Dr. Sommerville on Antiaging Skin Care


Q. Is it necessary to wear sunscreen throughout the year, or only during the summer?

Dr. Sommerville: One needs to wear sunscreen all year long. While UVB levels tend to be lower in the winter months, UVA levels are relatively constant throughout a year. While sunburn indicates skin damage from UVB rays, physical damage from UVA rays may not be immediately apparent but eventually results in destruction of collagen and elastin leading to premature aging. Regarding ultraviolet rays that reach the skin, only 5% are UVB and up to 95% are UVA rays.

Q. In recent years, we have seen many reports published regarding the essential role that vitamin D plays in overall health. Do sunscreens prevent vitamin D formation in the skin?

Dr. Sommerville: Recent data suggests that vitamin D deficiency is associated with a wide range of cancers including colorectal, prostate, breast carcinoma, and non-Hodgkin’s lymphoma. Adequate levels of vitamin D may also decrease the risk of serious chronic diseases such as multiple sclerosis, and rheumatoid arthritis.

Sun avoidance has been shown to greatly diminish blood vitamin D levels. Sunscreens in theory should also decrease vitamin D synthesis in the skin, although this has been only seen in laboratory setting in controlled experiments. In real life, sunscreen use has not been shown to negatively correlate with vitamin D levels, perhaps because insufficient amounts are usually applied. At any rate, we do not need more than 15 minutes of unprotected exposure to the sun to develop adequate amount of vitamin D in the skin. It is much safer however to obtain it from food and supplements.

Q. Does indoor tanning stimulate vitamin D production? What are the newest reports regarding the risks associated with indoor tanning?

Dr. Sommerville: Most indoor tanning devices emit mainly ultraviolet A (UVA) and only around 1% of UVB. It is ultraviolet B however that is necessary for vitamin D production in the skin. We know that first exposure to tanning beds before 35 years of age is associated with a 75% increase in the risk of developing the deadly cancer melanoma. Similar to melanoma, higher risk of basal cell carcinomas and squamous cell carcinomas are seen in those who began using tanning devices before the age of 20. Skin cancer is the most common of all cancers in the United States with 1 in 5 Americans developing skin cancer during their lifetime. Incidence of both melanoma and non-melanoma skin cancer has continued to rise over the past decades especially in young women. Finally, in 2009 the World Health Organization and International Agency for Research on Cancer (IARC) classified tanning bed exposure as “carcinogenic to humans.” IARC placed tanning beds in the highest risk category along with asbestos, cigarettes, and arsenic. This classification could not come soon enough. In 1988, as few as 1% of American adults reported using indoor tanning facilities, and by 2007 the percent reporting use had increased to 27%. The highest utilization of tanning facilities is in those aged 18-29 years. Howard County, Maryland passed a law prohibiting use of tanning beds by minors.

Q. To what extent can sun damage be reversed with skincare alone without resorting to such cosmetic procedures as lasers or chemical peels?

Dr. Sommerville: Using a powerful combination of prescription strength retinoids such as Retin A together with keratolytic agents like alpha-hydroxy and beta-hydroxy acids, bleaching agent hydroquinone, and effective sun protection, can indeed produce amazing effects over time. Such results can only be accomplished using a combination of prescription strength products and under supervision of a medical professional who can guide the patient through the initial phase of irritation and inflammation. For patients desiring faster results, in-office procedures can be added including chemical peels, microdermabrasions, and fractional laser resurfacing.

Q. If you could choose only one anti-aging skincare product, what would it be?

Dr. Sommerville: A well designed skin care regimen should include a combination of the following; a retinoid, a bleaching agent (if needed), an antioxidant, and a sunblock. If I could only choose one anti-aging product, it would have to be a retinoid. The search for topical agents that have a fountain of youth effect continues, but none thus far have proven better than topical retinoids. No other products have shown undisputed benefits in double-blinded, randomized, vehicle-controlled studies.

Q. What are retinoids and how do they affect the skin?

Dr. Sommerville: Retinoids can be broadly described as derivatives of vitamin A. In addition to antioxidant activity, they increase collagen and hyaluronate production. Retinoids also mediate cell differentiation and decrease degradation of matrix surrounding the cells. This results in decreased fine lines, fading of sun spots, and decreased skin roughness. Tretinoin (Retin A) was the first topical retinoid approved by the FDA in 1971 for the treatment of acne. Soon thereafter, it began to be used off-label for managing the signs of photoaging. In 2003, a tretinoin cream (Renova) was FDA-approved for the treatment of sun-damaged skin. Topical retinoids include tretinoin (Retin A, Renova, Refissa), tazarotene, and adapalene which are available by prescription only. What limits their use is the initial flaking and skin sensitivity that tends to resolve after 6 to 8 weeks. This effect can be mitigated with proper moisturizing and initially applying it every third night or every other night instead of every night.

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