More than skin deep

• What makes photoaging dangerous is the fact that any one of its symptoms could be an indicator of skin cancer.
• Skin cancer is caused by excessive sun exposure.

Sun spots and wrinkles might indicate more than chronological age; they could spell skin cancer. An annual screening can keep cancer at bay

You might not be overly concerned about your appearance. But here’s a sobering thought. Your wrinkles and sun spots may be reflect more than just your age, they may reflect your exposure to the sun. And as a doctor, I’d say you should be concerned, because it could be a manifestation of photoaging.

What is this curiously named process of photoaging? It refers to premature aging of the skin caused by radiation from ultraviolet (UV) rays (or light, that is, phos in Greek, which is the root of photo, and hence the name photoaging). Most of our UV exposure comes from the sun. In fact, the Canadian Dermatology Association attributes 90% of skin aging to the harmful effects of sun exposure. Artificial UV sources include tanning booths, mercury vapor lamps, and halogen lights.

Signs of photoaging include wrinkles around the eyes, mouth, and forehead; spider veins on the face and neck; paler and thinner lips; frown lines that are visible even when you are not frowning; leathery and loose skin; age or liver spots (solar lentigines in medical terminology); easy bruising of skin; red and scaly spots (referred to as actinic keratoses).

Our skin has three layers: the epidermis which is the outermost, the dermis which is the next, and the subcutis which is the deepest. UV rays, specifically UVA rays make their way through the epidermis and into the dermis. Here, they damage collagen, one of the fibers responsible for skin structure. Our body is not entirely helpless, so it deploys enzymes that help rebuild this collagen. However, repeated exposure and damage could cause the enzymes to malfunction. This would lead to incorrectly rebuilt skin, which eventually appears as wrinkles and leathery skin. Similarly, age or liver spots are the result of a congregation of melanocytes on a particular patch of skin. Melanocytes are the cells that create melanin which gives our skin its color. Reacting to excessive sun exposure, melanocytes proliferate in a particular location. For instance, among men, liver spots are usually found on the hands, arms, face, and back, which are more exposed to the sun than other parts of the body.

What makes photoaging dangerous is the fact that any one of its symptoms could be an indicator of skin cancer. Reportedly the most prevalent form of cancer in the United States, cancer of the skin is not just aesthetically displeasing but it could also prove to be fatal. In most cases, skin cancer is caused by excessive sun exposure. This is why the signs of photoaging could well indicate the risk of skin cancer. Actinic keratoses are particularly dangerous. These usually red, scaly or crusty, rough growths that appear on sun-exposed skin could, if left untreated, morph into squamous cell carcinoma (SCC), one of the three most common types of skin cancer.

Photoaging is very easy to guard against. Avoid tanning booths, for one and limit sun exposure. The harmful UVA rays are at their strongest from 11 am to 3 pm. So, it is best to avoid stepping out into the sun during this time. If you cannot do this, remember not to leave home without adequate protection for your skin. Doctors recommend liberal use of sunscreen that has a sun-protection factor (SPF) of 30 or higher and offers broad spectrum protection from UVA and UVB rays. Ensure that all exposed skin is treated with sunscreen. If possible, wear sunglasses that offer UV protection, long-sleeved clothes, and a wide-brimmed hat (or carry an umbrella).

Some among you might then ask, don’t we need Vitamin D and isn’t the sun the best source for it? According to doctors, lighter-skinned people need only a few minutes of sun exposure per day to meet their quota of Vitamin D, while darker-skinned or Asian people would need 20 minutes (for black people maybe 1 hour). Remember that lighter-skinned people with lesser melanin in their skin are more at risk of photoaging than darker-skinned individuals.

However, all is not lost if you think you have developed symptoms of photoaging. Of course, the first step is a comprehensive self-examination to detect such signs. Then, consult a doctor, ideally a dermatologist, to ascertain if any of these are causes for concern. If you are light-skinned, have a history of sunburn, have relatives who suffer from melanoma (another common type of skin cancer), then doctors advise regular self-examinations to detect skin abnormalities and annual medical examinations to determine if you are at risk of skin cancer. While skilled doctors will be appropriately thorough in their examinations, they also expect you to help by detailing your family history, your relevant medical history, and your observations from your own skin examination. You can use this opportunity to consult with your doctor about concerns you might have about your lifestyle, sun exposure, skin abnormalities, etc. You could also discuss the frequency of skin self-examinations and the best way to conduct these. No question is ridiculous so you could even ascertain if you are using the right sunscreen or what to look for when buying UV-resistant sunglasses.

If your doctor finds evidence of photoaging, he or she will recommend an appropriate course of treatment. Photoaging treatments are also anti-aging treatments, including those that we have all heard about at some time — botox and fillers. Laser, chemical peels, and the administration of retinoids (synthetic derivatives of Vitamin A) are some other popular treatments prescribed for photoaging. In fact, recent studies have found that some treatments for photoaging, such as chemical peel, laser and retinoid, could prevent skin cancer as well. However, this is not true for all treatments. Botox, for instance, is merely a cosmetic treatment.

Given the link between photoaging and cancer, it is important to take treatment advice seriously. It is not graceful but foolish to dismiss the signs of photoaging as part of the natural process of growing old. You could opt to avoid anti-ageing treatments if your situation is not considered medically threatening but to ensure that it isn’t, consult your dermatologist at the earliest.