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Sun damage

Sun damage is a result of DNA damage to skin cells. DNA, the brain of the cell, absorbs Ultraviolet B light and this damages the genetic code. Damaged genes are incapable of maintaining normal cell function. The visible result is sun damage.

The four categories of sun damage are colour change, texture change, loss of tightness and skin cancer.

Sun damage on chest
Sun damage on chest

Colour changes are either red, brown or white.

Brown blotches are caused by an irregular increase in a pigment called Melanin. Melanin is normally spread evenly through the epidermis. DNA damage to melanocytes, the cells that produce melanin, causes irregular production of the melanin pigment.

A decrease in melanin production leads to lighter or even white spots. An increase in melanin production results in brown, dark brown or even black spots.

Red blotches are a result of more prominent blood vessels. Blood vessels can increase in number and in size due to sun damage. An increase in the number of blood vessels is a result of inflammation. When you get a sun burn and the skin goes red and sore, it is due to inflammation. Inflammation is the bodies attempt to heal itself and in the process new blood vessels form by a process called neovascularisation.

Damage to the connective tissue, collagen fibres, elastic fibres and fibroblasts around blood vessels weakens the support structure of blood vessels and causes blood vessel to dilate and increase in size.

The second category of sun damage, a rougher skin texture, is the result of sun damage to the connective tissue in the dermis, sun induced enlargement in oil glands, enlargement of pores and dehydration of the skin.

Loss of tightness of the skin is also due to ultraviolet light (especially ultraviolet A) damage to elastic and collagen fibres and DNA damage to fibroblast cells that make collagen and elastic fibres. Eventually this leads to skin sagging.

The fourth category of sun damage is skin cancer. Sun induced skin cancer is a result of progressive and cumulative damage to the DNA of the epidermal cells. There are two main cell types in the epidermis. Damage to the DNA of melanocytes, the pigment forming cells, leads to Melanoma. Melanoma is a highly aggressive form of cancer, with a tendency to spread (metastasize) throughout the body early.

Damage to the DNA of keratinocytes, the cells that make up the bulk of the epidermis, causes the most common skin cancer in humans, Solar Keratosis. Eventually more aggressive skin cancers like Squamous cell carcinoma and Basal cell carcinoma develops.

Sun Spots

Age spots is a very non-specific term. It is similar to the terms liver spot or old mans wart. Liver spots have nothing to do with your liver and most so-called age spots is not directly related to intrinsic ageing, but rather to sun exposure. Human skin ages in 2 ways. Intrinsic ageing and sun-induced ageing.

The cause of so-called age spots include Solar Lentigos (an increase in melanin), Seborrheic Keratosis (an increase in melanin plus a thickening of the epidermis), flat moles (an increase in the number of cells making melanin), pigmented skin cancers and even Melanoma, among many others.

Solar Lentigos on the chest
Solar Lentigos on the chest

It is very important to see a dermatologist when you see any new age spots!

Most age spots will be due to Solar Lentigos. As mentioned above, Solar Lentigos develop due to a localised increase in melanin formation due to ultraviolet B damage to melanocytes. Melanocytes are the cells that make melanin.

Solar Lentigos most often form on the top of the hands, the face and the V of the neck; in other words. all the areas exposed to the sun.

The are 3 ways to improve Solar Lentigos:

1. Use a good sunblock

2. Pigment lightening creams, e.g. a retinoid containing cream applied every night

3. Laser that target melanin I prefer to combine all three treatments.

For the first month the patient will use a sunblock plus a pigment lightening cream like Hydroquinone. After one month I start with the laser sessions. One to three laser sessions is normally required.

Solar Lentigos respond well to the above combination treatment and a 50-70% improvement can be expected. The treatment does not prevent new Solar Lentigos from forming, so ongoing maintenance treatment is very important. The maintenance treatment combines the regular application of a high factor sunblock with nightly application of a retinoid cream.

What is Perioral dermatitis?

Perioral dermatitis is a type of dermatitis that occurs only around the mouth, nose and eyes. It does not have to be present in all of the areas at the same time.

Some dermatologists believe that Perioral dermatitis does really exist and that patients that fit the clinical picture of Perioral dermatitis has Rosacea. Rosacea and Perioral dermatitis can sometimes be present in the same patient. Because it is always more likely that a patient has 1 condition rather than two, the finding of both Rosacea and Perioral dermatitis in the same patient support to the thesis that the 2 conditions are in fact the same. Furthermore, when looking at a sample of skin under the microscope, both Rosacea and Perioral dermatitis displays the same type of inflammation, knows as a granulomatous peri-folliculitis. The word granulomatous refers to a collection of macrophages (a type of white blood cell). Peri-folliculitis means that the “collection of macrophages” is lying in close proximity to a hair follicle.

Whether or not Rosacea and Perioral dermatitis are the same disease or two separate diseases is an academic question and not very important from a treatment perspective. The fact is that the clinical picture known as Perioral dermatitis is quite classic and most often easily recognizable and treatable.

Classically young female patients are affected. The rash consists of small red bumps (knows as papules) and occasionally small pimples (knows a pustules) occurring around the mouth, nose and eyes. Interestingly, a small margin of skin around the edge of the lips are always unaffected. As mentioned before not all 3 of these areas has to be affected at the same time.

More than 80% of patients with Perioral dermatitis have been applying corticosteroid-containing creams to the face, before the rash started to appear. In the remaining cases the cause is unclear, but the excessive use of facial products seem to be another common factor.

The treatment of this condition involves the elimination of all (if possible) facial products. If topical corticosteroid-containing creams have been used they should be tapered off slowly and not stopped suddenly, because this will lead to a flare-up of the condition.

The treatment of Perioral dermatitis involves the use of oral tetracycline antibiotics for a few months. Sometimes this is combined with antibiotic creams, but in general it is better to avoid as many creams as possible. Most often this approach results in complete clearance of the skin condition in a few weeks.

How to remove post acne brown spots

There are two types of post acne marks: Acne scars and Brown Spots. Scars are a result of damage to the dermis. Brown Spots are a result of excess pigmentation. The rest of the article will focus on the treatment of the post acne brown spots, which is far more common than post acne scars.

Sometimes, after acne clears up, it leaves small, flat dark marks in place of where the pimples was. These marks are due to excess pigmentation that is a result of the inflammation induced by the acne. Pressing or squeezing pimples can also contribute  inflammation which will worsen the post acne brown spots. People with darker skin types are particularly vulnerable to post acne brown spots.

There are 2 main treatment options for post acne brown spots:
1. Wear a sunblock on a daily basis. This will prevent the sun from further tanning and darkening the dark spots.
2. Apply a skin lightening cream to the brown spots once or twice a day. Effective skin lightening creams are prescription medication and include products like Hydroquinone and Retinoids.

Lightening the post acne brown spots can take weeks to months.


Melasma is a light to dark brown pigmentation that can appear on the forehead, cheeks, upper lip and chin of mostly woman. Melasma is caused by an increase in melanin production. It most often occurs in women over 25.

Three broad factors influence the development of Melasma:

1. Genetic susceptibility
2. Hormonal factors, like taking the Oral Contraceptive Pill and pregnancy
3. Sun exposure

Severe melasma of cheeks and forehead

There are quite a few treatment options for Melasma, but whatever treatment option is chosen the regular application of a sunblock combined with minimizing sun exposure is essential. If possible also stop the Oral Contraceptive Pill.

One good way to treat Melasma is the application of a specially mixed Hydroquinone containing cream plus good sunblock for at least one month. This is followed, if required, by treatment with an IPL or laser. The specially mixed Hydroquinone cream, if it is working well enough, can be continued for as long a the Melasma improves. The IPL or laser treatments can also be repeated.

Melasma is prone to recurrence so maintenance treatment is important. Once an acceptable level of improvement is achieved the patient must continue with sunblock during the day and a milder melanin suppressing cream, like Differin or Skinoren cream, at night.