Photoaging of the Skin

Maria Victoria Rosabelle M. Rovira, MD

 OBJECTIVES
• To discuss on Photoaging of the skin among
Asians
• To discuss the preventive measures of
photoaging
• Sunscreens
Effects of the Sun in the Aging Skin
UVB and UVA
 Fitzpatrick Scale of Skin Phototypes

I - Always burns, never tans IV - Minimal burning, tans well

II - Always burns, tans minimally V - Rarely burns, tans darkly
III - Burns moderately, tans gradually VI -Never burns, tans darkly black
PHOTOAGING OF THE ASIAN SKIN
 PHOTOAGING
• Fine and coarse wrinkling
• Rough texture
• Sallow color
• Irregular pigmentation

Elastosis – prominent feature

– Yellow discoloration, sometimes pebbly surface
– Histology: tangled masses of degraded elastic fibers
forming disorganized tropoelastin and fibrillin
 • ALL races are susceptible to photoaging

• Those who fall within Fitzpatrick’s skin phototype

IV to VI are less susceptible, most likely owing to
the photoprotective role of melanin
Pathak MA, Fitzpatrick TB. The role of natural photoprotective agents in human skin.
In: Fitzpatrick TB, Pathak MA, Harber LC, Seiji M, Kukita A, Eds. Sunlight and Man.
Tokyo: University of Tokyo Press, 1974: 725-750.
 Photoaging in Asians,
Hispanics, and Africans
major form of
protection: Melanin

Photoaging in Caucasians
major form of
protection: stratum
corneum thickening

Munavalli GS, Weiss RA, Halder RM: Photoaging and nonablative photorejuvenation in
ethnic skin. Dermatol Surg 31:1250-1260, 2005
Sun protection factor for black
epidermis is 13.4 vs 3.4
for white epidermis

Black epidermis transmitted approximately 6% of

UVB to the epidermis compared to 30%
transmission through white epidermis; 18% of
UVA transmitted vs 55% in white dermis
Kaidbey KH et al: Photoprotection by melanin—A comparison of black and Caucasian
skin. J Am Acad Dermatol 1:249-260, 2009
 Caucasians Asians
More prominent wrinkles Fine wrinkles
Pigmentary alteration:
mottled hyperpigmentation
and uneven skin tones
(e.g., Melasma)
More prominent skin laxity Skin laxity
Textural changes

Rawlings AV. Ethnic skin types: are there differences in skin structure and function?
Int J Cosmet Sci. 2006; 28: 79-93.
 Photoaging in the Asian Skin

Major clinical features

of photoaging in
Asian skin:
• Solar lentigines
• Mottled
pigmentation
• Wrinkling (moderate
to severe)—6th
decade; ample time
in the sun

Chung JH et al: Cutaneous photodamage in Koreans: Influence of sex, sun exposure, smoking, and skin color. Arch Dermatol 137:1043-1051, 2001.
Chung JH. Photoaging in Asians. Photodermatol Photoimmunol Photomed. 2003;19:109-121.
• Individuals from
Singapore, Indonesia,
Malaysia, [or the
Philippines]
– Pigmentary changes
more important than
skin wrinkling

Chung JH. The effects of sunlight on the skin of Asians. In: Giacomoni PU, ed. Sun Protection in Man. Amsterdam, the Netherlands: Elsevier Science BV;
2001:69-90.
 Differences in the clinical manifestations of
photoaging in Asian skin

 melanin
darker phototype
thicker stratum corneum
epidermal proteins (ie, urocanic acid) in Asian skin

Goh SH. The treatment of visible signs of senescence: the Asian experience. Br J Dermatol. 1990;122(suppl 35):105-109.
 Different cultural habits:

Korean, Japanese, and

Chinese subpopulations:

traditionally avoid direct

sunlight

Andrew A. Photoaging in Skin of Color. Cosmetic Dermatology. August 2011; VOL. 24 NO. 8.
MANAGEMENT
 Prevention
• Sun avoidance
• 10am to 4pm
• Sunscreen use
• SPF 15 or higher
• Retinoids to prevent or treat wrinkles
• Avoid cigarette smoke & pollution
• Eat diet high in fruits & vegetables
• Oral anti-oxidant supplements or topical anti-
oxidants

Baumann, L. (2007), Skin ageing and its treatment. J. Pathol., 211: 241–251.

 SUNSCREENS
In 1978, the US FDA reclassified sunscreens from
“cosmetics” to over the counter “drugs”

Sunblock vs Sunscreen
Sunblock-physical agents used to prevent
sunburn (e.g., zinc oxide, titanium dioxide)
Sunscreen-chemical (organic or soluble) agents
- absorb, reflect, or scatter radiation in the
ultraviolet range at wavelengths of 290-
400 nm
Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier Health Sciences: Sept 2014,
 SPF = Sun Protection Factor
- measures UVB protection
- the only internationally standardized measure of a sunscreen’s
ability to filter UV radiation

SPF = MED of sunscreen protected skin (J/cm2)

MED of sunscreen unprotected skin (J/cm2)

*Minimal Erythema Dose – quantity of energy required to

produce the first perceptible redness reaction of the skin with
clearly defined borders

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier Health Sciences: Sept 2014,
 Sunscreen active ingredients: chemical

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier Health Sciences: Sept 2014,
 Sunscreen active ingredients: physical

Active ingredient Maximum concentration

(%)
Titanium dioxide 25

Zinc oxide 25

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier Health Sciences: Sept 2014,
 What is PA++?

• Protection UVA (PA) system

• Introduced by the Japan Cosmetic
Industry Association
• Measures UVA protection based on
the Persistent Pigment Darkening
(PPD) method
Sun Protection Factor (SPF) rating
does not provide explicit information
on the magnitude of the protection
provided specifically in the UVA range
of the spectrum (320 nm to 400 nm)
Japan Cosmetic Industry Association Technical Bulletin. Measurement standards for UVA protection efficacy. Issued November 21, 1995 and effective as from January
1, 1996
Protection Grade PPD
(Persistent Pigment
Darkening)
PA+ 2 to less than 4
PA++ 4 to less than 8
PA+++ 8 to less than 16
PA++++ 16 or above

Newly revised PA system adopted by

the Japan Cosmetic Industry
Association from ISO 24442:2011
(UVA)
starting January 2013
 In 2011, the FDA made several changes
to the labeling of sunscreens:

Broad spectrum sunscreens

with SPF > 15
product helps prevent sunburn
if used as directed with other sun
protection measures: cancer risk,
early skin aging

NOT Broad spectrum or Broad

spectrum but SPF < 15
product helps prevent sunburn
Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier Health Sciences: Sept 2014,
FDA Sheds Light on Sunscreens. Food and Drug Administration. May 17, 2012.
 • Required sunscreen
products that have SPF
values higher than 50 to
be labeled as
“SPF 50+”

• Water resistance claims

– How much time a user can
expect to get the declared
SPF level of protection
– 40 minutes or 80 minutes
FDA Sheds Light on Sunscreens. Food and Drug Administration. May 17, 2012.
http://www.fda.gov/forconsumers/consumerupdates/ucm258416.htm.
Recommendation:
• Reapply sunscreen every 2 hours and after
swimming, towel drying, or sweating
• Diffey: Sunscreen be applied 15-30 minutes
prior to exposure ad reapplication 15-30
minutes after exposure

Diffey, BL.. When should sunscreen be reapplied? J. A. Acad.

Dermatol, 2001. 45, 882-858.
 DOSAGE and USAGE
Current FDA approval: 2 mg/cm2
Actual usage: 25-50%
Effective SPF is < 33% of the labeled SPF

Factors influencing application:

Water activities
Perspiration
Sand abrasion
Rubbing of clothing or towels

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier

Health Sciences: Sept 2014,
 DOSAGE and USAGE
TEASPOON RULE

Can be used to
guide patients on
the appropriate
amount of
sunscreen
required

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier

Health Sciences: Sept 2014,
 Revised teaspoon rule for
sunscreen application

Draellos Z. Cosmeceuticals: Procedures in Cosmetic Dermatology Series, 3 rd edition. Elsevier

Health Sciences: Sept 2014,
 SUMMARY
• Ultraviolet radiation causes photoaging
skin aging
• Asians have more pigmentary changes;
Caucasians have more wrinkles and skin laxity
• Sunscreen is important for prevention from
photoaging and carcinoma
• SPF and PA measure protection against UVB
and UVA; dosage and usage are also important