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The skin has many important functions. It protects us from disease, injury and changes in temperature.
The skin has two main layers. The outer layer is called the epidermis. It contains basal cells and squamous cells, which link tightly together to form a barrier, and melanocytes, which produce melanin, the substance that gives the skin its colour. The layer underneath the epidermis is called the dermis. The dermis contains the roots of hairs, glands that make sweat and oil, blood and lymph vessels and nerves. Below this is a layer of fat.
Each time your unprotected skin is exposed to ultraviolet (UV) radiation, it causes changes to take place in the structure of the cells and in what they do. Over years of exposure to UV radiation, the skin becomes permanently damaged. The damage worsens with more UV radiation exposure.
These changes are often described as “premature ageing”, but they are, in fact quite different to normal ageing in the skin. In old age, the skin that is not exposed to the sun is smooth, without spots or blemishes. It is a little thinner than younger skin, but there are relatively few wrinkles and it remains fairly firm.
Skin that has been exposed to the sun, on the other hand, becomes thickened, rough and leathery. Gradually, over 20 to 40 years, it acquires many blotches and blemishes and fair skin particularly may become yellowish. It becomes loose, and it is covered with fine wrinkles broken by a number of deep creases. These effects are seen especially on the skin that gets the most sun – the face, the back of the neck, the backs of the hands and the arms and neckline.
The changes to your skin from sun damage range in a spectrum. At one end of the spectrum is what can be called photodamage where there may be a change in the colour (pigmentation and redness), contours (wrinkles) or texture (dry and rough) of the skin.
More severe sun damage may then manifest as skin cells damaged to the extent they are more likely to develop into skin cancers. These precancerous areas of skin are commonly called sunspots but medically are termed solar keratoses. The most serious level of sun damage to the skin is when the skin develops cancerous growths i.e. skin cancers.
Treatment depends on the degree of damage and the level of improvement required. In general the best results are achieved by a combination approach. Topicals are important to both slow the rate of further damage ( sunscreen), replace hydration ( moisturiser) and help with repair (cosmeceuticals such as Retinoic acid). Dermal treatments such as microdermabrasion and peels can help exfoliate dead skin cells and improve skin tone and texture. Laser treatments with the Fraxel 1927 and the Picosecond 755 can target excessive skin pigment whilst the Excel V and V Beam can target unwanted redness caused by increased vascularity. Skin needling including with fractional radiofrequency (Infini treatment) can produce collagen remodelling to improve scarring and wrinkling. Photo Dynamic Therapy can be used to treat precancers on the skin. Injectables such as Botox to soften and remove unwanted wrinkles and Dermal fillers to replace skin volume that has been lost because of sun damage may be appropriate for some patients.