A Dermatologists’ Guide To Photodamage And Dark Skin

What is photodamage?

Aging in the skin is a normal process and is caused by both internal and external factors. Intrinsic aging is caused by the passage of time and changes that our body undergoes such as hormone changes and enzyme activities. Meanwhile, extrinsic aging is caused by environmental factors such as UV radiation, pollution and smoke. Photodamage happens as a part of extrinsic aging resulting from sun exposure. It is a form of premature aging as sun exposure accelerates the rate at which skin aging occurs. Excess and chronic exposure to sunlight can significantly increase the rate at which skin aging occurs. Changes typically happenin mature and older agebut can show up much earlier, perhaps even decades earlier, in case of significant sun-induced damage.

What are the signs of photodamage?

There are several typical signs of photodamaged skin. Sun exposure can affect the outer layer of the skin (called the epidermis) and the deeper layer of skin (called the dermis).Signs of epidermal photodamage include:

• Changes in the color of the skin in the form of uneven skin tone, patchy pigmentation, mottled pigmentation
• Textural changes in the form of rough, dry skin
• Dermal photoaging results in premature loss of collagen. Collagen is the scaffold of the skin - it gives it its strength and support.

Signs of dermal photodamage include:

• Appearance of deep lines and coarse wrinkles
• Loss of skin turgor and suppleness
• Broken capillaries
• Senile comedonesi.e.blackheads getting accentuated from loss of collagen around pores.
• Loss of skin elasticity

Although these are the common signs of photodamage, the degree and severity of photodamage would vary significantly between individuals. There are inherent differences in susceptibility to sun exposure and varying degrees of skin repair capacity between individuals of different ethnicities.

Moreover, individuals of the same ethnicity would exhibit different degrees of photodamage based on their geographical location, occupation, and hobbies. Photodamage tends to be more severe in those with lighter skin types. These include skin phototypes I–III (Caucasians and people of Northern European descent). Skin phototypes IV–VI tend to suffer lesser photodamage as the melanin content of their skin offers natural protection. These include people of African, African-American, Asian, and Latino (or Hispanic descent), with melanin affording protection against sun-induced damage. However, when photodamage does occur in these skin types, it shows up more in the form of pigmentary changes. 

How do you treat photodamage?

There are several effective treatment options available for existing photodamage. Although they will not completely reverse the signs of aging, they can help minimize them and repair the skin to a certain extent.

These can be categorized into procedural and topical.Topical medications for photodamage include those targeting pigmentary changes and those targeting textural changes.Retinoids are the gold-standard skincare ingredient for treating photodamage. They help even out the skin tone. Primarily, they stimulate collagen production in the dermis, thus minimizing the appearance of fine lines and wrinkles. They improve the overall smoothness and texture of the skin.

Ingredients like vitamin C, tranexamic acid, kojic acid, and niacinamide also lighten uneven skin tone and pigmentation. Other topical antioxidants include vitamin E, selenium, zinc, silymarin, soy isoflavones, and tea polyphenols. Incorporating these into your skincare routine can supplement the use of sunscreens.

Chemical peels containing TCA (trichloroacetic acid), glycolic acid, retinol (yellow peel), phenol, and others can also significantly help reduce photodamage signs and make the skin look more even. Multiple sessions of chemical peels are needed, based on the severity of photodamage.

Lasers are often used in combination with the above treatments. These include ablative lasers that can induce artificial trauma in the skin, thereby stimulating collagen production. This helps minimize the appearance of fine lines and wrinkles. Lasers can also even out the skin tone and help with hyperpigmentation. Other devices include micro-needling radiofrequency for boosting collagen production in the skin. There is also monopolar radiofrequency and HIFU (high-intensity focused ultrasound) that can address skin laxity and give the appearance of tightened and younger-looking skin.

Often, a combination of the above treatments is needed to achieve significant improvement in the extent of photodamage. The response to these treatments would also depend on several factors, including your skin type, the size of photodamage, and others. Very advanced skin damage may require more intense treatment and may take longer to respond.

Additionally, every individual is unique; your dermatologist will tailor your treatment plan to maximize your results.If you suffer from photodamaged skin, get in touch with your dermatologist. They can then guide you on the best approach to repair and nourish your skin. Initiating treatment at an early stage will result in significantly better results.

How to prevent photodamage

If there's only one thing you should do for your skin, it is to wear sunscreen every day.Preventing photodamage from occurring in the first place is the best strategy to deal with it.

Mineral Zinc Oxide Sunscreens

Diligent use of a broad-spectrum sunscreen consistently, right from an early age, can delay the onset of photodamage. Even if some photodamage were to occur, it would be milder if you are using sunscreen regularly for years.

Mineral sunscreens are made with natural minerals such as titanium dioxide and zinc oxide, which act as a physical barrier to the sun's rays. These sunscreens are highly effective at blocking UVA and UVB radiation, and they are also safe for the environment.While research by the FDA has shown chemical sunscreens, particularly those including sun filtersoxybenzone, homosalate, and octocrylene, have been shown to cause environmental and biological issues.

With earlier mineral sunscreen formulations, the appearance of a white cast after the application was a significant cosmetic concern, especially on darker skin types. However, with the availability of new formulations of zinc, it has become possible for mineral sunscreens to look cosmetically elegant as well. More specialist formulations of sunscreen do not leave a white cast on the skin. Hero technologies such as Sunsolve MDSolvekleairTM have reinvented zinc oxide with highly high transparency for inclusive, adequate mineral coverage. Since they work by blocking and reflecting the sun's rays, they are effective as soon as they are applied (compared to chemical sunscreens that need to be applied 20-30 minutes before sun exposure).

A significant advantage of mineral sunscreens is that they offer broad spectrum protection against the spectrum - UV light, visible light, as well as infrared radiation. This comprehensive spectrum protection is essential, especially for darker skin types.

They are also inert, which means they do not react with the skin and are an excellent option for sensitive skin. Moreover, studies have shown that these mineral sunscreen filter particles are not absorbed through the layers of the skin and into the blood, making them perfectly safe to use even during pregnancy and lactation.

Even post-procedures like chemical peels and lasers, when the skin is sensitive and prone to post-inflammatory hyperpigmentation, mineral sunscreens are the most suitable for sun protection.

Lately, newer mineral sunscreen filters include pigments of iron oxides - these offer the additional benefit of providing a certain degree of camouflage and coverage for skin with underlying uneven pigmentation. These are also an excellent option for darker skin tones. Since consistent use of sunscreen is the most vital component of preventing UV-induced damage, it is essential to find a sunscreen that fits your budget and that you are happy using in terms of its consistency, feel, spreadability and texture. Your dermatologist can help you choose the most appropriate sunscreen for your skin type and any pre-existing skin conditions.

There are other ways to protect your skin from the sun:

• Avoid stepping outdoors during peak hours of UV exposure (10 am to 4 pm), unless essential.
• Know the UV index before stepping out is a great way to minimize potentially excessive sun exposure.
• Wear sun-protective clothing when outdoors. This includes clothing materials with UPF. UPF stands for Ultraviolet Protection Factor (UPF) and denotes how much UV radiation a fabric can reach your skin. Wearing UPF clothing can significantly enhance overall sun protection when you are outdoors.
• Large sunglasses can protect the thinner, delicate skin around the eyes. This can prevent pigmentation as well as fine lines.
• Wear wide-brimmed hats and caps when outdoors to add another layer of protection.
• Coveryour face with UPF scarves also offers an additional form of protection.
• Carrying umbrellas is an excellent way of protecting your skin from UV rays.
• Avoid tanning and sunbeds to minimize the occurrence of photodamage.
• Overall lifestyle measures that can be undertaken that enhance your skin's overall health and make it look younger include:
• Avoid smoking
• Consume plenty of fresh fruits and vegetables daily. These act as a great source of antioxidants which can help protect the skin from sun-induced damage.
• Minimize exposure to pollution can also help protect the skin from further damage.

References

Samuel, M., Brooke, R., Hollis, S., & Griffiths, C. E. (2015). WITHDRAWN: Interventions for photodamaged skin. The Cochrane database of systematic reviews, 2015(6), CD001782. https://doi.org/10.1002/14651858.CD001782.pub3 (https://doi.org/10.1002/14651858.CD001782.pub3)

Pinnell S. R. (2003). Cutaneous photodamage, oxidative stress, and topical antioxidant protection. Journal of the American Academy of Dermatology, 48(1), 1–22. https://doi.org/10.1067/mjd.2003.16 (https://doi.org/10.1067/mjd.2003.16), https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/024080367.pdf (https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/024080367.pdf)

Gabros S, Nessel TA, Zito PM. Sunscreens And Photoprotection. [Updated 2022 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537164/ (https://www.ncbi.nlm.nih.gov/books/NBK537164/)

Osmond, M. J., & McCall, M. J. (2010). Zinc oxide nanoparticles in modern sunscreens: an analysis of potential exposure and hazard. Nanotoxicology, 4(1), 15–41. https://doi.org/10.3109/17435390903502028 (https://doi.org/10.3109/17435390903502028)