sun damage
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● About Sun exposure back to top Sun exposure in excess or in a chronicle way can have some harmful effects on the skin. These effects can be immediate, like sunburns, or they can appear later, like early aging, premalignant lesions and skin cancer. On the other hand, from the sun we obtain some benefits: a pleasant heat sensation, a cosmetic attractive tan and the fact that sun promotes, fundamentally in the infancy, the synthesis of vitamin D, requiring just a short exposition to the sun. In this sense, we must indicate that today practically all the milks are enriched with vitamin D and, in addition, we are capable of forming sufficient vitamin D, even employing sunscreens with a high protection factor.
If we examine the skin
at the microscope, we see within the dermis several types of fibers that
are well arranged. These fibers provide elasticity and resistance. In
photoaged skin, this orderly standard is notably altered and the chaos
happens. These fibers appear fragmented, swollen and grouped in a
chaotic way. It may take years before we see the manifestations of all
this alteration on the skin. Aged skin can present several types of
lesions:
They also have been called hepatic stains (sun lentigines). They are small, flat and brownish, and are often located on
face, neckline, hands and arms. They result from the increase in the
number of cells that manufacture the pigment, the melanin, but they are
not premalignant or malignant. They are treated with bleaching products,
chemical peels or liquid nitrogen. It is manifested by a red stain that appears on any exposed area, but particularly on women's legs. It is treated technically as a cancer because malignant cells form it, but it is a superficial and not an invasive type of cancer. This means it stays confined to the epidermis, the most superficial layer. However, later these stains are turned invasive and become a scamous cell carcinoma. Because of this, they should be treated before it occurs. The treatment is effected through freezing with liquid nitrogen, coagulation with electrical scalpel or surgical excision
Solar keratoses or sun stains are spots with different colors, frequently brownish or reddish, whose surface is rugged and scaly, looking crusty or bark. Sometimes they are better touched than seen.
It is very important to treat them adequately, since they are premalignant lesions with capacity to degenerate in skin cancer later.
The treatment destroys the damaged cells, and so new skin heals from the
lower cells that have escaped the sun damage. We must emphasize that
damage produced by the sun was considered permanent and irreversible
until very recently. Therefore, besides treating them, it's advisable
monitoring the patient to look for the possible development of other new
lesions. Today we have creams (tretinoin) to repair sun damage and
reduce the lesions progressively. Anyway, patients who have suffered
them should be monitored by the dermatologist every 6 months in order to
treat soon incipient lesions.
It consists of applying liquid nitrogen over the stains to
freeze them, either through a cotton ball previously wetted in liquid
nitrogen or through an atomizer pistol spraying the liquid nitrogen (Cryac).
The application of liquid nitrogen produces a burning sensation, since
this gas has a temperature of 200 degrees under zero. This cold burn
destroys the pre-cancerous cells and the skin is regenerated from lower
layer cells. After 24 hours of the freezing, the skin appears irritated,
sometimes with blisters, looking like a hot oil splash burn, but this
ugly aspect should not concern, since is normal. In fact, this is what
the dermatologist is looking for. To cure the burn, clean every night
the burnt zone with a gauze or a piece of cotton wetted in peroxide
water or olive oil, and apply a small quantity of SilkSeS Protective
Cream.
The altered tissue is burnt through a high-frequency
current applied to the skin through a needle. The burn produced by this
method is cured by the same previously described method. Chemical
Peelings. Frequently solar keratoses are extensive and are accompanied
of other signs of chronic solar damage (solar lentigines or senile
stains, wrinkles, yellowish skin color). In this case, it's more
recommendable to perform a chemical peel with trichloroacetic acid to
completely treat all the lesions and rejuvenate the skin in only one
treatment.
It eliminates lesions in a very specific way, without
bleeding and with excellent cosmetic results.
These creams contribute to
repair the damage induced by the sun throughout the life. They should be
applied daily on the whole face: those of glycolic acid in the morning
and those of tretinoin at nights. Wash the face with soap or clean it
with cleansing milk before the application.
They must be employed all the year, but mainly in spring and
summer. Sunscreens should be applied in the morning before leaving home
and above the day cream. Finally, you must avoid excessive sun exposure
and use regularly sunscreens with a high protection factor (>15) as long
as you remain outdoors. Use hats if you are bald and dress long sleeve
shirts. Visit regularly your dermatologists every 6-12 months. It is called thus because is developed in the basal layer of the skin, where new cells are continually formed. It is the most frequent. Fortunately, it's rarely extended to other areas (not metastasize), though it tends to invade the underlying skin. In some locations (face and ears) it can be necessary a vast surgery to extirpate the tumor. Dermatologists recognize several types according to the appearance and location. Sun-exposure is the most important causative factor, but there is a variant in which a genetic bias exists to develop it. The most frequent type is the nodular, which is manifested by a flesh or pearly colored nodule with high edges and small blood vessels on the surface; sometimes it can bleed or develop a central sore.
Other type is the superficial, which is manifested by a
red spot with pearly and slightly high edges. It is frequently located
on the trunk and back. The pigmented type looks like the nodular, but it
has a black or brownish coloration. The rarest type is the morfeiform,
which is manifested by defined wrong plates and a hard consistence,
making its surgical removal more difficult and recurrent. The treatment
takes into account the size, location, type and age. These can be the
treatments: surgery, freezing with liquid nitrogen, coagulation with
electrical scalpel, Mohs microscopic surgery and injections containing
interferon within the tumor. It is important to detect these lesions in
their early stages to avoid vast or disfiguring surgeries.
They are developed from the squamous cells
that constitute the epidermis. They are less frequent than basal cell
carcinomas. People at a greater risk are those immunosupressed who have
received renal transplants or those who are in treatment with
immunosupressor drugs, and because of this, they should be extremely
wary of the sun. They are expressed as scaly surface bundles, firm,
slightly painful; they can bleed and may be ulcerated. It can be
extended to other organs (risk: 2%), fundamentally when they are located
on lower lips and ears. These lesions should be treated as soon as
possible. The adequate treatment is surgical removal. Occasionally,
radiotherapy is employed as an alternative, fundamentally for old
people.
The reason why the incidence of melanomas has
increased is not known. Sun-exposure has a clear role. The incidence is
related inversely to the latitude, at least in Australia and the United
States, so the incidence increases the closer you are to the Ecuador.
This can reflect an increase in the sun-exposure or an increase in the
time spent outdoors. People who are at a greater risk are those with
many moles and very white skin, which is burnt easily and is not tanned.
People who have intermittent or excessive sun-exposures with burn
development are at a high risk. Relatives of people previously affected
by melanoma too. Paradoxically, people working indoors are at a greater
risk than those who work outdoors, as opposed to the basal cell
carcinomas do. They probably have more intensive sun-exposures in
holidays.
It is the most frequent type. It
affects people who are 30-60 years old. Men tend to develop this tumor
on the back and women on the legs. It is manifested as a stain with
irregular pigmentation. This stain has a mixture of colors (brown,
black, pink and red). The edge is irregular and frequently flat, though
it can be increased thereinafter. Commonly, they have a diameter of 6-7
mm, even though actually is more frequent to diagnose smaller melanomas.
These stains are not symptomatic, though in the late stages they bleed
and sting.
Once this information is obtained, it can be decided to
widen the initial removal zone of the tumor. This zone around the
melanoma has a greater risk for recurrence of the tumor, though the
removal of this additional skin does not affect commonly the final
prognosis. This means that rarely are necessary drastic surgical
measures to obtain a better prognosis. However, there are cases that
require thereinafter a surgical treatment, as the lymphatic ganglia
removal. After the removal, is important that patients are examined and
the lymphatic ganglia explored. People with a melanoma are at a greater
risk of developing other melanomas. Therefore, the whole skin must be
explored annually. Finally, the members of the family should be warned
about the fact that they have a slight higher risk of developing a
melanoma.
The reflection is especially important on
surfaces like sand and water. This is very evident for people who are
protected from the direct sunlight through parasols, but they are burnt
by the reflected light. Though the temperature has not been mentioned,
you must know that the ultraviolet are neither cold nor hot. When the
temperature is 20ºC, it can be associated with the same sun exposure as
it was 35ºC. Besides the daily temperature, there is an increase in the
ultraviolet B at noon. Some people think we can burn with the wind when
we are outdoors in cold or cloudy days. The reality is that this type of
burn by cold does not exist, it is simply a sunburn.
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