, and cosmetic treatments until they create the desired result


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