Sun Induced Skin Damage

Pigmentation, Solar Lentigines, Melasma, Guttate Hypomelanosis, Telangiectasias, Poikiloderma of Civatte & Cancerous Skin Tumors

Tanning beds are hopping at this time of the year, with people wanting to maintain their “healthy” glow, some wanting the feel-good aspect of bathing in warm light, and others pre-tanning for a mid-winter tropical vacation.

What the indoor UV tanning industry does not want you to know is that a tan itself is indication of damage to your skin. There is unequivocal evidence that regular (meaning more than once per month) indoor tanning significantly increases the risk of skin cancers, including melanomas. More over, tanning under the sun confers minimal photo- protection, equivalent to a sunscreen with an SPF of 3. A tan obtained with a sun bed provides even less protection than this, but often gives people the impression that they are safe from the sun’s rays once they arrive at their holiday destination.

Aside from the generally well known risk of skin cancer from excessive sun exposure, UV light causes premature aging and unsightly blemishes which we will discuss further.

Pigmentation issues
1. When your unprotected skin is exposed to sunlight, the body tries to protect itself from further damage to the skin cells’ DNA by producing more melanin, or pigment in the skin. This is what we see as a tan. Some skin cells, however, may produce more melanin than others and result in uneven pigmentation of the skin.

2. Solar lentigines, or liver spots as they are more commonly known, commonly develop in sun exposed areas like the face, arms, hands, and upper back. They are due to localized proliferation of melanocytes, the cells that produce pigment, in response to sun exposure. They are flat spots that vary in size and do not fade with your tan, like freckles would.

3. Melasma, or the “mask of pregnancy” is a common condition in women which is related to female hormones. It is especially common in pregnant women, women on birth control pills or hormone replacement therapy. Sun exposure is also a strong risk factor for melasma. It is seen as a uniform brown color over the cheeks, forehead, nose, or upper lip.

4. Guttate hypomelanosis show up as small (about 5mm) round white spots on sun exposed skin. The exact cause of these benign lesions is not known, but is believed to be due to chronic sun damage.

Appearance of small blood vessels
Telangiectasias, or small capillaries, are common on sun-exposed skin. They commonly appear on the nose, cheeks, and ears.

Poikiloderma of Civatte is a rather common condition due to chronic sun exposure. The neck is reddened due to the presence of many telangiectasias, and there is also usually some brownish discoloration. The area right under the chin is usually spared because it is shaded by the sun.

Textural skin changes
Sun exposure hastens the normal aging of the skin and thins the skin prematurely by weakening the connective tissues, which decreases the skin’s strength and elasticity. The skin appears thinner and more translucent. Fine lines, deeper wrinkles, and skin laxity develop prematurely. The skin becomes dry and rough.

With chronic sun exposure, the skin can appear yellowish and leathery with deep wrinkling or furrowing of the skin. This is known as solar elastosis (picture below).

Production of benign and cancerous skin tumors
It is essential to always be on the lookout for changing moles or skin lesions. The ABCD’s of early melanoma detection has been discussed in an earlier article. Other than melanomas, there are also a variety of other skin cancers. The main feature of skin cancers is that they change over time. Any worrisome spot should be brought to the attention of your doctor.

Actinic keratoses, precancerous skin lesions, are very common in people with a history of excess sun exposure. These are rough, scaly, often red lesions found on sun exposed areas. They are sometimes easier to feel than to see. These should be brought to the attention of your doctor because of their malignant potential.

Seborrheic keratoses are also thought to be influenced by excessive sun exposure. These are benign lesions that are waxy and appear stuck on the skin.

Treatment for these conditions, obviously aside from precancerous or cancerous lesions, is done for cosmetic reasons. Options range from topical medications to chemical peels, laser treatments and surgical applications.

Prevention is key, and if you really must have a tan, the safest way to do this is from a bottle. Protecting yourself from the sun now is the best way to look your best into your real golden years.

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