The Crucial Role of UV Rays and Free Radicals in Skin Damage

You’ve probably heard it time and time again: wear sunscreen to protect your skin from the sun’s harmful effects. But what exactly is happening when your skin is exposed to the sun? In this updated blog post, we’ll delve into the science behind sun exposure and skin damage.

The Process of Skin Damage from Sun Exposure Breaking it down in 3 simple steps:

1. You venture outside with inadequate or no sunscreen protection.
2. UVA and UVB rays infiltrate your skin at various depths, initiating the production of free radicals.
3. Free radicals attack your skin, leading to dryness, sagging, wrinkles, and more.

Demystifying Free Radicals Free radicals might sound like a foreign concept, but they play a significant role in skin damage. These unstable molecules constantly search for an electron to bond with. When they “steal” electrons from other molecules, they set off chain reactions that damage healthy cells and tissue, resulting in compromised skin.

3 Visible Signs of Skin Damage

1. Wrinkles and Sagging Cause: Free radicals target collagen and elastin

Collagen and elastin are protein fibers that act as a supportive framework for your skin, maintaining the structure of your epidermis (outermost skin layer). When free radicals attack collagen and elastin, your skin loses strength and elasticity, resulting in sagging and wrinkles.

2. Dry, Leathery Skin Cause: Free radicals target lipids

Lipids contribute to a protective barrier for your skin, helping retain moisture and shielding it from external elements, like sun and wind. However, when lipids encounter free radicals, your lipid barrier becomes compromised, leading to dry, leathery, and irritated skin.

3. Sun Spots, Uneven Skin Tone, and Skin Cancer Cause: Free radicals target DNA

Prolonged exposure to UVA rays can elevate melanin production, causing hyperpigmentation (uneven darkening of the skin) and age spots. Worse still, when free radicals damage cell DNA, they can trigger cell mutations that may lead to skin cancer, including melanoma.

Solutions: Sunscreens and Antioxidants

To prevent free radicals from harming your skin, make sure to wear sunscreen consistently and increase your antioxidant levels topically.

Broad Spectrum Sunscreen Sun exposure is something you can control, making it a sensible starting point for addressing skin damage. Sunscreen with zinc oxide blocks most UVB and UVA rays before they can penetrate the skin and initiate a free radical chain reaction. Wear it daily, regardless of the time or weather conditions.

Antioxidants Antioxidants, found in a wide range of foods and drinks, are molecules that counteract the damage caused by free radicals. As you age, your body’s antioxidant levels decline, giving free radicals the advantage. While consuming antioxidant-rich foods is beneficial, it’s often not enough to protect your skin. Applying topical antioxidants can help fortify your skin against free radical damage.

“I can wear silk again without soaking woohoo!”

Chrissy Teigen is known for being totally candid about the personal aspects of her life. From getting real about postpartum depression to her vaginal steaming routine, she’s definitely not one to hold back. But her latest beauty treatment may just be one of her most honest.

Last night, Teigen shared a video of herself receiving anti-wrinkle injections (Wrinkle Relaxers) in her armpits as a way to combat her “excessive sweating.” In the video, she gives a shout out to Jason Diamond, MD, a Beverly Hills-based plastic surgeon, while calling the procedure the “best move” she “has ever made.”

While Teigen hasn’t revealed an exact diagnosis (she could simply just sweat a lot—feel that, girl!), excessive sweating can be a symptom of hyperhidrosis—and anti-wrinkle injections in the armpits are often a common treatment for the condition.

“What’s happening in hyperhidrosis is the nerves that send signals to sweat glands to sweat are way too chatty, and we don’t really know why that is,” Adam Friedman, MD, associate professor of dermatology at the George Washington University School of Medicine & Health Sciences, previously told Health. Medications and anti-wrinkle injections work by blocking those nerve signals that are responsible for activating the sweat glands, he explained.

The good news? Anti-wrinkle injections aren’t specifically meant for those with a hyperhidrosis diagnosis—even if you just want to rock a silk dress, sweat-free (like Teigen), you can go ahead and opt for the procedure. “You can absolutely get anti-wrinkle injections under your armpits, even if you don’t have hyperhidrosis,” Debra Jaliman, MD, a New York City–based dermatologist and author of Skin Rules, tells Health. “Some people may be allergic to antiperspirants, so for them, this is a good—and safe—alternative.”

As for the pain that might come with the procedure, Teigen said she didn’t feel anything. “Truly didn’t hurt at all” she wrote in a tweet later to a fan asking about the pain. “But I also do laser hair removal there so my pain tolerance might be quite high,” she added.One small drawback: anti-wrinkle injections only prevents sweating in the area that it is specifically injected, Dr. Jaliman added. That means if you’re just getting the treatments in your armpits, you can still sweat other places (hi, underboob sweat!), so one round of anti-wrinkle injections won’t solve all of your sweaty summer woes. Plus, the procedure only lasts about six to seven months, says Dr. Jaliman, so be ready to make multiple appointments to keep your underarms dry for good.

Earlier this month Dr. Suzan Obagi explained her thoughts on why she is not afraid of causing PIH in darker skin types. She offers her expertise and personal approach to understanding and treating pigmentation issues, below and via https://www.aestheticauthority.com/view/fillers-for-post-fat-grafting-finesse

It is not unusual for me to see a patient in consultation for skin concerns only to find out that they were referred by their dermatologist or cosmetic surgeon because of fear of treating their darker skin complexion without risking more pigmentation issues. While I am thankful that the physician referred the patient if they were concerned about treating their skin safely, it makes me wonder how many patients out there are being turned away from treatments based solely upon their skin color.

I think we have been taught, rightfully so, to be concerned about post-inflammatory hyperpigmentation (PIH) when treating darker-skinned patients, but there are steps we can take to prepare the patient’s skin well so that we can safely treat them.

First, let’s look at the difference between ephelides (freckles), lentigines (sunspots), PIH, and melasma. Patients may have a genetic predisposition to forming ephelides, but that gene varies racially. Biopsies show increased pigmentation but not increased melanocytes; however, ephelides have a predilection for sun-exposed skin. This suggests that there is an overproduction of melanin by melanocytes. Solar lentigines, on the other hand, arise in areas where repeated sun exposure induces mutations, resulting in increased melanin production and abnormal pigment retention by the keratinocytes. In these lesions, there is a mild increased number of melanocytes as well as evidence of photodamage in the dermis.

PIH is a temporary overproduction of pigment in response to an epidermal injury or trauma. Usually, this injury is thermal but PIH can be seen in patients that excoriate their skin or that have had inflammatory lesions in the skin. Rarely, severe inflammation can cause melanin to drop into the dermis and to be engulfed by melanophages. PIH is worsened by sun exposure.

Melasma, on the other hand, is a much more complex disorder that may have a genetic predisposition. Melasma arises mostly in women of child-bearing age but it can be seen in men and older women. In melasma, some unknown trigger has induced melanocytes to overproduce and distribute melanin to the keratinocytes. Sometimes, this pigment can drop into the dermis and be taken up by melanophages resulting in dermal melasma. While the trigger may be elusive, there is certainly a link to things that worsen melasma. These include ultraviolet light and certain visible light wavelengths, hormones (pregnancy, oral contraceptives, hormone IUD), and certain topical agents (chemical sunscreens, fragrances and certain botanical agents), heat (spas, saunas, hot yoga, cooking). Once these melanocytes are sensitized and over-produce pigmentation, it is challenging to quiet them down or to clear the melasma fully.

Evaluation & Diagnosis

When I see patients with dyschromias, it is important to assess the following:

• Diagnosis of condition: ephelides, lentigines, PIH, melasma
• Is this strictly epidermal or is there a dermal component?
• What has been tried, what has worked and what has failed or worsened the condition?
• For melasma, is the patient exposed to exogenous hormones such as oral contraceptives, excessive soy intake or the presence of a hormone IUD?
• How motivated the patient is to follow an aggressive skincare regimen?

Patients with ephelides and lentigines can be safely treated with light peels and non-ablative fractionated lasers, Q-switched lasers, and broadband light (BBL). However, the darker the patient’s complexion, the longer I pretreat with a comprehensive skincare regimen before performing any of these treatments. The risk of not doing so is that you will induce PIH during the healing process.

Patients with PIH — the dreaded complication — are actually easy to treat. It may resolve with proper management in one month, three months or six months, but in the end, it all resolves. Patients that develop hyperpigmentation in response to acne or oven burns are at risk for PIH from any face procedure. PIH is not permanent thus it does not scare me if it arises, but I try my utmost best to minimize the risk of PIH and to treat it preemptively. Any patient at risk for PIH should be pretreated with a comprehensive skincare regimen, and once they have healed after a procedure, the patient should quickly resume the topical regimen. If, despite this, PIH develops, the patient must be diagnosed quickly and started on a series of 30% salicylic acid peels at two- to four-week intervals until the PIH resolves. Being more aggressive with peels, or by performing a laser (heat trauma), will only aggravate the condition. Lasers have no role to play in treating PIH.

Melasma is the one condition for which I do not over-promise the results. If the patient has eliminated all their contributing factors (hormones, heat, certain topical agents) and they have used their comprehensive skincare regimen faithfully, epidermal melasma should show considerable improvement by six weeks (one skin cell turnover cycle). If at six weeks the patient is doing well, I then see them back at three months. However, if at six weeks, they are not improved despite using their products correctly, I add light peels to their regimen with 30% salicylic acid every four weeks. At three months, I reassess their skin. If it is considerably improved, I continue the skincare regimen unchanged for one year. The light peels can continue. If the patient is only moderately improved, I might add a non-ablative fractionated laser combined with a salicylic acid peel or Jessner’s solution peel. However, if there is little change at the three-month evaluation, it may indicate that the pigmentation is dermal. If so, I may proceed with a medium-depth trichloroacetic acid (TCA) peel to try to eliminate some of the dermal melanophages. I do not use more than a 24% or 25% concentration TCA peel, as higher concentrations can cause an inflammatory reaction in the skin. Of course, once the patient has healed, they resume their topical skincare regimen immediately. It is important not to let the melasma rebound.