The Skin Cancer Foundation Journal

MAY 2015

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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eather belongs on your handbag, not your face. Besides being the major cause of skin cancer, ultraviolet radiation (UVR) from both outdoor and indoor tanning ages and leathers your skin, doing its best over time to make you look reptilian. The sun's rays alone cause 90% of the visible skin changes we think of as aging 1 : lines, wrinkles, age spots, broken blood vessels, blackheads, blotchy pigmentation, and breakdown of collagen and elastin, leading to sags and bags. Obviously, the best way to achieve youth- ful-looking skin is by avoiding UVR damage – using sun protection strategies from shade and sunscreen to hats and sunglasses to keep your skin safe. Otherwise, the damage keeps mounting. Unfortunately, none of us prac- tices perfect sun protection, and we can't dial the clock back or wish away damage already done. But we can do many things to reverse the visible signs of aging. By doing them, we can also help prevent further damage and re- duce our lifetime risk of developing skin cancer. F I V E H O M E M E T H O D S 1. Exfoliate. The buildup of stratum corneum (the dead, outermost skin cell layer) can make skin appear rough, blotchy and uneven. Buff puffs or oatmeal, ground up nuts, apricot scrubs, and other granular agents can be ap- plied with a wash cloth to exfoliate the skin mechanically, revealing smooth, translucent skin below. Home microdermabrasion kits (in which tiny crystals are sprayed on the skin) can remove dead skin cells, leaving skin look- ing smoother. Alpha hydroxy acids, naturally occurring "fruit acids" such as glycolic acid, are chemical exfoliants that can penetrate the skin's outer layer, peel away the dead cells, and deliver a uniform, rosy glow. They may also help eliminate some abnormal cells on the skin that could one day develop into pre- cancers and cancers. 2. Apply a retinoid at night. Vitamin A deriv- atives, retinoids are the key ingredients in pre- scription topicals such as Retin-A and Renova ® . They help to repair and possibly prevent cell damage caused by free radicals, lighten brown spots, smooth rough spots and diminish fine lines and wrinkles. However, they may cause heightened sensitivity to UV light, so they are usually applied at night; even so, be very careful in the sun when using them. Over-the-counter cosmetics may contain a less potent retinoid called "retinol." 3. Bleach your brown spots. I recommend over-the-counter products containing ingre- dients such as kojic acid, bilberry, Vitamin C, arbutin, mild hydroquinones, or mulberry leaf extract. For resistant spots or blotchy brown areas, ask your dermatologist for stronger prescription bleaching creams containing combinations of hydroquinone, tretinoin and a mild steroid. 4. Try a light-emitting diode (LED). Some home units of these electronic light sources are available. I recommend a lower energy LED to promote collagen production and reduce fine lines and wrinkles. 5. Try needling. Micro-needling devices include rollers with wheels of tiny needles and pens with a cluster of needles at the tip. These devices deliver tiny pricks to the skin to stimulate the skin's natural healing. This can help minimize wrinkles and improve overall complexion. Use needles shorter than .25 -.5 mm at home to reduce the risk of scarring and infection. I recommend consulting your dermatologist before micro-needling at home. T E N P R O F E S S I O N A L M E T H O D S 1. Chemical peels. A series of gentle, gly- colic acid freshening peels, dubbed the "lunchtime peel," can treat sun-damaged skin. Though these acids do not penetrate the skin deeply, they smooth very fine lines, lighten age spots, even out blotchiness and unclog blackheads. Medium and deep chemical peels, using stronger acid solutions, such as trichloroacetic acid (TCA) or phenol, penetrate more deeply. While they can pro- duce dramatic, lasting changes, including new collagen and elastin formation, they have potential risks, including permanent skin whitening and scarring. 2. Intense pulsed light (IPL). A broad band of light, instead of a single wavelength, can be used to treat hyperpigmentation, lax skin, freckles, early sunspots, large pores, fine lines, a ruddy complexion and broken blood ves- sels. A series of treatments known as photo- facials can stimulate new collagen, which will smooth skin texture, making your pores appear smaller and diminishing fine lines and wrinkles. People with darker complexions or recent suntans are not candidates. 3. Lasers for redness. Broken blood ves- sels often stem from chronic sun damage. Vascular-specific lasers, such as the pulsed dye laser (PDL), target the red pigment in blood that flows through these superficial vessels. Treatments are quick, with little-to-no discom- fort and minimal downtime. 4. Lasers for brown spots. Age spots from chronic sun exposure make people appear older than their chronological age. Eradicating them with a pigment-specific laser, such as the Q-switched ruby, Q-switched alexandrite or Q-switched Nd:YAG, can erase years from your appearance. A recent breakthrough in brown spot removal and skin revitalization is the deliv- ery of ultra-short bursts of energy to the skin in picoseconds, with virtually no downtime. 5. Fractional non-ablative lasers for wrin- kles and discoloration. Fractional non-abla- tive lasers, whose beam of light is delivered in a pixilated platform, can mitigate wrinkles and other facial sun damage by creating micro zones of heat in the skin without injuring the skin surface. Recovery is short, but a series of treatments is usually needed for best results. 6. Fractional ablative laser resurfacing for wrinkles and discoloration. An erbium or CO 2 beam of light is emitted in a grid pattern, vaporizing the skin surface and stimulating collagen production. Downtime is 3 to 10 days. The more aggressive the treatment, the L 19

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