Sun Damaged Skin in Adults

Sun-damaged skin in adults shows the following symptoms:

• Dry skin — The skin appears dry, flaky and slightly more wrinkled than skin on other parts of your body that have not been exposed to the sun. Dry skin is also one of the most common causes of itching.
• Sunburn — Mild sunburn causes pain and redness on sun-exposed skin. In most cases, there are clear boundary lines where the skin has been protected from the sun by shirt sleeves, shorts, a bathing suit or other clothing. More severe cases of sunburn produce painful blisters, sometimes together with nausea and dizziness.
• Actinic keratosis — An actinic keratosis appears as a small bump that feels like sandpaper or a persistent patch of scaly (peeling) skin that may have a jagged or even sharp surface and that has a pink, yellow, red or brownish tint. At first, an actinic keratosis may be the size of a pimple. Rarely, an actinic keratosis may itch or be slightly tender.
• Long-term changes in the skin's collagen — Symptoms of collagen changes include fine lines, deeper wrinkles, a thickened skin texture and easy bruising on sun-exposed areas, especially the back of the hands and forearms.

Diagnosis

In most cases, your doctor can confirm that you have sun-damaged skin simply by examining the area. Often, a biopsy is done to rule out skin cancer in a patch of actinic keratosis. In a biopsy, a small piece of skin is removed and examined in a laboratory.

Expected Duration

The painful redness of sunburn will fade within a few days, provided that you do not re-expose your injured skin to the sun without using a sunblock or sunscreen. Some sun damage is permanent, although prescription medications, nonprescription remedies and skin-resurfacing treatments may improve the skin's appearance.

Prevention

You can help to prevent sun-damaged skin by taking the following steps:

• Apply a sunscreen before you go outdoors. Choose a water-resistant sunscreen that has a sun protection factor (SPF) of 30 or above, with a broad spectrum of protection against both UV-A and UV-B rays. Be sure to reapply often to avoid sweating off or washing off the sunscreen.
• Use a sunblock on your lips. Choose a product that has been specially formulated for the lips, with a sun protection factor of 20 or more.
• Limit your time outdoors when the sun is at its peak (from about 10 a.m. to 3 p.m. in most parts of the continental United States).
• Wear sunglasses with UV light protection.
• Wear long pants, a shirt with long sleeves and a hat with a wide brim.
• Be aware that some medicines and skin care products can increase your skin's risk of UV damage. These include certain antibiotics, as well as some prescription medicines that are used to treat psychiatric illness, high blood pressure, heart failure, acne and allergies. If you are taking a prescription medication and you normally spend a great deal of time outdoors, ask your health care professional whether you should take any special precautions to avoid sun exposure. Also, be aware that certain nonprescription skin care products containing alpha-hydroxy acids can make your skin more vulnerable to damage from sunlight.

To help detect actinic keratoses and other skin abnormalities in their earliest stages, examine your entire skin surface thoroughly every one to two months. Check for patches of discolored or scaly skin, moles, small pearly nodules, sores and other skin abnormalities on all parts of your body, including your scalp and genitals. Use a mirror to inspect harder-to-see areas of your back, shoulders, upper arms, buttocks and the soles of your feet. People who have numerous actinic keratoses should have their skin checked by a doctor at least twice a year.

Treatment

The type of treatment depends on the form of sun damage:

• Dry skin — Try using a moisturizer that contains at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts or alpha-hydroxy acids. Avoid using alpha-hydroxy acids or other acids on any sunburned skin. Avoid hot baths or hot showers, because these can make your sun-damaged skin even drier. Wash only with warm or cool water, using unscented soap that either has a high fat content or contains glycerin.
• Sunburn — For painful sunburn, try applying cool compresses (such as a cool, wet cloth) to your injured skin, or mist the area with sprays of cool water. If your discomfort continues, take a nonprescription pain medication such as ibuprofen (Advil, Motrin) or aspirin, as long as you do not have a health problem that has caused your doctor to advise you against taking these medications. Your doctor may prescribe stronger anti-inflammatory medication if you have extensive sunburn with severe blistering and pain.
• Actinic keratosis — The type of treatment that will work best for you depends on many factors, including the number, size and location of your actinic keratoses. Options include:
  • Topical fluorouracil — The anticancer drug 5-fluorouracil (5-FU) is applied directly to the skin to eliminate the actinic keratosis.
  • Topical imiquimod — This topical treatment up-regulates your own body's defense mechanisms to react against the actinic keratosis.
  • Topical diclofenac sodium gel — This topical anti-inflammatory gel is applied twice daily for three months to treat the actinic keratosis.
  • Cryotherapy — The actinic keratosis is frozen with liquid nitrogen.
  • Chemical peels — A strong chemical solution is used to remove the top layer of skin, with the anticipation that normal skin will grow back later.
  • Laser resurfacing — This works in the same way as a chemical peel to remove the top layer of skin, but it uses a laser beam instead of a chemical solution.
  • Shave excision — The doctor carefully shaves away the area of abnormal skin. The skin shavings can also be used as a biopsy specimen to check for cancer.
  • Photodynamic treatment (PDT) — A light-sensitizing solution is absorbed by the actinic keratosis and then "activated" by light, destroying the actinic keratosis.

Also, because an actinic keratosis is a sign that you are at increased risk of skin cancer, your doctor will schedule regular follow-up skin examinations to check periodically for new areas of abnormal skin.

Post by Harvard Medical School.