NY Times: Time to Take Stock After a Summer in the Sun
By Nick Burns
THE last long summer weekend has passed and fall is just a few cooling weeks away. But long after the sweet summer days are behind us, the effects can linger in the layers of the skin.
Too much ultraviolet exposure, too much heat, too little moisture — all can leave their marks. Regular moisturizing and exfoliation can make skin look and feel supple and healthier, but the sun’s more damaging effects often require more attention.
This might be the time to ask a dermatologist for an end-of-season assessment of summer damage.
“It’s a good time for a full body check for moles, for skin cancer,” said Dr. Amy Wechsler, a dermatologist in New York City. “Also, if you need a biopsy, it’s not so bad to do it after the summer when you’re not baring your skin so much.”
The first priority will be to check for cancer, which often can be evident on the surface of the skin.
To look deeper, some dermatologists use special UV lights, cameras and magnifying lenses to measure sun spots and photodamage, wrinkles and more — the cosmetic effects of the sun you may want to address.
Not all doctors buy into the technology.
“A dermatologist can absolutely see sun damage with a naked eye,” Dr. Wechsler said. “UV photos aren’t necessary.” She said they are often used as a scare tactic, “something to show the patient so they can see what’s happening under the surface.”
It can seem gimmicky, she said.
To treat brown mole-like spots or patches, dermatologists might prescribe bleaching products containing hydroquinone, which doesn’t actually bleach the skin but inhibits the production of melanin, and reveals lighter skin in four to six weeks.
Products containing 2 percent hydroquinone are available over the counter. But the Food and Drug Administration is concerned about the safety of the bleaching ingredient and last week proposed banning nonprescription sales after research suggested a link to cancer in laboratory rats. The ingredient also has been linked to reported cases of exogenous ochronosis, a permanent darkening of the skin.
The actual risk of cancer or skin darkening is unknown, and it’s unclear if using less concentrated formulations reduce the likelihood of problems, so dermatologists don’t recommend over-the-counter, unsupervised use. Under the proposed ban, hydroquinone will be available only by prescription.
But some doctors said limited and supervised use can be effective in treating pigmentation from sun damage and recommend a prescription of Tri-Luma, which combines 4 percent hydroquinone, Retin-A and a steroid into one cream. A two-month supply costs $100 to $150.
“Hydroquinone is very effective when used correctly but it can be tricky,” said Dr. Debra Jaliman, assistant clinical professor of dermatology at Mount Sinai School of Medicine and a spokeswoman for the American Academy of Dermatology, who said she has been prescribing lightening creams for 20 years without complications.
“It can be irritating for some people,” she said. “You don’t want to use it for a long period of time, and you must wear a broad-spectrum sunscreen to get results. In my care, I watch patients closely and tell them when to stop.”
Some dermatologists will also recommend more aggressive treatments, which are also potentially more risky. In-office peels may reduce pigmentation as well as treat rough areas and thickened skin, both of which can be caused by sun damage. But the cost of the most common peels, glycolic or salicylic acid, are about $100 to $200 a treatment, and they can cause mild peeling or redness for a couple of days.
Other peels are more intense — like Jessner’s or TCA peels, which cost $200 to $500 — and cause more severe peeling and require up to a week of recovery.
Many dermatologists will also recommend laser and intense pulse light treatments to address pigmentation, broken capillaries and stubborn redness, and even to treat precancerous skin cells. Though they are considered safer than aggressive chemical peels, they can still damage the skin and, in rare cases, cause scarring.
Those treatments are also more expensive: $200 to $2,000 each, depending on the laser and size of the area to be treated, and some require up to five sessions to achieve full results.
Dr. Thomas Kupper, chairman of dermatology at the Brigham and Women’s Hospital in Boston, as well as at the Dana-Farber Cancer Institute, said he is skeptical of some lasers. “The concern is not that lasers are harmful, but that they won’t live up to their hype and expectation,” he said.
Before embarking on a course of treatment for sun damage, it’s important to discuss the risks and potential side effects with a dermatologist. As for preventing damage in the seasons ahead, it is O.K. to worship the sun, dermatologists say, but it is best done lathered in a broad-spectrum sunscreen from beneath the cool shade of an umbrella or wide-brimmed hat.
