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How to Prevent and Treat the Effects of Photoaging

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Gina Way •Apr 6, 2021

The interplay between internal and external factors influences how our skin looks and how it will age. The chronological aging process is determined by the inevitable passing of time plus intrinsic characteristics, such as genetics and skin tone. “These are the predetermined cards we’re dealt,” says Dr. Dendy Engelman, a board-certified dermatologist in New York City, “but most of the visible signs of aging, especially brown spots and fine lines, come from external causes, like sun exposure.” It’s estimated that photoaging accounts for 90% of skin aging. Yes, you read that right. “It’s a shocking percentage, but the good news is that you can actually control your skin’s future,” says Dr. Engelman.

How does photoaging happen?

The photoaging cause-and-effect cascade goes like this: UV light causes DNA damage to skin cells and triggers free radicals, the unstable molecules that can break down collagen and elastin. Over time, this leads to wrinkles and sagging. Of course, sun exposure also creates hyperpigmentation, or “sunspots,” an overproduction of melanin, the protective pigment that absorbs ultraviolet light.

While UV light is the primary culprit, it’s not the only one. “We used to think that if a person was indoors, they were protected from most of the environmental elements that can damage skin, but that’s not the case anymore,” says Dr. Engelman. “Obviously, UV rays come through windows, for one thing, and now we’re learning that high-energy visible light (HEV) or blue light from computer and phone screens as well as from LED and fluorescent light bulbs has an effect on the skin too. Research is ongoing, but it’s thought that HEV may break down collagen, lead to DNA damage, and increase melanin production.” Pollution is another factor. “Research has shown that people who live in more polluted urban environments are more prone to hyperpigmentation and other signs of aging,” adds Dr. Engelman.

How skin tone plays a role in photoaging 

“Light skin types develop freckles and pigment spots more readily, and they tend to get more wrinkling and crinkling,” says Dr. Corey L. Hartman, a board-certified dermatologist in Homewood, Alabama. “Light skin is also susceptible to ruddiness and broken capillaries due to UV damage. Since dark skin has more melanin, which provides a built-in SPF of 8 to 13, you don’t see the same kinds of visible aging, but all skin types will experience collagen and elastin degradation that shows up as a loss of volume.” Dark skin is prone to hyperpigmentation that’s not sun-related, in the form of postinflammatory hyperpigmentation (PIH) and melasma. “Because UV exposure can exacerbate both,” says Dr. Engelman, “sunscreen is essential for improving those conditions.”

Why sunscreen is so important

“It doesn’t matter how consistent you are with your regimen or if you spend hundreds of dollars on an anti-aging cream. If you’re not using sunscreen every day, then you’re wasting your time and money,” says Dr. Hartman. “Broad-spectrum UV protection is the anchor to any good skin-care routine, and it’s the key to preventing photoaging of all kinds. Even though dark skin tones have an inherent SPF of up to 13, that’s not total protection. We need to use a minimum of SPF 30.” He’s a fan of Isdin Eryfotona Actinica SPF 50+ ($55), “a zinc-only sunscreen that won’t leave a caste on brown skin.” Zinc oxide and titanium dioxide are the only sunscreen ingredients that protect skin from blue light. “Iron oxide has also been shown to help block HEV, so a tinted mineral formula is ideal,” says Dr. Hartman. Try HydroPeptide Solar Defense Tinted Broad Spectrum SPF 30 ($48).

At-home treatments that reverse photodamage

“Antioxidants such as vitamin C and E, idebenone, resveratrol, and ferulic acid neutralize the toxic free radicals that aren’t fully filtered by your SPF,” says Dr. Engelman. “Quenching those unstable molecules stops them from destroying your collagen.” Vitamin C, a superhero antioxidant, works to fade brown spots and blocks the enzyme tyrosinase, which helps to prevent melanin production. It’s also been proven to stimulate collagen production, so it’s a win-win-win. “I recommend applying a vitamin C serum, like SkinCeuticals C E Ferulic [$166], onto clean skin in the morning and layering a broad-spectrum sunscreen on top,” says Dr. Engelman.

Using a chemical exfoliator with glycolic acid can gradually fade discolorations, and retinoids (including over-the-counter retinol) do the same by accelerating skin-cell turnover. Of course, retinoids are also proven to stimulate collagen production. “I use it to address aging skin concerns and to treat serious photodamage,” says Dr. Engelman. “When I have a patient with precancers like actinic keratoses, I’ll prescribe topical tretinoin to reverse and repair some of that.”

In-office procedures that reverse photodamage

Intense pulsed light (IPL) 

IPL is often referred to as a photorejuvenation treatment, and it’s the gold-standard solution for repairing sun damage on light skin types. Because IPL specifically targets pigment, “dark skin doesn’t necessarily have a need for this treatment,” adds Dr. Hartman. “IPL is like a magic eraser for photodamage like brown, red or light sunspots—that mottled appearance called ‘poikiloderma.’” Dr. Hartman recommends a series of three treatments, once a month, and then one treatment, quarterly, for maintenance.

Chemical peel 

Chemical peels effectively remove surface pigment and soften fine lines too. “Combinations of acids, such as azelaic, lactic, trichloroacetic [TCA], retinoic, or glycolic, can be tailored so they’re safe to use on all skin types,” says Dr. Hartman. (He typically does a series of three to six peels, spaced one month apart.) TCA, which is melanotoxic, meaning it destroys the cells that contain melanin, is often used to treat sun damage and melasma, but it can be tricky to use on people of color who are prone to PIH. “I never go above 15%, and it must be used with great caution,” says Dr. Hartman. “Instead, my favorite peel for dark skin is the SkinMedica Vitalize peel with retinoic acid, to help even the skin tone without adverse side effects.”

Fraxel

“Fractionated laser resurfacing is a treatment that can be used on any skin type, when in the hands of a skilled technician,” says Dr. Hartman. “Fraxel Dual is my workhorse go-to for treating hyperpigmentation, melasma, wrinkles, texture issues, and sagging. It can do it all because there are two wavelengths—one is used for tightening, and one is for pigment. One or two treatments is optimal for photodamage.”

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