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Skin care: repair of sun damage SKIN CARE: REPAIR OF SUN DAMAGE
Sun damage, as has been mentioned, is cumulative over the years. In this aspect it is like alcohol and cirrhosis of the liver, or smoking and lung cancer. For many years nothing appears to be happening, and then after a certain latent period, which depends on your skin type and the amount of exposure received, the damage appears.
Certain degenerative changes of the pre-cancerous type can be treated. These changes include patchy pigmentation ('liver spots'), early wrinkling, and dry, scaly patches or keratoses.
Cryosurgery, or freezing, with either carbon dioxide snow or liquid nitrogen, is one of the commonest methods used. This selective destruction of damaged skin is induced by the extremely cold temperatures of these substances. Following their careful application, either to selected lesions or to a larger damaged skin area, blistering is induced. Once the blisters heal, smooth normal-looking skin remains.
Electrodessication has a similar effect to cryosurgery but is induced by the heat of an electric cautery. This is usually carried out under local anaesthetic, and has the advantage of being very accurate, therefore useful for small lesions. It can also be used with curettage, enabling deeper lesions to be removed.
Chemosurgcry, using chemicals such as 5 Fluorouracil, has become more common in recent times. This chemical is applied to both normal and abnormal skin for a period of about three weeks. It is able to inflame and subsequently destroy certain superficial malignant lesions and the latent pre-malignant ones. It is also able to uncover and destroy lesions that are clinically undetectable. The major disadvantage of this method is the severe skin inflammation it induces.
Peeling techniques, using either trichloracetic acid or phenol, are another form of treatment. This procedure destroys living tissue, and may be used on small lesions or larger skin areas. Recently it has been advocated for the treatment of more extensive sun damage, including wrinkling, particularly about the mouth, where it is often used in conjunction with a facelift. Great skill is required to perform this procedure satisfactorily.
Finally, dermabrasion may be used. Here the skin is snap-frozen to anaesthetize it, and a rapidly rotating brush is stroked across the skin to remove the damaged upper layers. Swelling and extensive crusting develops in 48 hours, and disappears gradually over the next ten days, leaving the underlying skin thinner, smoother, and pinker than before. It resumes a normal, undamaged appearance anywhere between six weeks and six months later.
All these procedures destroy the damaged epidermis and upper dermis, allowing regeneration of undamaged skin from below to occur.
If It were no longer fashionable to be tanned and people realized that tanning was by no means a harmless procedure, then dermatologists would lose at least a quarter of their patients and beauty salons more than half their clients.
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