Are Sunlight-Induced Adverse Skin Alterations Treatable And/or Reversible? If So, How?

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Sunlight-induced adverse skin alterations include NMSC, melanoma, actinic keratoses, as well as textural and pigmentary changes characteristic of chronic photodamage. All of these cancers are treated by standard surgical techniques. Precancerous lesions such as actinic keratoses are treated by topical chemotherapy (e.g., by the use of 5-fluorouracil) and physical methods of superficial skin destruction (e.g., cryosurgery). Various therapies to improve the features of chronic photodamage (scaliness, coarse and fine wrinkling, telangiectasis, and irregular pigmentation) including chemical peels, the topical use of 5-fluorouracil, alpha-hydroxy acids, and all-transretinoic acid have been tried. Although the beneficial cosmetic effects of some of these treatments have received wide publicity, there are insufficient data demonstrating sustained improvement, reversibility of tissue pathology, or the preservation of normal skin function by those agents. There is no information regarding long-term positive, negative, or toxic effects of these agents. Conflicting data exist demonstrating both prevention and potentiation effects of topical retinoids in the development of UVR-induced skin tumors in animals. There are indications that systemic use of beta-carotene and certain retinoids may be beneficial in prevention of sun damage in people with certain disorders. Long-term, large-scale studies of normal individuals in the general population are in progress.

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