Amy Chircop from the Malta Medical Students’ Association delves into the adverse cosmetic and health consequences of too much sun exposure.

With summer around the corner, it seems inevitable not to daydream about long, relaxing days at the beach, soaking up the sun in order to get that perfect tan. However, there are gross repercussions associated with long hours of sun exposure, and few people seem to be aware of these despite all the promotions.

To begin with, excessive sun exposure is the cause of the majority of skin changes which most of us attribute to the normal process of ageing. The ultraviolet light rays damage the fibres in the skin called elastin, causing the skin to stretch, sag and lose the ability to go back into place after stretching: a condition known as solar elastosis.

What’s more is that there are multiple pigmentary changes which take place as a protective mechanism against sun damage. Our skin contains special cells called melanocytes which produce melanin, giving our skin its characteristic colour. The major role of this pigment is to protect the deeper layers of the skin from sun damage; hence there is increased production of melanin in response to ultraviolet radiation.

In some cases, this increased production of melanin is uneven, resulting in patchy areas of pigmentation which can be very distressing, especially from a cosmetic point of view. In addition, the sun also causes permanent stretching of blood vessels, giving the skin a mottled, reddish appearance.

The most immediate reaction to solar exposure, one which most of us have definitely experienced at one point or another, is what we refer to as ‘sunburn’. Yet what few people realise is that a sunburn is actually a first-degree burn. In some cases, it may be so severe that it leads to skin blistering and might be a very painful experience indeed.

Not all solar damage is evident immediately

However, not all solar damage is evident immediately and some lesions develop as one ages, especially if one is excessively exposed to the sun in the long term.

Solar lentigenes, commonly known as age spots, are areas of increased pigmentation whose colour may range from black, brown to grey. They are most commonly found on the back of the hands, face, arms, upper back and scalp in case of baldness – the areas mostly exposed to the sun. Although they may be found in any age group, they are mostly prevalent in the over 40s due to the decreased ability of the skin to regenerate at this age, and may be found in quite a large number.

Being benign, they pose no risks. They may however be considered unsightly and some people may opt to have them removed. This can be done either by laser treatment or by cryotherapy, which is the use of very cold liquid nitrogen, with varied results.

Another condition associated with sun damage, which may pose a cosmetic nuisance rather than a health risk, is medically known as poikiloderma.

It is characterised by redness, pigmentation changes and skin atrophy mostly found on the chest and neck. Albeit difficult, the treatment of poikiloderma involves intense pulsed light therapy, commonly known as IPL.

Unfortunately, some lesions are not only a cosmetic nuisance but may actually pose a risk of malignancy. One such lesion is known as solar keratosis, which is a scaly lesion which ranges from flesh-coloured to pink to brown. These are mostly found on ears, face, arms and hands, especially in fair-skinned people.

Identifying malignant lesions

If left untreated, they may progress to a type of skin cancer known as squamous cell carcinoma.

Lentigo maligna is another type of lesion with malignant potential. This has a similar distribution to solar keratosis and is characterised by a dark spot which darkens and enlarges with sun exposure.

This brings us to the most feared subject by many: melanoma. Contrary to what many believe, melanoma need not always present itself as a pigmented lesion, even though most lesions are indeed pigmented. To remember the red flags which should prompt you to seek medical advice, just follow the ‘ABCD’ of melanoma:

Asymmetry: if a line had to be drawn through the lesions, the spots would not look the same on both sides.

Border: melanomas usually have a jagged or blurred edge.

Colour: a mole with more than one colour or shade should immediately raise suspicion and be checked immediately.

Diameter: a diameter of more than about 6mm should be checked even in the absence of the above features.

Who can develop complications?

Each person is on thin ice in the face of ultraviolent rays; having said that, it is also true that some people may be more susceptible than others. People who tend to burn easily, such as fair-skinned people, are at higher risk of developing sun-related tumours of the skin.

The amount of exposure plays an important role, hence the longer the hours of sun exposure, the greater the risk. Excessive sun exposure in childhood, with frequent episodes of sunburn, augments the risk greatly.

The one thing that must not be forgotten is that once the damage is done, there is no way back as in the majority of cases, it is not reversible.

What we can do

Finally, some good news. There is much we can do to prevent solar damage, especially with regards to pigmentation and the development of skin tumours.

A high SPF sunblock is truly a must-have in your beach bag. Try to choose a water-resistant sunblock of at least SPF30 and a broad spectrum of protection against both UVA and UVB. UVA rays are mostly responsible for skin pigmentation, photo-ageing and skin cancer, while UVB rays are the main contributors to sunburn and pose the greatest risk to the development of skin malignancy.

All this further accentuates the importance of choosing a sun cream which would protect us against both types of ultraviolet radiation for maximal protection. Much of its benefits would be lost if it spread too thinly so don’t stint on the sun cream, and remember to re-apply it after you get out of water or if you sweat too much. Never forget to include lips, tops of ears, tips of nose and bald scalps.

Sunglasses, hats and covering as much of exposed skin with clothes as possible are also vital preventative measures.

If possible, limit your time outdoors when the sun is at its peak, that is, from around 10am to 3pm. It is of utmost importance that one seeks medical attention should he observe an unusual lesion.

On another positive note, the majority of lesions are curable if dealt with early.

Melanoma need not always present itself as a pigmented lesion, even though most lesions are indeed pigmented

If someone is already suffering from pigmentary lesions related to sun exposure, and has already excluded serious pathologies, there are some measures which may improve skin pigmentation. These include:

• Intense pulsed light therapy.

• Lotions containing tyrosinase inhibitors which break the cycle of production of the melanin pigment.

• Creams containing vitamin A/retinol or vitamin C.

One must keep in mind that removing skin pigmentation completely is quite a difficult task and these measures may only improve skin pigmentation slightly.

A glorious sunny day may give you a spring in your step, and we actually need sunshine in our lives.

It is a must to enjoy it as much as possible, as after all, it is a vital part of our well-being, but one must keep in mind to do so in the right doses and to protect ourselves and our loved ones.

Consultant dermatologist Michael Boffa reviewed this article.