The sun’s rays can take a toll on your skin, and in the short-term, that can mean contending with a scorching sunburn.

But there can also be long-term consequences lurking within the skin, even if you don’t experience a burn. When the sun prematurely ages the skin, this is called photoaging, and this can lead to skin cancer.

Dermatologists refer to the damage the sun does to skin by several names, including photoaging, photodamage, solar damage, or sun damage. It happens when ultraviolet (UV) light hits skin unprotected by sunscreen, causing DNA changes at a cellular level. Because photodamage happens in the deepest layers of the skin—the dermis—it can take years before the damage surfaces and becomes visible.

“I see many patients who have a lot sun damage,” says Kathleen Suozzi, MD, director of Aesthetic Dermatology at Yale Medicine Dermatology. “They feel like their skin aged them, that they appear older than some of their peers, and they’re regretful of not being better with sun protection in their youth.”

At Yale Medicine Dermatology, our dermatologists and dermatologic surgeons can help address the aesthetic concerns you may have if your skin is showing signs of photoaging. These signs can include brown spots, wrinkles, broken capillaries, and uneven skin texture. Our dermatologists are also experts in using the latest minimally invasive techniques to remove skin cancer while minimizing scarring and can address sun-induced precancers that, if left untreated, are at risk for developing into skin cancer.

Unlike normal, chronological aging, which is dictated by age and genetics, photoaging happens when ultraviolet light from the sun and/or tanning beds permanently damages the skin’s structure. To see the difference between chronological aging and photoaging, compare skin on an area of your body that is not exposed to the sun with the skin on your face.  

Signs of photodamage begin in the teens to early twenties. Symptoms include the following:

• Wrinkling
• Pigmentation changes such as age spots, liver spots (solar lentigines) and freckles
• Loss of skin tone (decreased elasticity) 
• Rough, uneven skin texture
• Broken capillaries (spider veins), usually around the nose and chest
• Redness and blotchiness

Ultraviolet radiation causes DNA changes in the skin that can lead to premature aging and skin cancer. There are three kinds of UV light:

• UVA light. This form of solar radiation damages skin at all levels—from the surface layer (epidermis) down deep into the dermis. Within those layers, several parts of the skin are affected, including collagen and elastin fibers, which give the skin its youthful tautness and elasticity, as well as epidermal cells and tiny blood vessels called capillaries. 

• UVB light. This type of solar radiation irradiates the outer layer of the skin. UVB damages DNA (more potently than UVA) in the epidermis and can cause photoaging, as well as precancerous cells (actinic keratoses) to form.

• UVC light. This type of solar radiation is absorbed by the ozone layer and atmosphere, and as a result, it is not much of a health risk.

Everyone is susceptible to photoaging, but how much photodamage you sustain depends on how much unprotected sun exposure you’ve had over time, in addition to your skin type and geographical factors, including your latitude and the climate. In general, lighter skin is more susceptible to photoaging and skin cancer. Darker skin can also be photodamaged and develop skin cancer, but the more likely outcome is that the skin will develop uneven dark patches (melasma). Dermatologists use the Fitzpatrick’s Scale to determine skin’s phototype (or skin color) and assess photodamage risk:

• Type 1—Pale skin, light-colored eyes, blond or red hair. Always burns, does not tan.

• Type II—Fair skin with light-colored eyes. Burns easily but may tan.

• Type III—Medium light skin that initially burns and then tans.

• Type IV—Light brown skin that tans with minimal burning.

• Type V—Medium brown skin that rarely burns.

• Type VI—Dark brown or black skin that tans easily and never burns.

While photodamage cannot be removed completely, the following treatments can often help minimize it:

• Lasers. There are numerous laser modalities that can address the signs and symptoms of photoaging. Fractional resurfacing lasers use laser energy to rejuvenate skin and minimize the appearance of brown spots and fine lines, as well as improve texture and the appearance of enlarged pores. Other lasers, such as picosecond and nanosecond lasers, can address pigmentation concerns.

• Chemical peels. By applying a chemical substance such as trichloracetic acid or glycolic acid to the skin, dermatologists can remove brown spots and actinic keratoses and improve the tone and texture of photoaged skin.

• Photodynamic therapy. This treatment helps remove precancerous spots that can result from sun exposure. The doctor applies a topical medication on the skin and then uses a blue or red fluorescent light to activate the medication, which destroys precancerous cells but preserves normal cells.

• Topical medications. Certain medications such as a topical retinoid medication (like tretinoin) can be prescribed to even out your skin tone and address roughness and fine lines that result from photoaging.

• Cryotherapy. Liquid nitrogen is sometimes used to freeze noncancerous age spots or actinic keratoses, and after a few days, the spots become dark and shed off.

It’s never too late to practice good sun protection to prevent future photodamage. Dermatologists recommend using a broad-spectrum sunscreen, which will shield skin from both UVA and UVB rays.

Look for a sun protection factor (SPF) of 50 or higher. Water-resistant formulas are encouraged. Reapply every two hours or sooner if swimming or exercising.

If you sustained a lot of sun damage, including blistering sunburns in childhood, see a dermatologist who can evaluate the extent of your photodamage and look for signs of skin cancer early, when it’s most treatable. 

If you’re self-conscious about the appearance of your skin due to photoaging, a dermatologist can examine your skin and recommend a treatment plan. He or she can also provide advice on sun protection so that you can avoid more sun damage.

“Also, make an appointment if you see a new or changing 'mole' or spot that is brown, black, red, or white, which could be a sign of skin cancer,” advises Dr. Suozzi. Another sign of skin cancer is if a spot on your skin is bleeding spontaneously or is painful. “A lot of patients will say, ‘This started as a cut that I nicked while I was shaving and just kept bleeding on me.’ That's something you want to get checked out."

Yale Medicine Dermatology offers a comprehensive approach to treating both the medical and cosmetic aspects of your skin. “We will tailor treatments that are best for each patient and their specific concerns,” says Dr. Suozzi. “We have a team of dermatologists that specialize in skin cancer detection and treatment, prevention and management of precancerous damage, and cosmetic concerns related to sun damaged skin.”

Our dermatologists have vast experience in the treatment and management of skin cancer. We have expertise in Mohs Surgery for removal of skin cancers and use a wide range of the latest lasers and light-based devices to address a variety skin concerns, including premature aging.