Photoaging

Degenerative ICD: L57.0

Also known as: Sun Damage, Photodamage, Premature Ageing

Description

Photoaging refers to premature skin ageing caused by chronic ultraviolet radiation exposure. It is distinct from intrinsic (chronological) ageing and manifests as coarse wrinkles, dyspigmentation, loss of elasticity, and a rough texture. It is the primary extrinsic cause of visible skin ageing and a significant risk factor for skin cancers.

Symptoms

  • Fine and coarse wrinkles
  • Uneven pigmentation and lentigines (age spots)
  • Loss of skin elasticity and firmness
  • Rough, leathery skin texture
  • Telangiectasia
  • Actinic keratoses (pre-malignant lesions)

Causes & Triggers

  • Chronic UVA and UVB exposure
  • Reactive oxygen species (ROS) generation
  • Collagen and elastin degradation (MMP activation)
  • DNA damage and impaired repair mechanisms
  • Smoking as an accelerating co-factor

Severity Classification

Mild Fine lines, minimal pigment changes, early textural roughness
Moderate Visible wrinkles, scattered lentigines, noticeable elasticity loss
Severe Deep furrows, widespread dyspigmentation, actinic keratoses, leathery skin

Treatment Ladder

  1. 1 Foundational: Daily broad-spectrum sunscreen SPF 50+ and sun avoidance
  2. 2 Mild: Topical retinoids (retinol → tretinoin) + antioxidants (vitamin C, E)
  3. 3 Moderate: Chemical peels (glycolic acid) + prescription retinoids
  4. 4 Moderate–Severe: Laser resurfacing, microneedling, IPL
  5. 5 Actinic keratoses: Cryotherapy, topical 5-FU, or photodynamic therapy

Relevant Compounds

Alpha Arbutin

Reduces age spots and sun-induced pigmentation

Alpha arbutin is a biosynthetic glycosylated hydroquinone derivative that inhibits melanin productio…

Coenzyme Q10

Mitochondrial antioxidant — reduces oxidative damage

Coenzyme Q10 (ubiquinone) is a naturally occurring lipid-soluble benzoquinone that is present in vir…

Glycolic Acid

AHA — exfoliation and collagen stimulation

Glycolic acid is the smallest alpha hydroxy acid with the greatest bioavailability due to its low mo…

Green Tea Extract

Polyphenol antioxidant — UV damage protection

Green tea extract is derived from the leaves of Camellia sinensis. It is rich in polyphenols called …

Hyaluronic Acid

Hydration and plumping of fine lines

Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…

Kojic Acid

Depigmenting agent for age spots

Kojic acid is a natural metabolite produced by several species of fungi (Aspergillus, Penicillium). …

Niacinamide

Improves fine lines, pigmentation, and barrier function

Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…

Retinol

OTC retinoid for milder anti-ageing regimens

Retinol is an over-the-counter retinoid and a precursor to retinoic acid (tretinoin). It must be con…

Tretinoin

Gold standard — stimulates collagen, normalises cell turnover

Tretinoin is a first-generation retinoid derived from vitamin A. It is one of the most extensively s…

Vitamin C

Antioxidant photoprotection and collagen stimulation

Vitamin C is a potent water-soluble antioxidant essential for collagen synthesis. In topical skincar…

Vitamin E

Antioxidant — photoprotection and membrane stabilisation

Vitamin E is a fat-soluble antioxidant vitamin and a key component of the skin's natural antioxidant…

Recommended Drugs

Suggested Cosmetics

Lifestyle Tips

  • Sunscreen is non-negotiable — apply 2 mg/cm² to face, reapply every 2 hours
  • Wear wide-brimmed hats and seek shade during peak UV hours (10 AM–4 PM)
  • Start retinoid therapy early — prevention is easier than reversal
  • Antioxidant serums (vitamin C) in the morning, retinoids at night
  • Quit smoking — it independently accelerates skin ageing

When to Refer

  • Suspicious actinic keratoses or lesions needing biopsy
  • Desire for procedural interventions (laser, peels, injectables)
  • Use of high-strength prescription retinoids requiring monitoring