Photoaging of the skin: how to prevent and how to treat if it was not possible to prevent

Over the past few decades, scientists have been talking more and more about the dangers of photoaging, emphasizing that modern man is much more exposed to sunlight than those who lived a hundred years ago. This is due both to the deterioration of the environmental situation and to a change in lifestyle: today a tan has become a sign of a person who takes care of himself. Unfortunately, exposure to solar ultraviolet radiation greatly accelerates the aging of the skin, causing premature sagging and wrinkling.

The term “photoaging” used to describe a group of features that distinguish the condition of skin that has been exposed to ultraviolet radiation (UVR) for a long time from skin that has been protected mainly from such exposure. Although there is no precise data on the prevalence of this skin condition, it occurs in all races, and the most severe changes are observed in people with fair skin, in people whose lifestyle is associated with being outdoors, and in areas with high intensity and duration UVI.

It is generally accepted that most of the changes in light-aged skin are due to UVA class (UVA, 320-400nm) and Class B (UVB, 290-320nm). Recent studies have shown that even low levels of UVB can increase the expression of metalloproteinases in human skin, leading to the degradation of collagen, elastin, and other dermal matrix proteins. When comparing changes in the skin aged from light exposure with changes in its light-protected areas in the same patient (control of the effects of age-related aging), it was shown that the levels of collagen I and III in the dermis during photoaging of the skin are lowered, and in the dermo- of the epidermal junction, the number of anchor fibrils is reduced and the network of fibrillin microfibrils is destroyed.

Clinical characteristics and hazards of photoaging for the skin

The main signs of photoaging are deep and fine wrinkles, skin laxity, mottled hyperpigmentation, painful yellowish color and dry, hard skin texture, and prominent telangiectasias. These signs are especially pronounced in areas such as the face, dorsal part of the neck and forearms. Such skin is susceptible to the development of neoplasias such as actinic keratosis, basal cell and squamous cell carcinomas. Conversely, sun-protected areas (such as the skin of the buttocks) remain pale and smooth, and fine lines develop only at a later age.

Without treatment and adequate protection from further UV exposure, the changes progress slowly, giving the erroneous impression of “premature aging”.

General therapeutic recommendations for preventing photoaging

Photoaging is a common condition and not all patients require treatment. However, sun protection measures should be advised to all such patients to reduce the risk of developing skin cancers. The treatment of patients who need it is carried out for a long time in order to maintain its beneficial effects.

Smoking abstinence should be recommended. In addition to the well-known health risk, it also contributes to the development of wrinkles. Dry skin, a sign of aging, can be reduced by regular use of moisturizers.

Sun protection measures

Patients who wish to improve the appearance of their skin with signs of photoaging should be advised to take adequate sun protection measures to stop UV damage occurring in the skin:

avoid sun exposure between 11 am and 2 pm when UV exposure is at its highest;
when outdoors in sunny weather, wear protective clothing and headgear: the fabric should be tightly woven to provide an adequate barrier against UV exposure;
Apply sunscreen with a SPF of at least 15 every 2 hours.

Methods of photoaging treatment: drugs and procedures

Topical all-trans retinoic acid

The clinical improvement with all-trans retinoic acid can be attributed to the regulation of expression of retinoid-specific genes. A cream-based preparation is applied at night to the affected areas of the skin. Wrinkle smoothing occurs within the first 4 weeks of treatment and is associated with the deposition of new collagen within the dermis.

Other topical retinoids

Isotretinoin has been shown to be effective in the treatment of photoaging and is well tolerated by patients. Retinal, when applied topically at concentrations up to 1.6%, shows an effect similar to all-trans-retinoic acid, but without the development of its characteristic erythema.

Alpha hydroxy acids

Glycolic and lactic acids at low concentrations, when applied to photoaged skin, have been reported to reduce wrinkles. The mechanism is associated with a decrease in the adhesion of corneocytes in the lower part of the stratum corneum. The effect on wrinkles can be enhanced by the simultaneous use of higher concentrations of these acids as a superficial peel.

Chemical Peeling

Imic peeling is the application of a controlled wound to the skin, followed by regeneration. Peeling can be deep (damage to the skin reaches the reticular layer of the dermis) or superficial (only the stratum corneum and epidermis). Deep peeling gives better results, but there is a higher risk of scarring, pigmentary changes and, if phenol is used as a peeling agent, systemic toxicity. Patient selection is important, as is experience to perform the procedure safely.