Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, to answer a woman whose skin damage from the sun has recently progressed, she has reached out to Monica Schadlow, M.D., a board certified dermatologist in private practice in New York at Manhattan Dermatology and Cosmetic Surgery.  She is a voluntary attending physician in the Department of Dermatology at New York–Presbyterian Hospital and a diplomate of the American Academy of Dermatology.

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Dear Dr. Pat:

I am 48 years old and have always loved being outdoors. My family has a compound on a lake in the Midwest, and I spent years skiing, swimming, and sailing in the hot sun.  I always used sunscreen, but it never seemed to prevent sunburns. I have red hair, blue eyes, and lots and lots of freckles all over. My complexion is a mess.  I have discolored areas, red cheeks and nose, and wrinkles. Honestly, my mother, who is 70 and always stayed out of the sun (and warned me to do the same) looks younger than I do.

I am willing to do whatever I have to do to restore my complexion. I would like to know, though, why did my skin start to age so quickly in the last two years?  Is it hormonal?  What can I do to get rid of the red patches, the broken blood vessels, the lines and wrinkles? Where do I begin?

Pam

Dr. Schadlow Responds:

Dear Pam:

Summer is just around the corner, and your concerns are voiced by many of my patients. I think you hit the nail on the head with your observation about your mother. Sun damage accumulates over time, and it sounds as though your mother is a great example of the difference sun avoidance can make in our skin. When you combine years of sun exposure with genetic factors such as skin type, the effects start to become apparent in our 40s—for many, even younger.

One of the biggest myths that I have to debunk on an almost daily basis is that a tan, or a “base tan,” is beneficial. Any tan, even if it does not progress to sunburn, is a sign of skin damage. There is simply no such thing as a safe tan. In your case, an active life outdoors has resulted in more sunburns than expected, even though it sounds as though you have consistently used sunblock. The issue there is likely twofold. Most of us do not apply the recommended amount of sunscreen. This is important, because the sun protection promised on the bottle is based on a certain amount of sunscreen used. Roughly, this is about one ounce (or a shot-glassful) of sunscreen for exposed areas. Reapplying sunscreen every two hours is also essential. And remember, “waterproof” does not mean “towel proof”! If you dry off, you are likely removing your sunscreen.

Before we address the more cosmetic concerns of accelerated photo-aging, my first priority is to make sure you are healthy. Your fair skin and blue eyes, along with your history of multiple sunburns, puts you at increased risk for skin cancer, so a skin cancer screening is of utmost importance. Learning how to examine your own skin and knowing what to look for is something your dermatologist can also address. Depending on the assessment, he or she may advise you to return for exams on a yearly or even biannual basis. Certainly any changing mole should be brought to your doctor’s attention immediately.

So, what to do now? Well, all is not lost. Although there has certainly been damage done, a lifestyle change and a good dermatologist can help to mitigate, and even reverse, some of that damage.

First, the lifestyle change. Wearing a broad-spectrum sunscreen on a daily basis (even in the winter!) is a must. Avoiding the sun during peak hours and wearing sun-protective clothing such as rash guards for swimming and sailing are also important.

To address the blood vessels and uneven tone and wrinkles, a multifaceted approach is most helpful. At home, a regimen of sunscreen and a topical antioxidant such as a vitamin C serum, along with a night-time retinoid and moisturizer, is a good place to begin. This can serve to mitigate fine lines and even out the skin tone. In addition, your dermatologist can guide you toward appropriate laser and light treatments to address the photodamage you describe. Resurfacing, photodynamic therapy, and chemical peels are among the treatments that may offer benefit, depending on the extent of the damage seen.

Dr. Monica Schadlow