The general appearance of someone’s skin is influenced by a combination of the individual’s health, lifestyle, genetics and age. The mechanisms of skin aging are still not fully understood, although intrinsic and extrinsic factors play key roles. Unlike intrinsic aging, which is determined by genetic predisposition, extrinsic aging mainly depends on environmental exposures and lifestyle choices. The degree of unprotected solar exposure is one of the dominant factors that promotes premature skin aging in all ethnicities, regardless of skin color. Solar radiation affects skin structure and function however the extent of solar damage to the skin is directly related to the length, amount and condition of the exposure such as time of day, season of year and geographic location. Unprotected solar exposure increases the amount and degree of DNA alterations that may result in skin tumors. Ultraviolet photons (UV) are the most energetic among the solar spectrum, producing large amounts of damage in short periods of time. Despite decades of education by dermatologists about the dangers of UV radiation, many patients either do not use sunscreen or do not use adequately. The majority of patients today are aware of the dangers of cumulative UV exposure and acknowledge the link between chronic sun exposure, premature aging, and skin cancer. Still that knowledge may not motivate change. The data regarding UV protection behaviors are particularly concerning. Only 40% of US households purchase sunscreen. Among the various types of cancer, skin cancer is one where we have a clearly identified contributing factor: UV exposure. Clearly education about long-term health risks associated with various behaviors is not sufficient to motivate change. Habits, beneficial or not, are difficult to change. In the case of UV exposure, the immediate risk of sunburn may motivate some patients to apply sunscreen. This is especially true of individuals who have had a significant, uncomfortable burn in the past. But the pain is not always significant to change behaviors long-term. The real concern is not the short-lived discomfort but the long-term skin cancer risk associated with each sunburn. Future risk does not always motivate a patient to protect their skin now. The statistics that we have around melanoma are very hard to understand in terms of what it means personally. Individuals rationalize that they only have a risk of developing skin cancer, and among those who develop skin cancer, only a proportion die as a result. Patients are more responsive to an argument based on skin aging and wrinkles, we are all going to get wrinkles as we age. But premature wrinkling and premature aging of the skin is clearly induced by chronic overexposure to the sun. Microscopically sun damage is clearly evident with the normal fine wavy collagen and elastin which gives skin its youthful resilience being replaced by non-functional solar elastosis. This substance has no structure and clinically looks like deep wrinkling. So how can dermatologists change the conversation about UV safety and encourage patients to adopt healthy behaviors? Tie sunscreen use to other healthy behaviors, creating a concept of a healthy lifestyle that involves being active and eating healthy and using sunscreen. Skin is the largest organ of the human body and its dynamic barrier protects us from allergens, irritants, and pollution. Research shows that beyond causing damage to the skin layers, UV radiation can actually affect the immune system, leading to a reduction in immune response. Sun safety needs to be a daily habit and involves more than just using sunscreen. It requires protective clothing, sunglasses, and using skin care products that compliment sunscreen.
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