Questions and Answers with Clinique’s Guiding Dermatologist, Dr. David Orentreich.
Q. I have heard that dark spots, lines, wrinkles and skin roughness are symptoms of sun damaged skin. Is this true?
Yes. All 3 can be signs of skin that has been damaged by exposure to UVA and UVB.
Q. What happens to your skin when it’s exposed to the sun?
Excessive exposure to sun can cause sunburns (a known contributor to skin cancer), premature aging, local and systemic immune system depression (this is one of the reasons some people who have herpes simplex will have an outbreak of cold sores, also known as ‘fever blisters’ when they have had too much sun), uneven pigmentation, wrinkles, damage to collagen and elastic fibers (which leads to lines and wrinkles), skin growths (actinic keratoses and possibly seborrheic keratoses) and telangiectasia (“broken” capillaries).
Q. How are dark spots formed?
Dark spots may be caused by an increase in the skin pigment melanin or to a focal area of increased epidermal thickness (seborrheic keratoses). While we know that uneven pigmentation is often caused by exposure to UVA and UVB, sun exposure is just one of many culprits. External aggressors, improper moisture balance and hormonal changes also contribute to hyperpigmentation. When these cells are irritated by the sun and other external aggressors, they increase the production of melanin resulting in dark spots. There are several kinds of dark spots:
• Scars from blemishes are a result of photo damage and can result in hyperpigmentation (an increase in colour) – this has to do with the way that skin heals itself after an insult.
• Tanned skin – Also a result of photo damage, a tan is actually a sign that the skin has been damaged. Skin reacts to the sun’s UVB rays and increases the production of melanin. The cumulative after-effects are sun spots or solar lentigo.
• Age spots – Often referred to by the misnomer “liver” spots, age spots are a common form of acquired hyperpigmentation. Although they occur from sun damage, some people may be more genetically predisposed to developing these spots. These small, darkened patches are usually found on the face, hands, décolletage and other areas frequently exposed to sun.
• Freckles are small brown spots that can occur anywhere on the body, but are most common on the face and arms. Unlike age spots, freckles are a genetic or inherited characteristic, and therefore are present from an early age.
Q. I have heard that your skin thickens. Isn’t that a good thing?
Skin is very adaptable. It can thicken in response to friction, as on the sole of the foot. It thickens after puberty, especially in men, due to the onset of testosterone production. Skin also thins from age and chronic exposure to sunlight.
Q. What about the correlation between the damage you had as a child and the sun damage later in life?
The damage that sun causes when you are young takes place on the genetic level; it is the DNA in the chromosomes that is damaged. As the years pass, the damaged DNA program instructs the cells to produce damaged proteins such as collagen, elastin, and many others. Over time these damaged components replace the healthy (normal) ones as they wear out.
Eventually, we are able to see with our own naked eye the effects of these alterations. They appear as wrinkles, mottled colour, loss of elasticity and growths in the skin surface.
From the time we are born, the body and skin is continuously replacing worn out parts such as collagen fibers, elastin fibers and other cellular components. It is our DNA program which instructs the cell how to make new parts to replace the worn out ones. Unprotected sun exposure containing ultraviolet radiation, damages the DNA. The more exposure we get the greater the accumulated damage. The damaged DNA instructs the cell to produce faulty replacement parts for those which are wearing out. Over years and decades the accumulation of DNA damage and damaged skin components with the normal wear and tear associated with sun exposure produces the appearance of aged skin.
Q. Do you suggest an SPF every day, all year long?
Yes, we recommend daily sun protection, as 80% of skin aging is UV-related! Sun protection is necessary all year round. UVB or “burning rays” are strongest in summer and weakest in the winter. Consequently, one sees fewer sunburns in the winter (notable exceptions are sunburned skiers). However UVA, or “aging rays” are strong all year round. Therefore the skin is equally as susceptible to photo-aging and increased skin cancer risks in the winter. The only thing that should change when the season changes is the sunscreen formulation, not SPF. Lighter formulations are appropriate in the warmer, humid months, and richer, more hydrating formulations in the colder, drier months. Some important things to remember are:
• Even during the first minute of exposure you could be generating damage.
• Without adequate protection today, the likelihood of wrinkles, age spots and even skin cancer is increased.
• Sun damages the sensitive area around the eyes too.
Q. How high should the SPF level be?
The SPF level really pertains to the amount of time a person can spend in the sun without burning – based on their skin type. In many cases a SPF 15-30 is adequate. When you consider that you are protecting your skin from short term and long term damage – it is not advisable to use anything less than SPF 15.
Q. Some people do not use enough sunscreen. How much (measured in teaspoons) do you need for your face?
Apply an SPF product about 15-20 minutes before you head into the sun. If you are swimming, reapply after getting out of the water. It is recommended that you apply sunscreen every 2 hours. And do not forget to apply enough In order to protect a full body you need to apply 30 grams (one ounce).
Q. Can you repair sun damage with a cream? How?
It depends on the degree of damage. Skin that is immediately treated with repairing products after exposure to damage could end up with less damage than it would have without the treatment. Sunscreen protects from additional damage and allows the skin to repair itself. Anti-inflammatories and antioxidants may reduce the extent of damage at the time of exposure. Prescription medications such as 5-Fluorouracil and solaraze can remove pre-malignant cells and retinoic acid has an effect on collage production.
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[...] perfect tone. Of course, given I spend a lot of time in the sun this is cause for prevention. As you know, sun damage causes premature aging, wrinkles and pigmentation of the skin – nobody wants [...]