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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.