Sun Exposed Skin Changes & Skin Rejuvenation Therapy

Khalique Zahir MD, FACSAssistant Prof of Plastic Surgery VCU School of

MedicineChairman 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 problemsClassify skin disordersCome 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

SunburnAfrica is a good place to get a “sun burn”Over exposure to ultraviolet sun raysMelanin can protect but not when exposed too long to

the sunSymptoms

Minor Redness of skin Burning of affected areas Tightness of skin Itching and peeling of skin

SunburnSevere 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

MelasmaCharacteristics

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

MelasmaTreatment

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-dimethyl-4-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

PhotosensitivitySun AllergyAlso caused by fragrance, plant, fruit, vegetable and

chemical contactMedicines – sulfonamides, TCN, Amiodarones and

ThiazidesCaused by Diseases including lupus, rosacea and

psoriasis, metabolic disorders

PhotosensitivitySymptoms

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

MolesMoles are a common effect of sun exposure and can

appear anywhereOccur most often before age 20Some harmless, some cancerousSymptoms

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 ElastosisWrinkling that occurs when skin’s elastic tissue

deteriorates from sun exposureSymptoms

Wrinkles Loose and sagging skin Deep lines in skin

Treatment Imiquimod or tacrolimus to help improve tightness Laser resurfacing

MelanomaSymptoms

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

MelanomaDiagnosisA - AsymmetryB - Border irregularityC - Color variationD - Diameter > 6 mmE - Evolution

Melanoma Morphologic Types

Superficial 60%-70% Flat during early phase; notching,spreading scalloping, areas of regression

Nodular 15%-30% Darker and thicker than superficial spreading, rapid onset; commonly blue-

black or blue-red (5% amelanotic)

Lentigo ~5% Enlarge slowly; usually large, flat, tan maligna 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

Acral 1.7% Rare, locally aggressive, occur Desmoplastic primarily on head and neck in elderly

Type Frequency Features

Squamous Cell CancerSymptoms

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 CancerUV 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)RadiationArsenicChronic ulcer

Basal Cell Cancer

Superficial Basal Cell Cancer

Superficial Basal Cell

Basal Cell CancerMost 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 skinTime 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

10mJ2500 MTZ/cm2

Bi-weekly intervals

Melasma: Before and After

Home

Before Treatment After Treatment

FRAXEL LASER Melasma: Before and After

CO2 Resurfacing FRAXEL LASER

1 Day Post CO2 Resurfacing

1 Day Post Fraxel Laser Treatment

Immediately post treatment

Baseline

CO2 LASER RESURFACING

FraxelLaser

CO2

Laser

Asian Resurfacing

Resurfacing

Tx for Acne Scarring

SummarySkin 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.