- Best ResultsLong-term
- Treatment RecoveryNA
- Procedure Time1 minute daily
- Skin SpecialistDermatologist
- Duration of ResultsLifetime
- Back to WorkNA
Solar Keratosis Prevention
The use of sunscreen, topical retinoids, & antioxidants including ascorbic, ferulic acid & tocopherol can potentially reduce the formation of new sunspots. In many cases, some sunspots will involute without active treatment. Niacinamide or Vitamin B3 should be supplemented by all patients who are susceptible to skin cancers & actinic keratosis.
FactsFacts on Preventing Solar Keratosis
- Up to 35% of sunspots can be treated with simple measures
- Oral supplementation of vitamin B3 can cause involution of one third of solar keratosis
- Sunscreen can spontaneously improve one quarter of solar keratosis
- SPF & niacinamide can markedly reduce the rate of some forms of skin cancers
- Vitamin A including retinoic acid, retinol, retinaldehyde & trifarotene can reduce sun damage
- Antioxidants including ascorbic, ferulic acids, vitamin E, green tea & botanicals reduce UV & environmental damage to cells
- Solar keratosis prevention is not complex, nor costly
- Read more to understand
What is the role of skin care?
It is never too late to look after your skin. Think of skin care as the equivalent of toothpaste for enamel health, it is about prevention. The use of scientifically proven skin care actives such as retinoids, ascorbic acid, glycolic acids, salicylic acids, ferulic acid & niacinamide, tocopherol & adequate sunscreen can reduce more than 25% of solar keratosis.
How important is sunscreen?
Very important. Sunscreen reduces the rate of skin cancers & plays an important role in preventing solar keratosis. Adequate & frequent use of a broad-spectrum SPF can involute one quarter of sun spots. It is a fact.
What is the correct sunscreen application technique?
The simple explanation, two finger lengths of sunscreen twice a day, regardless of sun exposure. This covers the head & neck.
The scientific explanation, SPF, is determined by 2 mg per cm2, or about 5 grams per application. Ideally sunscreen should be applied 15 minutes before exposure. Remember your ears, neck & chest.
What is the best sunscreen for skin cancer & sunspot prevention?
A broad-spectrum SPF is best. The Cancer Council provides good formulations at a reasonable price. Sunscreens are divided into chemical, physical and hybrid sunscreens. Most offer UVB & long wave UVA protection. My favourites are-
Daily: Cancer Council, Invisible Zinc, Melan 130, LRP Anthelios
Sport: Neutrogena, Ego Sport & Waterproof sunscreens.
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What are antioxidants?
Antioxidants are the second layer of defence (after sunscreens). These compounds prevent damage to your DNA caused by reactive oxygen species, generated by UVR & environmental pollutants. Antioxidants with the most amount of science include-
- Ascorbic acid or vitamin C, usually in concentrations of 10-20%.
- Ferulic acid
- Tocopherol or vitamin E
- Argan oil, green tea & botanical extracts
How to use antioxidants?
Antioxidants should be used in the morning, underneath your sunscreen. Ideally, they should be used on the face, neck, chest & decolletage areas. Some formulations such as CE Ferulic Acid have been shown to be stable for up to 72 hours, meaning an evening application can see you through the next day.
Can chemical exfoliation reduce sunspots?
Yup. There are many ways to employ skin care acids & retinoids. These chemical exfoliants are usually scripted and differ markedly from fluffy stuff online or in Mecca/Sephora. Your dermatologist will have their own recipe. Some formulations include-
- Lactic acid 10-20%
- Salicylic acid 5-10% +/- PG & olive oil
- Glycolic acid 5-8% with retinoic acid 0.25 to 0.5%
- Retinoic acid 1-7%
Disclaimer: I am a procedural dermatologist, I do not prescribe, unless it pertains to a procedure, or you are an existing patient. For chemical exfoliating prescriptions please see your skin care expert.
Can retinoids help?
Retinoids have the most amount of evidence to reduce solar keratosis & some forms of skin cancer, including IEC-Bowen disease. Oral retinoids are the most effective. Acitretin or oral isotretinoin (shorter half-life) is the drug of choice. Be guided by your dermatologist.
Disclaimer: I am a procedural dermatologist; I only prescribe retinoids to my pre-existing patients. If you would like to discuss retinoid therapy, please book an appointment with my colleagues @cutis_dermatology.
What are topical retinoids for sun damage?
Vitamin A derivatives are one of the most useful compounds to reduce & prevent solar keratosis. Medically prescribed retinoids are the most powerful. If you have a history of epic sun damage, topical retinoids such as tretinoin, trifarotene & tazarotene may be considered. For mild sun damage, retinol, retinaldehyde & hydroxy pinacolone retinoate are better options as they cause less skin irritation.
Disclaimer: I am a procedural dermatologist; I only prescribe retinoids to my pre-existing patients. If you would like to discuss retinoid therapy, please book an appointment with my colleagues @cutis.
How to start retinoids?
Be guided by your dermatologist. The most important concept to grasp is that prescribed retinoids will cause skin irritation. This means sooner or later you will get redness, flaky skin, itch, burning, sensitive & dryness. It depends on your skin’s irritant threshold, the concentration of retinoid & absorption. Find your limits, then back off.
Start with 2-3 evening applications per week. Moisturise 30 minutes before or after application. Modulate your dosing based upon side effects. I have done many posts on how to start retinoids on this website & on @101.skin Instagram.
What is short contact tretinoin?
Mastering the use of powerful topical retinoids can be tricky. In the early stages of using tretinoin, your skin will be dry, red & irritated. Short contact retinoid therapy is an option (see below). I prefer alternate night therapy, however if you have super sensitive skin, short contact is an option. See below.
Week 1: Apply, leave on for 15 minutes then wash off
Week 2: Apply, leave on for 30 minutes then wash off
Week 3: Apply, leave on for 45 minutes then wash off
Week 4: Apply, leave on for 1 hour then wash off
Week 5: Apply, leave on for 1 ½ hours then wash off
Week 6: Apply, leave on for 2 hours then wash off
You can work up to overnight use, skip a night (or three) if you have any irritation.
What is the role of vitamin B3 for sunspots?
Niacinamide or Vitamin B3 is an effective treatment for managing actinic or solar keratosis. It can reduce the burden of new sunspots & reduce pre-existing ones by up to 35%. The ideal dose is 500 mg B3 twice a day. Oral vitamin B is more effective than topical niacinamide.
*Nicotinamide at 500 mg daily can improve sunspots by up to 25%.
What is acitretin or Neotigison?
Neotigison is a vitamin A derivative employed by dermatologists to treat severe solar keratosis. It decreases the rate of some skin cancers including Bowen disease, Squamous Cell Cancers & in some cases Basal Cell Cancers. The usual dose varies between 10 to 50 mg daily. Side effects include dryness, & elevated cholesterol levels.
Can diet help?
Oral vitamin B3, including supplements, have the highest level of evidence. There are theoretical benefits of food rich in antioxidants such as vitamin C, tocopherol (E), fish oil, omega fatty acids, green tea, ginseng, & resveratrol (red wine).
How much does it cost to look after your skin?
Not much. For less than two cups of coffee at Maccas, you can start on a basic, scientifically proven skin care regimen. The foundation of skincare is a good sunscreen. This will cost a dollar a day. Thereafter invest in an antioxidant combination & retinol. Go to The Formulated to understand.
What is a simple skin care routine to reduce sun damage?
A scientifically proven no bullsh*t routine that can reduce sun damage or extent the benefits of procedures such as laser resurfacing goes something like this-
AM: Vitamin C, Tocopherol, Ferulic Acid, then SPF 50+ Sunscreen. Nicotinamide 500 mg orally.
PM: Sunscreen reapplication before 1400. Evening retinoid of choice (retinol, tretinoin, trifarotene). Option for niacinamide topically. Nicotinamide 500mg orally.
Chemical exfoliation once a week with lactic, glycolic or salicylic acid combination.
Davin’s Viewpoint on Preventing Sunspots
Sunspots or solar keratosis are super common in Australia. Nearly half of the population will have multiple sunspots by the age of 50, many will have over a dozen. As the name suggests, UV exposure is the number one cause of actinic keratosis. Other predisposing factors include smoking, immune suppression, arsenic exposure & other rare genetic conditions.
Prevention means early detection of solar damage as well as mitigation of recurrent solar keratosis after procedures such as photodynamic therapy & laser resurfacing. I normally start patients on a simple routine 2-6 weeks post procedure. The prevention combination will depend on previous history, skin examination & importantly skin sensitivity. As a guide-
High risk, aggressive sun damage: Oral retinoids including acitretin or prescription retinoic acid 1-5%, topical tretinoin, pulsed 5 FU. topical lactic – salicylic acids.
Moderate risk, topical retinoids. Clinical strength glycolic or retinoic acid peels.
Low risk, OTC retinol, antioxidants & chemical peels.
The evidence of niacinamide – vitamin B3 is solid, 500 mg twice a day can reduce the incidence of SCCs, BCCs & involute over a third of actinic keratosis. It’s a no brainer. Oral supplementation with antioxidants do no harm, more research is required to document the benefits.
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