Sun Exposed Skin Changes & Skin Rejuvenation Therapy Khalique Zahir MD, FACS Assistant Prof of Plastic Surgery VCU School of Medicine Chairman of Plastic Surgery INOVA Hospital System
Disclosure “IMANA is committed to providing CME activities that are fair, balanced, and free of bias. Full and specific disclosure information is provided in your handouts.” I have no relevant financial relationship with any commercial interest.
What are our Goals? Identify Skin problems Classify skin disorders Come up with a treatment plan Conservative and laser treatments
10 Common Conditions caused because of Sun Exposure Sunburn Photosensitivity Age spots Moles PMLE- Polymorphous Light Eruptions Solar Elastosis Skin Cancer Melanoma Basal Cell Carcinoma Squamous Cell Carcinoma
Sunburn Africa is a good place to get a “sun burn” Over exposure to ultraviolet sun rays Melanin can protect but not when exposed too long to the sun Symptoms Minor Redness of skin Burning of affected areas Tightness of skin Itching and peeling of skin
Sunburn Severe Sunburn Blisters, Chills, Fever, Weakness and Shock
Treatment Apply lotions ideally with aloe vera to burnt area Aspirin or ibuprofen to reduce pain Hydration If skin peels do not irritate Apply sun block of SPF 30 or greater at least 20 min prior
Age Spots / Melasma Over exposure to the sun Brown markings that appear anywhere on the body Changes occur because of inability to fend off UV rays Symptoms Brown or Gray pigmentation Pigmentation is flat on skin
Treatment Bleaching creams, hydroquinone Alpha hydroxy lotions IPL laser
Melasma
Melasma Characteristics Postinflammatory pigmentation Lentigo Drug- induced pigmentation, eg minocycline Lichen Planus Skin bx might be needed
Treatments Stop hormonal contraception Hydroquinone 2-4% every night for 2-4 months…. DO NOT use too long or you can turn BLUE – GREY !! Azealic acid can be used long term Kojic acid
Melasma Treatment Ascorbic acid through its action with copper decreases pigmentation production Others include mequinol, arbutin and deoxyarbutin (from berries), licorice extract, rucinol, resveratrol, 4-hydroxy-anisole, 2,5-dimethyl4-hydroxy-3(2H)-furanone and/or N-acetyl glucosamine
Device usage Fraxel laser IPL – Intense pulse light Erbium-YAG, Ruby and Alexandrite laser although used may make postinflammatory pigmentation worse
Photosensitivity Sun Allergy Also caused by fragrance, plant, fruit, vegetable and chemical contact Medicines – sulfonamides, TCN, Amiodarones and Thiazides Caused by Diseases including lupus, rosacea and psoriasis, metabolic disorders
Photosensitivity Symptoms Red or pink skin rash Itching Burning sensation Scaly and blistered areas of skin
Treatment Natural medicines – beta-carotene, fish oil, vitamin B3, vitamin B6 and adenosine monophosphate Phototherapy
Moles Moles are a common effect of sun exposure and can appear anywhere Occur most often before age 20 Some harmless, some cancerous Symptoms Raised skin Skin tone, brown, reddish-brown or black coloring Rounded or oval shape Changing ABCDE
Polymorphous Light Eruption Affects women between 20-40 Occurs to women sensitive to sunlight and appears on skin Symptoms A red or pink and bumpy rash Raised areas of skin Itchiness Dry patches Burning sensation
Treatment Hydroxychlorquine (Plaquenil) Avoid sunlight exposure
Solar Elastosis Wrinkling that occurs when skin’s elastic tissue deteriorates from sun exposure Symptoms Wrinkles Loose and sagging skin Deep lines in skin
Treatment Imiquimod or tacrolimus to help improve tightness Laser resurfacing
Melanoma Symptoms Change in color, elevation, shape, size etc A new mole or other abnormal skin growth Itching Bleeding or discharge of the mole
Treatment Mole removal Radiation therapy Chemotherapy
Melanoma Diagnosis A - Asymmetry B - Border irregularity C - Color variation D - Diameter > 6 mm E - Evolution
Melanoma Morphologic Types Type Superficial spreading
Frequency 60%-70%
Features Flat during early phase; notching, scalloping, areas of regression
Nodular
15%-30% Darker and thicker than superficial spreading, rapid onset; commonly blue-black or blue-red (5% amelanotic) Lentigo maligna
~5%
Enlarge slowly; usually large, flat, tan or brown
Uncommon
Asians (46%)
On soles, palms, beneath nail beds;
lentiginous
Blacks (70%)
usually large, tan or brown; irregular border; subungual melanoma more common in older, dark-skinned people
Squamous Cell Cancer Symptoms Unhealed sore Changes in mole Scaly growth with red areas
Treatment Removal Mohs surgery Radiation therapy Chemotherapy
Squamous Cell Cancer
Squamous Cell Cancer
Basal Cell Cancer UV exposure –
History of intermitent sun exposure in youth more important than cumulative life time UV
–
Seems to be a plateau of UV exposure beyond which no increase in risk is seen
Fair skin Immunosupression (HIV, transplant) Radiation Arsenic Chronic ulcer
Basal Cell Cancer
Superficial Basal Cell Cancer
Superficial Basal Cell
Basal Cell Cancer Most common type Dome papule Pearly border Telangiectasia Firm consistency May be crusted/eroded can have pigment
Non Ablative Treatment Safer than ablative Requires epidermal cooling Reduces efficacy Small therapeutic window Achieves no resurfacing
Nd:YAG 1,320 nm pulsed laser e.g., “Cooltouch”
Fractional Resurfacing New class of therapy Intact stratum corneum Thousands of wounded tissue islets completely surrounded by viable tissue for rapid healing Immediate and delayed therapeutic results Epidermal coagulation for resurfacing effect Dermal denaturization for deep remodeling
FDA Approved Indications for Use of the Fraxel laser Treatment of wrinkles around the eyes (crows feet) Removal of dyschromia (brown spots) caused by sun damage or aging Skin resurfacing procedures (texture improvement, i.e. acne scarring) Acne Scars, Surgical Scars, Traumatic Scars Melasma (mask of pregnancy) All skin types Anywhere on the body
Understanding Treatment Each session targets 15-30% of skin Time to treat: Full face: 30 min; Neck/Hands: 10 min
Typical course: 3-5 treatments spaced 14-30 days apart Discomfort managed by topical anesthetic and air cooling
Before Treatment
Two Months After 4 Treatments
Melasma: Before and After 10mJ 2500 MTZ/cm2 Bi-weekly intervals
Home
Melasma: Before and After
FRAXEL LASER Melasma: Before and After
Before Treatment
After Treatment
CO2 Resurfacing
1 Day Post CO2 Resurfacing
FRAXEL LASER
1 Day Post Fraxel Laser Treatment
Baseline
Immediately post treatment
Fraxel Laser
CO2 LASER RESURFACING
CO2 Laser
Asian Resurfacing
Resurfacing
Tx for Acne Scarring
Summary Skin care management done with UV skin protection. Identify skin type and problem with knowledge of treating or referring. Thank you
Disclosure “IMANA is committed to providing CME activities that are fair, balanced, and free of bias. Full and specific disclosure information is provided in your handouts.” I have no relevant financial relationship with any commercial interest.