Dr. Pat Allen is a collaborative physician. Her patients, she believes, will be her best partners in providing diagnostic information, as long as they are asked the right questions. She also believes in consulting with the best medical minds on issues that require specialization or unique clinical experience. Today, on the problem of skin damage, she consults with Dr. Joel Kassimir, a dermatologist in private practice in New York City.
Dear Dr. Pat,
I am only 40 years old, but have noticed at the end of this summer at the beach that my skin has more brown spots than usual. I did spend lots of time in the sun when I was younger, and am of Irish-American ancestry, with red hair, blue eyes, and fair skin. The skin on my face is thickened in areas and slightly red. Is this due to hormonal change, or is it just due to the sun? What can I do to restore my complexion?
It is the curse of our ancestry: the Irish-American people generally have delicate, thin skin that is more sensitive to the sun and sun damage. The unfortunate issue is that repeated sunburns are not only an ultimate cosmetic problem, but do increase the frequency of skin cancers as well. I have asked Dr. Joel Kassimir, a noted New York City dermatologist who is both a scientist as well as a clinician, to address your questions. He both treats diseases of the skin and hair and is a cutting edge physician in the repair of damaged skin. We are delighted that he has joined our Medical Advisory Board and will be contributing more posts on the many diseases and problems of the skin and their treatment.
Thanks for sending in this timely question.
Dr. Patricia Allen
What the Sun Has Wrought: A Dermatologist’s End-of-Summer Analysis
By Joel Kassimer, M.D.
Chances are you never listened to your mother when she told you to stay out of the sun. A few mothers actually told their children to “put youe face in the sun.” Hard to believe. We know all too well that sun will make a mess of the DNA found inside the 1 trillion cells and 23,000 genes that our bodies have and make it more likely for you to develop a Basal Cell Carcinoma, a Squamous Cell Carcinoma, or a Malignant Melanoma.
The most detrimental sun exposure occurs before the age of 15. According to the Skin Cancer Foundation, an estimated 11,680 deaths will result from skin cancer each year. Those cases that are not life-threatening can be disfiguring.
If the prospect of cancer doesn’t deter you, perhaps premature aging will. Take a moment to look at the inside of your arm, the part that has never seen the light of day. It is pale relative to the surrounding skin, devoid of unsightly sun-induced brown spots (solar lentigines, or liver spots), and has more elasticity and more robust collagen, making it more youthful and attractive. Now try to imagine this skin replacing the abused, overexposed skin on your face, neck, décoletté, hands, and extremities. You would be spectacular, worthy of goddess status.
Gravity, time, light eye color, and fair complexion will play a role in the aging process, but it is the sun that will dramatically accelerate the process—like throwing gasoline into a fire. Sun exposure will thin our collagen bundles and unravel our elastin fibers. Youth is about volume and perkiness, and no amount of Botox, fillers, or surgery—though very helpful—can restore the natural beauty that the unexposed person can achieve.
Dermatopathologists tell us that we actually peak at 25 years old. Fibroblasts—cells found in the dermis—gradually reduce their production of collagen. Photographs at five-year intervals reveal the insidious changes that these structural changes bring. I remember all too well a 38-year-old, Caucasian mother of two, whose skin was so deeply tanned that it made you uncertain of her ethnicity. When asked why she felt the need to pursue such an unwise activity, she responded by saying she didn’t feel pretty without a tan. I assure you that she didn’t look pretty with one. Without exaggeration, she had the skin of a 70-year-old woman. Of course I didn’t tell her this, lest it send her into a deep depression or worse.
My maternal grandmother, g-d bless her, died at 90 years old with nary a wrinkle or uneven pigmentation. In her day, women were careful to stay out of the sun. It really wasn’t until the sixties that a tan became a sign of wealth and the ability to fly to warmer climates for the weekend.
According to the FDA, retinoids are the only products able to partially reverse the effects of photo-aging. In good hands, bleaches, peels, and lasers can fade brown spots, resurface lines, and give us clarity, which translates into “really pretty.” Prescription topical chemotherapeutic creams and photodynamic therapy can remove pre-cancers before they require surgery and prevent scarring.
Skilled professionals can use dermal fillers such as Juvederm, Restylane, Perlane, and the about-to-be-released Belotero to help us replace the volume necessary for a youthful appearance. Neuromodulaters such as Botox, Dysport, and Xeomin can help refine etched-in lines and actually give a lift to sagging brows, and even the most modest, but strategic, surgery can re-drape the redundancy in a hanging neck, ill-defined jaw and almost nonexistent cheekbones.
In the end, physical beauty, like all disease, begins at the cellular level. If we’re lucky, we are all going to get old, but we don’t need to encourage the process. Buy a hat, wear a sunscreen, preferably one that is zinc and titanium based, and wear clothing that provides sun protection. You’ll never regret it.