PERSONAL PERSPECTIVE OF SUNDAMAGE

Just about everyone gets happy in the sun's warmth! Animals and humans alike are drawn to the comfort of warm sun and bright blue skies. By springtime, a person in Saskatchewan might feel emancipated as they emerge outdoors in T-shirts..

PERSONAL PERSPECTIVE OF SUN DAMAGE

Just about everyone gets happy in the sun’s warmth! Animals and humans alike are drawn to the comfort of warm sun and bright blue skies. By springtime, a person in Saskatchewan might feel emancipated as they emerge outdoors in T-shirts! It is not hard to believe the relationship between warm sunshine and mental stability. Most people become excited by the energy of the growing season as we observe greenery and birth all around us. The people of Saskatchewan go to great lengths to "get out there" after a long cold season spent mostly indoors. The countless hours on the golf course, at the cabin, gardening, or exercising our bodies are our pursuits of happiness made so enjoyable by the fair weather.

Now, you know that an article about skin and sun is moving toward a "But….." Yes, indeed! In fact, it is about preserving the good, and diminishing the bad. It is about reducing the risks.

By the way, those at risk include everyone, but the most important are the little ones. Most of our lifetime accumulated sun (UVA and UVB) rays are experienced by the time we are 18, yet the resultant observed changes are generally not noticed until well along in adulthood. By this time, many adults have adopted protective habits. In fairness, education about the effects of UV on skin was not there for the older generations. They just did not know there were serious consequences. While it is never too late, it is clear that the effects of the sun take years to express themselves. Often the older adult is surprised and frustrated to see the increasing effects of sun damage despite their concurrent efforts to protect from the sun. It helps to know that there is a long latent time until visible expression of problems, and therefore sun damage will manifest even after good habits are initiated. The goal in this case is maintenance of skin health and reversal of some of the existing adverse effects. And whenever possible, influence the young to adopt good sun protection habits!

Heather is a 50 year old woman who has already had one skin cancer removed from her back, the site of many sun-burns during her childhood and early adult years. Fortunately, her cancer has a good prognosis, but she was advised that simply the presence of this sun cancer indicates she is at high risk for other more aggressive skin cancers. She has a completely new perspective now as she continues to enjoy summer, with her wide brim hat and SPF 45 sunscreen with Titanium and Zinc that protects her from both UVA and UVB if applied every two hours. She also avoids the mid-day sun whenever possible, and she regularly protects her eyes with UV protective eyewear.

Despite her conscientious habits, she attends doctor appointments every 6 months to monitor for and remove the pre-cancer skin spots from her face and body. This kind of surveillance is very important for her as neglect of these skin spots will likely result in more skin cancer. She is able to point out many of the pre-cancer spots only because they have been the focus of surveillance and treatment. The spots are usually persistently growing and scaling, slightly more pink than surrounding skin. They just "don’t go away". Last time she had treatment, there were more than 10 such spots to have burned off.

The worry about skin cancer is only one aspect of sun damage that Heather deals with. She is bothered daily by the appearance of her face. She used to tan for the perceived beauty of a browned face and body. Now she is seeking help to rid herself of the blotchy brown on her forehead and cheeks. Her cheeks look like dirt on sweat, especially in the summer. Even with all her good efforts to protect from the UV rays, she does experience darkening of her hyperpigmentation every August. She tries to cover the spots with camouflage make-up and then foundation, but it is time consuming and requires touch up throughout the day. Sometimes she gets comments from others about a "bruise" on her cheeks.

Further to her concerns about brown, she is also noticing a bed of streaky red spider veins on her cheeks and nose. She understands now that these too are the result of UV injury, and they have combined with the brown to create a dense mottled array of dark colors on fair skin. She relies on thick foundation to "even the tones". She would dearly like to drop the cover-up and go out with uniformly colored glowing skin. As she remains vigilant for skin cancer, she is embarking on a program of restoration of her facial sun damage with Health Canada cleared treatments, including Photodynamic Therapy, Intense Pulsed Light, and pharmaceuticals.

It is a myth that the darker skinned individuals "don’t need sunscreen because they never burn." Although they generally do not suffer the acute effects of the sun on their skin such as sun-burn or sun-rash, they are more often troubled by intense blotches of brown on their face, especially the cheeks. This is particularly problematic if the inherent surrounding color is light enough to provide a sharp contrast to the brown. The effect is like brown paint on light colored canvas, especially in late summer, despite recent gallant efforts to sunscreen. Natalie wears her hat and sunscreen correctly and consistently when she runs, but every August she is embarrassed by the dark stains on her jawline and cheeks. Even down her neck the color is dark and looks like dirt. She wears camouflage make-up but on occasion the well meaning acquaintance will point out the dark mark on her face. By now, she has tried many varied approaches to diminishing the dark blotches, but there has been little or no improvement. She is aware that her hyperpigmentation is fairly deep in the skin and difficult to treat, even with intense pulsed light. There are newer therapies that are demonstrating good improvement, but these are still anecdotal and rather expensive. At least menopause might bring about permanent neutral complexion as the pigmentation potential of skin is reduced along with the reduction in estrogens.

Lilly is a 30 year old Asian woman who has noticed the onset of new brown spots on her high cheeks during the past two years. She is deeply disturbed by this as she has always had uniformly colored light brown skin. Her skin is otherwise smooth and healthy looking. She is used to beautiful skin, but these spots threaten that reputation. She would like them eradicated. Instead she was offered the chance to moderately diminish the browns with Intense Pulsed Light. Fortunately for her, the color was not too deep and hence her chance of success was better than that for Natalie. She was reminded though that she would probably acquire new spots if she continued to expose herself to the sun in future.

Most people have learned that both UVA and UVB are damaging to the skin. There are interesting distinctions between the characteristics and the consequences of each type, but it is clear that avoidance of both sub-types is recommended. Sun damage is not limited to surface changes such as skin cancer, abnormal pigmentation, or red spider veins. Rather, droopiness of the jowls and brows may be a tough reality check for those in their late 40’s and early 50’s who still feel like a young adult at heart. The deeper skin layer is also affected by UV rays as the natural gel fillers deplete and stiffen. With obvious sadness Sharon traced the creases between her nose and mouth down to the jowls. She was certain that her "face fell" very suddenly last year when she was in the midst of divorce and other stressful life circumstances. Although she was not ready to consider cosmetic surgery, she certainly looked intently for hope that "something could be done". Experts believe that as much as 90% of skin aging may be due to the sun, and loss of thickness and elasticity as the face droops is another manifestation of too much sun in earlier years. Sharon was a sun worshipper in her teen and early adult years. "In those days we used Baby Oil to get more sun into the skin. We didn’t know any better". There are new developments in this day of intense research and development into non-surgical alternatives for cosmetic rejuvenation. Treatment with a radiofrequency device, Thermage, plus or minus a laser peel, might offer her long lasting fullness and tightening that will ease her mind through this difficult time of her life.

Our face, our skin, is the cloak that presents on behalf of our inner self. Not surprisingly the inside expects the best of the outside. So take care of it, protect it from the sun.

[ Top of Page ]