Sun-damaged Skin (Photoaging)

What is photoaging?

Photoaging is the premature aging of your skin due to ongoing exposure to ultraviolet A (UVA) and ultraviolet B (UVB) radiation. Photodamage can come from natural UV radiation exposure from the sun or artificial UV light sources (tanning beds or sun lamps). UV exposure not only ages your skin more quickly than it naturally would, but can also increase your risk for skin cancer.

Photoaging is also called sun damage, solar damage, dermatoheliosis and photodamage.

What’s the difference between photoaging and chronological skin aging?

Chronological skin aging is the natural aging of your skin according to your age and your genetics. It’s not preventable. Photoaging is caused by a lifetime of UV radiation exposure, mostly from the sun. Photoaging causes DNA changes in the cells of your skin and can lead to cancer. If you take precautions, photoaging can be significantly reduced.

Can sun damage be reversed?

Once UV radiation changes your skin cells’ DNA, the DNA damage can’t be reversed. However, this doesn’t mean that you can’t change the appearance of your skin. You can treat, reduce and/or repair the effects of sun-damaged skin. Treatments can remove spots and other skin discolorations, reduce wrinkles and fine lines, smooth out skin, stimulate new skin and collagen production — steps that improve the look, tone and quality of your skin.

Where is photoaging most visible?

Photoaging most commonly occurs in the most visible areas of your skin — on your face, neck, back of your hands, arms, legs and upper chest.

Who is at risk for skin damage from the sun?

Everyone is susceptible to sun-damaged skin. However, you’re more at risk for skin damage if you:

• Have a light skin tone.
• Have had skin cancer or have a family history of skin cancer, especially melanoma.
• Have many moles.
• Have freckles and burn before tanning.
• Have blue or green colored eyes, or blond, red or light brown hair.
• Live or vacation at high altitudes.
• Get intense sun exposure on weekends while spending weekdays mostly indoors.
• Spend a lot of time outdoors and/or at tanning salons, especially as a child or teenager.

Are people of color at risk for sun-damaged skin?

People of all skin tones are exposed to UV radiation. Exposure to UV radiation increases the risk of sun-damaged skin. However, people of color are less likely to get sunburned because they have more of the brown pigment, melanin, in their skin. Melanin helps protect against some of the sun’s damaging UV rays.

If you’re Black or have skin of color — even though you’re less likely to get sunburned — you can still experience damaged skin or get a sunburn, which could be painful and cause peeling.

There’s a relationship between sun exposure and risk of skin cancer in lighter-skinned people, but no relationship seems to exist between sun exposure and skin cancer in dark-skinned individuals. People of color who develop skin cancer develop it mostly on the palms of their hands or the soles of their feet and it’s often in late stage when diagnosed. More study is needed to determine skin cancer risks and the effectiveness of treatments in dark-skinned people.

Are there health conditions that increase your risk for sun-damaged skin?

You have an increased risk for skin damage if you:

• Have certain autoimmune diseases, such as systemic lupus erythematosus, or conditions that weaken your immune system, including HIV.
• Have had an organ transplant.
• Take medicines that weaken your immune system, including corticosteroids, biologics, monoclonal antibodies and calcineurin inhibitors. These medications treat a wide array of health conditions including arthritis, asthma, rheumatoid arthritis, psoriasis, inflammatory bowel disease and cancer.
• Take medicines that make your skin more sensitive to sunlight, such as tetracycline and fluoroquinolone antibiotics, tricyclic antibiotics, the antifungal agent Griseofulvin®, oral contraceptives, cholesterol-lowering drugs and many others. Ask your healthcare provider or pharmacist if any of the medications you take make your skin more sensitive to sunlight.

What are the signs of photoaging?

Signs of photoaging usually begin in your teens to early 20s. Signs include:

• Spider veins (broken capillaries) on your nose, cheeks and neck. Also called telangiectasia.
• Loss of skin tone (loss of elasticity) in sun-exposed areas.
• Lines and wrinkles around your eyes and mouth that increase in number and depth.
• Worry lines on your forehead that are always there.
• Red, rough scaly spots (called actinic keratosis) on your skin.
• Lip lesions (called actinic cheilitis).
• Pigment changes, such as colored spots or patches (melasma), freckles, liver spots (solar lentigines) and age spots.
• White spots on your arms, legs and back of your hands (called idiopathic guttate hypomelanosis).
• Uneven skin color or uneven skin texture.
• Thinning of your skin.

What causes photoaging?

Ultraviolet (UV) radiation causes changes to the DNA in the cells of your skin. This can lead to premature skin aging (photoaging) and skin cancer. There are two types of UV light:

• UVA light: This form of UV light penetrates all levels of your skin, from your outermost layer (epidermis) to the deepest layer (dermis). The epidermis layer gives your skin a smooth and youthful appearance. The dermis layer contains collagen and elastin, which give your skin its elasticity and tightness. UVA light is mainly linked to long-term skin damage, such as wrinkles, and probably plays a role in some skin cancers. UVA stimulates melanin production, which protects your skin by absorbing ultraviolet radiation within the epidermis.
• UVB light: This form of UV light penetrates the epidermis layer, causing photoaging and the development of precancerous cells called actinic keratosis. UVB rays are the main rays that cause sunburn and the cause of most skin cancers.

What are the complications of photoaging?

Complications of photoaging include:

• Increased risk of melanoma.
• Increased number of precancers, such as actinic keratosis.
• Worsening of rosacea.
• Development of seborrheic keratosis, actinic lentigines (sun spots), actinic elastosis (destruction of the skin’s elasticity by the sun) and telangiectasia (spider veins).

What can I expect when I go to a dermatologist?

Your dermatologist will conduct a complete physical exam. They’ll examine all exposed areas of your skin — your face, neck, ears, head, chest and back, arms, hands, legs and feet. They will use magnifying lenses to get a closer look for small abnormalities. Your dermatologist will biopsy any suspicious lesions.

How is photoaging treated?

Photodamage can’t be completely reversed but some treatment options can help rejuvenate your skin. Talk to your provider about the risks of complications. Possible treatments include:

• Retinoids, retinols: These topical products provide their best benefit when treating early signs of photoaging. These chemicals encourage skin cells to slough off so new cells come to the surface. They also stimulate collagen production, which keeps skin tighter. Retinoids are good for treating fine lines and wrinkles, age spots, and for reducing roughness and the size of pores.
• Vitamin C and other antioxidants: These substances slow skin damage due to rogue chemicals, called free radicals, which cause visible signs of damage. Antioxidants can slow skin aging, lessen UV radiation damage and decrease the breakdown of collagen.
• Alpha hydroxy acid: This is an exfoliant, meaning it promotes skin cell turnover.
• Lightening agents: Whitening or lightening agents, such as hydroquinone, can lighten blemishes, sunspots and uneven pigmentation.
• Laser skin resurfacing: Lasers remove the damaged top layer of skin and increase collagen production, which makes the skin’s surface smoother and provides a more even appearance. Laser skin resurfacing treats uneven skin pigmentation, age spots, sun-damaged skin, fine lines and wrinkles and more. Fractional resurfacing delivers microbeams of laser light into the lower layers of skin to create deep, narrow columns of tissue coagulation. The coagulated tissue stimulates a natural healing process that results in the fast growth of new healthy tissue. Pulsed dye lasers use a gentle beam of light to remove broken blood vessels and redness.
• Chemical peels: In a chemical peel, a chemical liquid, such as trichloroacetic acid or glycolic acid, is applied to your skin. Peels remove the outermost layer of your skin so new skin comes to the surface. The peel removes brown spots and actinic keratosis and treated fine lines and wrinkles. It also improves your skin’s tone and texture.
• Photodynamic therapy: In this therapy, your skin is coated with medication and a blue or red fluorescent light then activates the medication. Photodynamic therapy destroys precancerous cells while leaving normal cells alone. Treatment may cause a sunburn-like reaction that can take one to two weeks to heal.
• Cryotherapy: This procedure uses liquid nitrogen to freeze noncancerous age spots and actinic keratosis. The treated areas become dark and shed in a few days.
• Dermabrasion: This technique “sands” away skin to unveil the smooth new skin underneath. Dermabrasion is useful for improving wrinkles, age spots and more.
• Dermal fillers: OnabotulinumtoxinA (Botox®), hyaluronic acid (Belotero®, JUVÉDERM®, Restylane®, Voluma®), calcium hydroxyapatite (Radiesse®) and poly-L-lactic acid (Sculptra®) are among the dermal filler products used to treat fine lines and wrinkles and to restore volume to loose skin.
• Facelift, neck lift, brow lift or other plastic surgery procedures: These procedures treat deep wrinkles, sagging skin and extreme loss of skin elasticity.

How can I prevent ultraviolet photoaging?

It’s typically hard to prevent photoaging completely. Photoaging is sun damage that collects over a lifetime of exposure. While it’s difficult — and not wise — to avoid sunlight entirely, you can still take steps to limit your exposure to UV radiation to reduce premature skin aging. Remember that lowering your risk of sun damage also lowers your risk of skin cancer.

• Wear broad-spectrum, water-resistant sunscreen every day. A broad-spectrum sunscreen protects your skin against both UVA and UVB rays. Use products with a sun protection factor (SPF) of 30 or higher. Reapply every two hours, sooner if you’re swimming or exercising. Keep in mind that exposure to UV radiation can happen while driving in your vehicle and outdoors on cloudy days. This is why you should apply sunscreen every day to all skin areas not covered by clothing.
• Wear a wide-brimmed hat, sunglasses with UV protection and lightweight long-sleeved shirts and pants while outside. Look for clothing with an ultraviolet protection factor label for extra protection.
• Avoid the peak UV hours, usually between 10:00 am and 4:00 pm.
• Avoid all forms of tanning. If you want a tanned look, use a spray-on tanning product.

Are there other ways to reduce premature aging of the skin?

• If you smoke, stop. Smoking speeds up skin aging. It causes wrinkles and a dull complexion.
• Try to be aware of repetitive facial expressions. Contracting the same muscles for many years can cause lines in your skin that become permanent.
• Eat healthy foods, drink less alcohol, exercise on most days of the week and get adequate sleep. Eating a diet high in fruits and vegetables and low in sugar and refined carbohydrates may help prevent damage that leads to premature skin aging. Drinking alcohol is dehydrating to your skin. Exercise increases circulation and boosts your immune system, which may help improve the quality of your skin. Sleep gives your body time to repair itself.
• Gently cleanse your skin. Scrubbing your skin can irritate it, increasing skin aging.
• Wash sweat off your skin as soon as possible. Perspiration can irritate your skin.
• Apply skin moisturizer every day. Apply within three minutes of bathing. Look for moisturizers that contain ceramides, which keep skin hydrated and create a natural barrier to help seal in the moisture.

Are there at-home treatments or over-the-counter remedies to treat premature skin aging?

There are hundreds of over-the-counter (OTC) treatments. Before trying any products, it’s important to get a basic understanding of the ingredients in skincare products that can improve the quality of your skin. Some of the ingredients you’ll discover include retinoids, antioxidants, peptides, alpha hydroxy acids, emollients and humectants.

You may also read about many at-home remedies to treat wrinkles, age spots or aging skin in general. It’s best to ask your provider which products or ingredients might work. Many ingredients are discussed on the internet, but not all have the scientific evidence to support their use. Your dermatologist or other provider should have the expertise to guide you on the use of these products.

What can I expect if I have sun-damaged skin?

Your provider will conduct a full examination of all of your skin. They may refer you to a dermatologist. Any suspicious findings will be further checked for skin cancer.

If your skin is damaged from the cumulative effects of sun exposure, treatments are available to help improve the tone and quality of your skin. It’s wise to check with your insurance carrier before beginning any skin treatment. Many treatments are considered cosmetic and aren’t covered by insurance.

The best “treatment” for sun-damaged skin is to do your best to prevent it from happening in the first place. Always apply sunscreen, with 30 or higher SPF, to all exposed skin before leaving your home.

When should I see my healthcare provider or dermatologist?

See your healthcare provider if:

• You’ve accumulated a lot of sun damage, including blistering sunburns when you were younger.
• You’re self-conscious about the appearance of your skin.
• You notice new or changing moles or spots that are brown, black, red or white. This could be a sign of skin cancer.
• You have a spot on your skin that spontaneously bleeds.

How does sun damage cause white spots on my skin?

The white spots, called idiopathic guttate hypomelanosis, are likely related to cumulative sun exposure. It’s most commonly seen in fair-skinned individuals but can also be seen in older dark-skinned persons, too. The areas most affected are the legs, arms, upper back and face. Legs are usually affected first, with white spots visible along the front of the leg. The white spots are due to a decrease in melanin in your skin. Idiopathic guttate hypomelanosis isn’t a harmful condition. If you’re unhappy with how the spots look, talk to a dermatologist about possible cosmetic treatments.

A note from Cleveland Clinic

Enjoying nature, gardening, going for a walk, breathing in the fresh air — all are great reasons to be outside. If you want to keep your skin in the best shape possible, you’ll want to apply 30+ SPF sunscreen every day to all exposed skin before stepping a foot outside your door — even on cloudy days or before getting into your car for a quick shop at the grocery store. UV radiation, especially from the sun, prematurely ages your skin. See your dermatologist if you’re concerned about the quality of your skin or notice any changes in your skin color or skin spots or lesions. Many treatments are available to repair sun-damaged skin and to easily treat skin cancers that are caught early.