Sun damage treatments

Sun damage may present in several ways including-

• Dry, flaky and prematurely wrinkled skin.
• Actinic keratosis or solar keratosis- these are persistent rough and scaly areas of sundamaged skin that has a pink, red or yellow-brownish tint. These lesions do not resolve unless treated. Symptomatically they may cause pain and bleed. As actinic keratosis develops in areas of skin that have undergone repeated or long-term exposure to the sun’s UV light, they are a warning sign of increased risk of skin cancer.
• Areas of pigmentation change can also present as sun damage. Most frequently the skin of sunexposed areas are mottled in appearance with increased and irregular pigmentation. This is most commonly seen in the chest and the sides of the neck.
• Loss of skin tone is seen in more extreme forms of sun damage. UV radiation can fragment and destroy collagen, the scaffolding of the deeper layers of the skin. The subsequent loss of collagen contributes to the weathered wrinkling of photodamaged skin.

Apart from the cosmetic implications of sun damage, exposure can give rise to ‘solar keratoses’ or actinic keratoses. These precancerous skin lesions are the result of years of unprotected exposure to the sun’s ultraviolet rays. Left untreated a percentage of these precancerous skin lesions can develop into a squamous cell cancer, a dangerous form of cancer that can spread to other parts of the body.

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New treatments such as PDT (photodynamic therapy)and laser resurfacing are at the forefront of medical advances, associated with a much quicker heal time and better cosmetic results than older treatment modalities such as Efudix treatment.

The goal of treatments are aimed first and foremost at treating abnormal or precancerous cells.  The second goal of treating sun damage is of cosmetic benefit- that is reduction of uneven skin tone, uneven skin texture, mottling, and wrinkles. Different treatments are used, depending on the balance of the degree of sundamage, the downtime of treatment, and the cosmetic request of patients.

Photodynamic therapyis a new procedure that utilises a chemical known as ALA which is activated by a specific wavelength of LED light or laser. ALA is concentrated in precancerous skin cells over an incubation period of 3 hours and causes a substance known as porphyrins to accumulate. These prophyrins are light sensitive, so when the area is exposed to a LED light source it causes a chemical reaction in the skin that destroys the lesion. For mild to moderate areas of sundamage one treatment session is recommended. For severe areas of sundamage and skin cancer treatment two sessions are required.

PDT treatment is over in a matter of hours, recovery time ranges from 6days to 8 days maximum.

To read more on new reporter’s Mike Munro’s PDT treatment, click here.

More on Photodynamic Therapy PDT

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Laser resurfacing with Fractionated laser/ Fraxel is at the forefront of technology due to minimal downtime, minimal side effects and reproducible results. The combination of Fractionated laser with fully ablative laser can target more photodamaged areas. Fractional photorejuvenation resurfacing combines both IPL/ BBL and Fractionated laser for the best possible cosmetic outcome.

The standout advantage of laser treatment for sun damage is the cosmetic benefits of laser- namely an improvement in skin texture, skin tone and wrinkle reduction.

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Glycolic acid peels (AHA peels)

Peels regenerate and resurface the skin at varying depths depending on the agent and concentration used. Superficial peels remove the dead layers of the skin and can help improve uneven pigmentation, whilst medium depth peels target the deeper layers of the epidermis. Deeper peels have the ability to stimulate collagen production, which improves both texture and tone.

Glycolic acid is a superficial chemical peel, and is frequently referred to as the ‘lunch time peel’. Side effects are uncommon, recovery is quick (within an hour or two), and the procedure is affordable ($95 per peel.)  Our peel concentration starts at 20% and typically ends at 70%.  We recommend a series of peels spaced between 2-3 weeks apart.

Higher concentrations of peeling agents have the ability to remove precancerous cells.

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TCA chemical peels

TCA (Trichloroacetic acid) peels are a time tested method of treating sundamage, uneven skin texture, and decreased skin tone.

TCA peels can be an excellent method of treating skin pigmentation and uneven skin texture.  Conditions such as freckles, sun spots, and melasma can be successfully treated by TCA peeling. In higher concentrations of TCA , dermal collagen is stimulated – which accounts for the improvement in tone and wrinkle reduction.

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This treatment is a well recognised and clinically proven method of treating sundamage including precancerous solar keratoses. The active ingredient is a chemotherapy medication known as flurouracil.  Chemotherapy is preferentially absorbed in abnormal cells, and essentially targets the cell’s ability to reproduce.

This treatment is cost effective (prescription cost of $60), however inflammation to the areas treated last 4-6 weeks.  Patients are required to apply this cream twice a day to the specified areas for a period of between 3-5 weeks. Limitations on sunexposure, exercise and social activities apply during this period and one week thereafter.

Though the outcome of Efudix is good, newer treatments such as PDT or laser resurfacing have quicker healing times and a better cosmetic outcome.

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For mild cases of sun damage a customised prescription can give modest results.

• Tretinoin is made from Vitamin A, and can help reduce the fine wrinkles, and treat age spots.
• Tretinoin works by stimulating the production of collagen, and also changes the thickness of the epidermis.
• Tretinoin also can reduce melanin production and hence reduce pigmentation.
• AHA or alpha hydroxy acids can improve skin texture, and in higher concentrations improve skin tone
• Vitamin C acts as a free radical scavenger and an antioxidant and can be compounded in various creams containing vitamin A and AHAs
• Prescription creams are often a fraction of the cost of equivalent over the counter creams, however are more potent
• All prescriptions are best customised according to the patient’s skin type and condition
• Sunscreen selection is important in antiaging regimes. We recommend La Roche Posay sunscreens on a daily basis

Your dermatologist will advise you on the most suitable treatment for your skin, taking into consideration the amount of sundamage visible on examination, the cosmetic outcome desired, the downtime available and the costs.

Summary of treatments available

• If patients are not concerned in regards to cosmetic outcome and can tolerate a downtime of 4 weeks, Efudix is the treatment of choice. Downtime 3-4 weeks. This is the most cost-effective treatment.  Average cost $ 180-210. This includes cream and follow up.
• If patients wish to address other signs of photoaging such as pigmentation, decreased skin tone, wrinkling and understand a downtime of 7-9 days can be expected, the treatment of choice is laser. The average cost is $2,200
• If patients are only concerned in regards to premalignant sunspot treatment, and can only have a downtime of 7 days, PDT is the treatment of choice. This treatment is less invasive than laser, with a quicker recovery time than Efudix.  The average cost is $1600
• If patients exhibit only mild photodamage, a series of glycolic acid /AHA peels can rejuvenate the skin.  Little or no downtime is associated with chemical peeling.  The average cost is $95 per peel, 4-5 advised.
• If sundamage consist mainly of uneven skin pigmentation, then Fractional photo rejuvenation is the treatment of choice. The average cost is $ 1, 650. One to two treatments advised
• We recommend the Radiant Skin Program for patients wanting to reduce sunspots and rejuvenate their skin, this is suited for the busy professional in mind with a minimal down time, but brilliant results. Cost is $1290.

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The costs of treatments vary considerably, and in most situations are NOT covered by Medicare or Health insurance funds. Total procedure costs depend on the extent of sundamage, and the treatment provided.

PDT (photodynamic therapy)is partially covered by some private health insurance companies.

TCA peels and laser resurfacingprocedures are NOT covered under Medicare or Private Health insurance.

After careful examination of your skin, your dermatologist will give you treatment options and discuss costing and down time in detail.

The use of a high factor SPF sunscreen on a daily basis will help reduce the amount of sun damage. We advise a sunscreen of at least factor 30+ on a daily basis. In many cases your dermatologist will also customise a prescription vitamin A cream known as tretinoin to rejuvenate your skin, and help treat and prevent sun damage.

A series of gentle AHA or glycolic acid peels can also treat and prevent mild forms of solar damage.

Dermatologists are Specialist Practitioners recognised by Medicare. In addition to a medical degree, dermatologists at Westside Dermatology undergo an additional 5 years training under a structured training scheme by the Australasian College of Dermatologist. We combine our expertise with the latest in technology to give patients more choices to treat their sundamage, and tailor a treatment plan bases upon their needs.

Discuss with your GP who you should see if you think you may need further treatments for your skin.

As we are a specialist group of doctors, a referral from your GP is advisable. Call us directly on (07) 3871 3437 to make a booking or enquire about the referral process.

Dr Davin Lim and Dr Shobhan Manoharan

The importance of treating solar damage can not be overstressed. Efudix treatment is the time tested treatment, however downtime approaches 4 to 6 weeks. This still remains as the most cost effective treatment. This treatment is ideal for patients who have accumulated sick leave or who are retired. Newer modalities such as PDT and laser resurfacing have significantly reduced downtime with the added advantages of cosmetic benefits, however costs maybe an issue for some patients. Dermatologists will find a solution for each patient depending on their desired outcome, downtime, and cosmetic concerns.

"PDT is an excellent modality for treating superficial skin cancers on cosmetically sensitive areas such as the face and chest" Journal of the American Academy of Dermatology, 2007

"Photodynamic therapy (PDT) is a highly effective, targeted treatment that destroys cancer cells without harming surrounding skin. High intensity red light is used to activate a light sensitive substance that accumulates selectively in cancer cells, sparing normal surrounding tissue." Dr Davin Lim, Dermatologist

"PDT gives me the ability to go back to work within a week. Great results with minimal time off. Well worth the effort." Garry B, Corinda