Is it possible to reverse prior sun damage?

Emphatically Yes. Dr. Ting believes in aggressively going after precancerous lesions and treating sun damaged areas prophylactically rather than waiting for eventual biopsies and/or skin cancer surgeries.

For the appropriate patients, Dr. Ting may recommend prophylactic chemotherapy creams such as topical 5-fluorouracil or imiquimod to treat sun damaged areas of the scalp, chest, shoulders, arms, hands, and even the legs. Patient undergoing treatments may expect to have varying degrees of inflammatory reaction (e.g. itchy scaly red rash) reflecting the extent of underlying sun damage. At the end of the treatment course, the risk of skin cancer in the treated area should be significantly reduced. For the appropriate patients who have significant personal history of skin cancers (particularly squamous cell carcinomas), Dr. Ting is  experienced in tailoring appropriate dosage of acitretin (Soriatane) for  chemoprevention of skin cancers.

For the face, he prefers prophylactic treatment with other modalities since the downtime associated with topical 5-fluorouracial cream is typically 3-5 weeks and not acceptable for most patients. He recommends consideration of photodynamic therapy, TCA 35% chemical peel, or fractional CO2 resurfacing laser. Click for Febuary 2007 MORE Magazine article on 'Beauty Treatments That Stop Skin Cancer'.

• Photodynamic therapy (PDT) 
• helps to slough off sun damaged skin via a photochemical reaction between aminolevulinic acid (ALA) and a blue light source. Think of PDT as a smart bombing where the precancerous lesions will get highlighted by inflammatory reactions consisting of red scaly patchy rash and subsequently sloughed off. Dr. Ting has treated more than 1000 patients with PDT for actinic keratoses and other indications for the past couple years. Based on his experience, he will prescribe a precise sets of incubation time (duration of ALA application) and exposure time (duration of blue light exposure) to balance the need for clinical efficacy and tolerability.

 

• TCA 35% chemical peel
• is known as a medium depth chemical peel which sloughs off top layers of the skin. Think of TCA chemical peel as a carpet bombing where both the bad, i.e. precancerous lesions, and the nonmalignant lesions such as superficial acne scarring and wrinkles may be peeled off in an even fashion. Significant improvement of pigmentary changes such as melasma will be evident as well. Therefore, for people who are looking for both therapeutic and cosmetic upsides, TCA 35% chemical peel offers a good value.

   

• Fractional CO2 resurfacing laser
• is now the gold standard for patients looking for true ablative results with non-ablative comfort. With the new Fractional technology that delivers the CO2 laser energy in a pixel-like fashion where microscopic holes 0.3mm in diameter are punched beyond the epidermis and into the papillary dermis; the microscopic holes are precisely lasered right next to each other via a computer-generated algorithm. As a result, the Fractional CO2 Laser Resurfacing achieves complete rejuvenation of the skin by sloughing 5-10 years of sun damage, minimizing future risk of skin cancers, reducing pigmentary disparity and softening old acne scars and wrinkles.

Patients should expect 6-7 days of 'downtime' where skin goes through evolution of redness, dusky brown changes, and peeling with all 3 modalities discussed above.