Problem · Sun damage (photoaging)
Sun damage, honestly.
Four problems on one patch of skin — leathery texture, brown spots, red vessels and precancerous patches — sitting on a cancer field. Below, the self-checks that sort them, every treatment from sunscreen to retinoids to light, lasers and the field therapies graded by the trials behind it, and the cancer numbers stated plainly.
The whole guide in two minutes
What's actually happening
Ultraviolet
Two wavelengths doing two kinds of damage
UVB burns the surface and mutates DNA — the cancer wavelength; UVA reaches the dermis through cloud and glass, generates free radicals and switches on the enzymes that shred collagen and elastin — the wrinkle wavelength. Both build a mutated field over decades.
Dose
Decades of incidental exposure, not just holidays
The dose that ages a face comes from commuting, driving, lunch outside and winter walks — UVA through side windows, off snow and water, on cloudy days — plus the tanning beds that raise melanoma risk by 75% when first used before 35.
Skin type
Your phototype decides which damage you get
Fair skin burns, wrinkles, freckles and grows precancers; darker skin resists the burn and the cancer but pigments from visible light as well as ultraviolet, and photoages a decade or two later with the same elastin loss underneath.
What sun damage actually is
What sun damage actually is
Ultraviolet light injures skin in two bands. UVB (290–320 nm) is absorbed in the epidermis, where it burns, forms the DNA lesions that accumulate into the mutations behind squamous-cell carcinoma and melanoma, and switches on the matrix metalloproteinases — MMP-1, -3 and -10 — that cut collagen (UVB and MMPs). UVA (320–400 nm) is thirty times more abundant, passes through cloud and window glass, reaches the dermis, generates reactive oxygen species and induces MMP-12, an elastase that dissolves elastic fibres and leaves behind the tangled, non-functional material called solar elastosis (NEJM review; pathogenesis review).
Over decades the skin thickens with elastotic debris and thins in collagen, the melanocytes overproduce in patches, the small vessels dilate, and the epidermis carries clones of mutated cells — the "field" from which actinic keratoses and carcinomas grow. That is why sun damage is four cosmetic problems and one medical one on the same skin, and why the treatments on this page are sorted by the sign rather than by the machine.
How much of aging is the sun, and who shows it
How much of aging is the sun, and who shows it
The cleanest demonstration is your own body: the inner upper arm, which rarely sees sun, keeps its texture and colour into old age while the face, neck, hands and forearms of the same person coarsen, mottle and wrinkle. The asymmetry shows up wherever exposure does — in a study of facial aging, the side of the face that faces the car window aged measurably more, attributed to cumulative UVA through glass (asymmetric aging study). Clinicians grade the whole picture on Glogau's four-step scale, from mild pigment change with no wrinkles (I) to the yellow, leathery, precancer-bearing skin of type IV. Fair, freckling, burn-prone skin reaches type IV decades before olive or brown skin, whose extra melanin absorbs much of the dose; every phototype loses elastin underneath, and the differences by skin type are laid out in the reviews (skin-type review).
Why the cosmetic problem and the medical one share a page
Why the cosmetic problem and the medical one share a page
Actinic keratoses — the rough, scaly, sandpapery patches on sun-damaged skin — are the visible tips of a mutated field. In a retrospective analysis of 6,691 patients, the interval from a keratosis to a squamous-cell carcinoma at the same site averaged 24.6 months (kinetics study); the lifetime risk of a carcinoma for someone with keratoses followed for ten years is put at 6–10%, and a Swedish cohort of 17,651 patients with the diagnosis carried a raised risk of every skin cancer (progression review; Swedish cohort; field cancerization).
The good news is that the interventions overlap. Daily sunscreen cut carcinomas and melanomas in a randomised trial and reversed visible photodamage in another; a course of fluorouracil cream that clears keratoses also cut carcinomas needing surgery by three-quarters; photodynamic therapy clears the field and, with light, smooths the skin over it. The ladder on this page starts with stopping the dose, rebuilds the surface with retinoids, picks a machine by the sign — light for colour, lasers for texture — treats the field where there is one, and puts an annual skin check on the calendar for anyone in Glogau III or IV.
Which sun damage do you have?
Leathery texture, coarse wrinkles, sallow colour
Leathery texture, coarse wrinkles, sallow colour
Pinch the cheek and look at the surface under a window: a coarse, criss-crossed texture, a yellowish cast, deep static wrinkles across the cheek and neck, sometimes with small yellow bumps or enlarged pores, is the elastotic type — the dermis has swapped its elastic network for solar debris. This is the Glogau III–IV skin that retinoids were licensed for, that fractional and full-field resurfacing were built for, and that intense pulsed light, which treats colour, leaves unchanged. The wrinkles guide covers the fine-line end of the same spectrum.
Brown spots and blotchy colour
Brown spots and blotchy colour
Flat, sharply edged brown spots that appeared after forty on the face, the backs of the hands, the chest and the shoulders are solar lentigines, and the uneven colour between them is mottled pigmentation — melanocytes that decades of sun have set to overproduce. They are the sign that responds first to sunscreen alone (the one-year study measured a 40–52% improvement in pigmentation), lighten with retinoids and vitamin C, and disappear with intense pulsed light or a Q-switched or picosecond laser. Any spot that is growing, has an irregular edge or several colours, or is new after sixty needs a dermatologist's dermatoscope before a laser — lentigo maligna is a melanoma that starts as a "spot". The dark-spots guide grades every treatment.
Redness, broken vessels, the blotchy neck and chest
Redness, broken vessels, the blotchy neck and chest
Sun dilates and multiplies the small vessels of the dermis, and on the neck and chest it produces the reddish-brown, mottled, slightly shiny patch with pale skin under the chin called poikiloderma of Civatte — the pattern of a lifetime of open collars. Fine red lines on the nose and cheeks are the facial version. Neither responds to creams; both respond to vessel-targeting light — intense pulsed light cleared more than 80% of the vascular and pigmented components in a 175-patient series — and the treated skin needs the sun kept off it afterward. The neck guide covers the neck's other problems.
Rough, scaly patches that keep coming back (actinic keratoses)
Rough, scaly patches that keep coming back (actinic keratoses)
Run your fingertips over the forehead, the bald scalp, the tops of the ears, the nose, the lower lip and the backs of the hands. A rough patch you feel before you see it, that flakes and returns in the same place, is an actinic keratosis; several mean the surrounding skin is a mutated field even where it looks normal (field cancerization). About a quarter of individual keratoses regress on their own (regression analysis); the field does not. Red flags that turn a keratosis into an urgent appointment: a patch that thickens, bleeds, becomes tender, grows a horn or a crust, or fails to heal in a month (warning signs). Single lesions are frozen; a field is treated with fluorouracil cream or photodynamic therapy, graded below.
Where the dose actually comes from
Where the dose actually comes from
Sunburn comes from holidays; photoaging comes from the daily dose. Measurements across modern cars found windscreens (laminated glass) blocking 99% of UVA and side windows (tempered glass) only 89% — a tenfold difference in what reaches the driver's window-side cheek and forearm (vehicle-glass study); ordinary window glass at home and at work blocks UVB and passes UVA (window-glass review); cloud attenuates UVA far less than it feels; snow, water and sand reflect it upward under a hat. Tanning beds are the concentrated version: first use before 35 raises melanoma risk by 75% in meta-analysis, and any use by 15% (indoor-tanning review; JEADV 2025). A "base tan" is the skin's injury response and protects trivially. The habits that matter are the ones that happen on an ordinary Tuesday.
Sun damage in darker skin
Sun damage in darker skin
Melanin absorbs much of the ultraviolet dose, so Fitzpatrick IV–VI skin burns rarely, keeps its texture longer and grows far fewer keratinocyte cancers — and melanomas in dark skin appear on palms, soles and nails, where nobody looks. Its sun problem is pigment, and the wavelength is broader: visible light, which ordinary sunscreens ignore, produced darker and longer-lasting pigmentation than UVA in darker phototypes, and only formulations containing iron oxides — the tinted sunscreens — blocked it (iron-oxide study; 2025 study). Every device on this page carries more pigment risk in darker skin, which the dark-spots guide and the laser guide spell out; the elastin loss beneath arrives a decade or two later and answers to the same retinoids.
The arm test, the fingertip test and the annual look
The arm test, the fingertip test and the annual look
Three minutes in daylight. Hold the inner upper arm next to the back of the hand and the cheek: the gap in texture and colour is what the sun did, and what the treatments below can and cannot recover. Run fingertips over the scalp, forehead, ears, nose, lower lip, forearms and hands for the sandpaper roughness of a keratosis, and note any spot that has changed, has an irregular edge or more than one colour, or is new after sixty. Photograph the face, neck, chest and hands straight on in daylight — the pigment and vascular treatments are judged against exactly that picture. Then the audit that decides the plan more than any machine: how much sunscreen actually goes on and how often, whether the neck, ears, chest and hands get any, what you drive and sit beside, and whether you have ever used a sunbed. Rough patches, many spots or a previous skin cancer put a yearly dermatologist's skin check on the calendar before anything cosmetic.
The full breakdown
Sun damage — what the evidence says
Part 01
At home: stopping the dose and repairing the surface
Strong evidence Daily broad-spectrum sunscreen
The only anti-aging treatment with cancer trials: 1,621 people randomised to daily use had 39% fewer squamous-cell carcinomas, 73% fewer invasive melanomas over the next decade, and 24% less measured skin aging; in a one-year study, daily sunscreen alone improved existing texture and pigment by 40–52%.
Daily broad-spectrum sunscreen
The only anti-aging treatment with cancer trials: 1,621 people randomised to daily use had 39% fewer squamous-cell carcinomas, 73% fewer invasive melanomas over the next decade, and 24% less measured skin aging; in a one-year study, daily sunscreen alone improved existing texture and pigment by 40–52%.
The only anti-aging treatment with cancer trials: 1,621 people randomised to daily use had 39% fewer squamous-cell carcinomas, 73% fewer invasive melanomas over the next decade, and 24% less measured skin aging; in a one-year study, daily sunscreen alone improved existing texture and pigment by 40–52%.
The Nambour trial in Queensland randomised 1,621 adults to daily broad-spectrum sunscreen on the head, neck, arms and hands or to use at their own discretion. After 4.5 years the daily group had 39% fewer squamous-cell carcinomas (rate ratio 0.61) with no effect on basal-cell carcinoma (Lancet, 1999); ten years after the trial ended, 11 melanomas had occurred in the daily group against 22, and invasive melanomas 3 against 11 — a 73% reduction (JCO, 2011); and the daily group showed no detectable increase in skin aging on microtopography, 24% less than discretionary users (Hughes 2013). Existing damage improves too: 32 people applying an SPF 30 sunscreen to the face daily for a year improved on every photoaging measure from week 12, with texture, clarity and mottled pigmentation 40–52% better at week 52 and every subject improved (one-year study).
The rules that make the trials true: broad-spectrum, SPF 30 or above, enough of it (most people apply a fraction of the amount tested), every morning regardless of weather, carried to the neck, ears, chest and backs of the hands, and reapplied when outdoors. Tinted iron-oxide formulations for anyone whose problem is pigment. No supplement, serum or device on this page ranks above this row.
- Best for
- everyone, every morning, on the face, neck, ears, chest and hands — the base under every other row
- Sessions
- Every morning; reapply outdoors
- Downtime
- None
- Cost
- €10–30 / month
Strong evidence A prescription retinoid (tretinoin, tazarotene) or adapalene
The one topical licensed for photodamage: eight randomised tretinoin trials in 1,361 patients show fewer fine and coarse wrinkles and less mottling; a 563-patient tazarotene trial improved every sign over a year; biopsies show collagen restored. Adapalene 0.3% matched tretinoin in a head-to-head.
A prescription retinoid (tretinoin, tazarotene) or adapalene
The one topical licensed for photodamage: eight randomised tretinoin trials in 1,361 patients show fewer fine and coarse wrinkles and less mottling; a 563-patient tazarotene trial improved every sign over a year; biopsies show collagen restored. Adapalene 0.3% matched tretinoin in a head-to-head.
The one topical licensed for photodamage: eight randomised tretinoin trials in 1,361 patients show fewer fine and coarse wrinkles and less mottling; a 563-patient tazarotene trial improved every sign over a year; biopsies show collagen restored. Adapalene 0.3% matched tretinoin in a head-to-head.
Retinoids reverse photodamage at its source: they switch off the collagen-cutting enzymes, thicken the epidermis, disperse pigment and drive fibroblasts to lay down new collagen — restored on biopsy in the classic study (NEJM, 1993). The evidence is regulator-grade: a systematic review and meta-analysis of eight randomised, vehicle-controlled tretinoin trials in 1,361 patients found significant improvement in fine and coarse wrinkling and overall photodamage (meta-analysis); a 12-month multicentre randomised trial of 0.1% tazarotene cream in 563 patients found significantly greater success than vehicle at 24 weeks for fine wrinkles, mottled pigmentation, lentigines, elastosis and roughness, with further gains to week 52 (tazarotene trial); and adapalene 0.3%, available without prescription in some countries, matched tretinoin 0.05% over 24 weeks in 86 photoaged women (head-to-head). Start two nights a week, expect months of dryness, use it under sunscreen, not in pregnancy. The wrinkles guide covers the retinol-to-tretinoin ladder.
- Best for
- the leathery, mottled type — the base that rebuilds what the sun took, over a year
- Sessions
- Nightly, indefinitely
- Downtime
- Weeks of dryness and peeling
- Cost
- €10–30 / month
Moderate evidence Hats, clothing, shade and window film
A three-inch brim cuts UV to the nose by two-thirds, the cheeks by three-quarters and the neck by 96%; UPF fabric blocks what sunscreen misses; car side windows and home glass pass UVA that a film stops. Physics rather than trials, and free of the reapplication problem.
Hats, clothing, shade and window film
A three-inch brim cuts UV to the nose by two-thirds, the cheeks by three-quarters and the neck by 96%; UPF fabric blocks what sunscreen misses; car side windows and home glass pass UVA that a film stops. Physics rather than trials, and free of the reapplication problem.
A three-inch brim cuts UV to the nose by two-thirds, the cheeks by three-quarters and the neck by 96%; UPF fabric blocks what sunscreen misses; car side windows and home glass pass UVA that a film stops. Physics rather than trials, and free of the reapplication problem.
Fabric and shade have no reapplication problem. Measurements behind the Skin Cancer Foundation's standard show a three-inch (7.5 cm) brim reducing UV to the nose by 66%, the cheeks by 77% and the neck by 96%, and the foundation now requires UPF 50 fabric and that brim for its seal — with a caveat from a Drexel study that a third of hats sold with UPF claims fall short of European criteria, so brim width is the number to trust (hat study). Long sleeves in UPF fabric cover the forearms and hands that the Nambour trial protected; a UV film on a car's side windows brings them to windscreen standard (vehicle-glass study; window-glass review); shade between eleven and three removes most of the day's UVB. Moderate because the evidence is dosimetry rather than randomised outcomes; in practice it is the half of photoprotection that people forget.
- Sessions
- Whenever outdoors
- Downtime
- None
- Cost
- €20–100
Moderate evidence Topical vitamin C and niacinamide
A 5% vitamin C cream reduced photoaging furrows over six months in a double-blind trial; niacinamide 5% improved fine lines, mottling and elasticity in a split-face RCT. Antioxidants mop up what sunscreen lets through; the supporting cast under it.
Topical vitamin C and niacinamide
A 5% vitamin C cream reduced photoaging furrows over six months in a double-blind trial; niacinamide 5% improved fine lines, mottling and elasticity in a split-face RCT. Antioxidants mop up what sunscreen lets through; the supporting cast under it.
A 5% vitamin C cream reduced photoaging furrows over six months in a double-blind trial; niacinamide 5% improved fine lines, mottling and elasticity in a split-face RCT. Antioxidants mop up what sunscreen lets through; the supporting cast under it.
Sunscreen filters most ultraviolet; what passes generates free radicals that topical antioxidants neutralise, and two have controlled trials on photoaged skin. A 5% vitamin C cream applied for six months reduced deep furrows and improved photodamage against vehicle in a double-blind study (Humbert 2003); niacinamide 5% reduced fine lines, mottled pigmentation and sallowness and improved elasticity in a 12-week double-blind split-face trial (Bissett 2005). Morning vitamin C under sunscreen, niacinamide at either end of the day, a retinoid at night is the regimen the trials support; the wrinkles guide grades the rest of the shelf.
- Sessions
- Daily, under sunscreen
- Downtime
- None
- Cost
- €15–60 / month
Moderate evidence Oral nicotinamide, for people who have had skin cancer
In a phase 3 trial of 386 people with two or more prior skin cancers, 500 mg twice daily for a year cut new non-melanoma skin cancers by 23% and squamous-cell carcinomas by 30%, with fewer keratoses; a later trial in transplant recipients found no benefit. Cheap, safe, for the high-risk field.
Oral nicotinamide, for people who have had skin cancer
In a phase 3 trial of 386 people with two or more prior skin cancers, 500 mg twice daily for a year cut new non-melanoma skin cancers by 23% and squamous-cell carcinomas by 30%, with fewer keratoses; a later trial in transplant recipients found no benefit. Cheap, safe, for the high-risk field.
In a phase 3 trial of 386 people with two or more prior skin cancers, 500 mg twice daily for a year cut new non-melanoma skin cancers by 23% and squamous-cell carcinomas by 30%, with fewer keratoses; a later trial in transplant recipients found no benefit. Cheap, safe, for the high-risk field.
Nicotinamide, the amide form of vitamin B3, replenishes the cellular energy that ultraviolet depletes and supports DNA repair. The ONTRAC trial randomised 386 people who had had at least two non-melanoma skin cancers in the previous five years to 500 mg twice daily or placebo for a year: new non-melanoma skin cancers were 23% fewer, squamous-cell carcinomas 30% fewer, and actinic keratoses 11–20% fewer, with no significant side effects (NEJM, 2015; meta-analysis). The counterweight is a later trial in organ-transplant recipients, the highest-risk group, that found no benefit (NEJM, 2023), and the benefit stops when the tablets do. Nicotinamide, not niacin, which flushes; for the high-risk field rather than for looks, and moderate on one positive phase 3 trial and one negative one.
- Best for
- anyone with a previous keratinocyte cancer or a field of keratoses — a vitamin, not a cosmetic
- Sessions
- 500 mg twice daily, ongoing
- Downtime
- None
- Cost
- €5–10 / month
Moderate evidence Take vitamin D rather than sun
In a 628-person randomised trial, a year of daily SPF 50+ lowered vitamin D by a small, real amount and left 46% deficient against 37% of controls; a 1995 trial with SPF 17 found no effect. A daily supplement removes the only medical argument for unprotected sun.
Take vitamin D rather than sun
In a 628-person randomised trial, a year of daily SPF 50+ lowered vitamin D by a small, real amount and left 46% deficient against 37% of controls; a 1995 trial with SPF 17 found no effect. A daily supplement removes the only medical argument for unprotected sun.
In a 628-person randomised trial, a year of daily SPF 50+ lowered vitamin D by a small, real amount and left 46% deficient against 37% of controls; a 1995 trial with SPF 17 found no effect. A daily supplement removes the only medical argument for unprotected sun.
The one medical reason people give for skipping sunscreen is vitamin D, and the trials now answer it. The Sun-D trial randomised 628 Australians (median age 52) to daily SPF 50+ for a year or discretionary use: vitamin D rose 1.6 nmol/L in the sunscreen group against 6.8 in controls, a difference of 5.2 nmol/L, and 45.7% of daily users were deficient at a year against 36.9% — small, real, and the authors' conclusion that regular users may need a supplement (Sun-D trial); the earlier 113-person trial with SPF 17 found no effect at all (1995 trial). A daily 1,000–2,000 IU supplement costs pennies and delivers the vitamin without the mutations; the supplements guide covers dosing.
- Sessions
- Daily
- Downtime
- None
- Cost
- €3–5 / month
Emerging evidence Oral photoprotectants: Polypodium leucotomos, flavanols, carotenoids
A fern extract raised the dose needed to burn by 29% in 47 volunteers; a meta-analysis of 40 trials finds cocoa flavanols raise it too and collagen and polyphenols improve elasticity, while carotenoids, lycopene and hyaluronic acid do nothing measurable. An SPF of about 1.3 in a capsule; never a substitute.
Oral photoprotectants: Polypodium leucotomos, flavanols, carotenoids
A fern extract raised the dose needed to burn by 29% in 47 volunteers; a meta-analysis of 40 trials finds cocoa flavanols raise it too and collagen and polyphenols improve elasticity, while carotenoids, lycopene and hyaluronic acid do nothing measurable. An SPF of about 1.3 in a capsule; never a substitute.
A fern extract raised the dose needed to burn by 29% in 47 volunteers; a meta-analysis of 40 trials finds cocoa flavanols raise it too and collagen and polyphenols improve elasticity, while carotenoids, lycopene and hyaluronic acid do nothing measurable. An SPF of about 1.3 in a capsule; never a substitute.
Some swallowed antioxidants raise the ultraviolet dose needed to redden skin. Polypodium leucotomos extract at 480 mg a day raised the minimal erythema dose by 29% in 47 volunteers over 30 days, without measurably reducing DNA damage in biopsies, while oral nicotinamide in the same trial raised neither (intraindividual trial); a five-day gummy course produced smaller, inconsistent gains (gummy study); an antioxidant combination raised the dose against baseline but not against control in a randomised trial (RCT). The systematic review and meta-analysis of 40 randomised trials in 2,119 adults found flavanols raised the erythema dose and collagen and polyphenols improved elasticity, with carotenoids, lycopene and oral hyaluronic acid showing no significant benefit, and heterogeneity everywhere (meta-analysis). A 29% rise in burn threshold is an SPF of about 1.3; useful for the person who will be in the sun regardless, and no substitute for a cream with an SPF of 30.
- Sessions
- Daily
- Downtime
- None
- Cost
- €20–40 / month
Emerging evidence Glycolic and lactic acids
A 22-week double-blind trial of 8% glycolic and lactic creams improved photodamage grades over vehicle in about three-quarters of users; a 5% glycolic formulation has its own controlled trial. Surface smoothing and brightening for the mottled, rough type.
Glycolic and lactic acids
A 22-week double-blind trial of 8% glycolic and lactic creams improved photodamage grades over vehicle in about three-quarters of users; a 5% glycolic formulation has its own controlled trial. Surface smoothing and brightening for the mottled, rough type.
A 22-week double-blind trial of 8% glycolic and lactic creams improved photodamage grades over vehicle in about three-quarters of users; a 5% glycolic formulation has its own controlled trial. Surface smoothing and brightening for the mottled, rough type.
Alpha-hydroxy acids exfoliate the roughened, pigmented surface of photoaged skin and, over months, modestly thicken the epidermis. In the reference trial, 76% of women on 8% glycolic acid and 71% on 8% lactic acid improved at least one grade of photodamage against 40% on vehicle over 22 weeks (Stiller 1996), and a daily 5% glycolic formulation has a double-blind randomised trial in photoaging (1998 trial). They increase sun sensitivity, which in a guide about sun damage is the caveat: nights only, with the morning sunscreen non-negotiable. The peel guide covers the clinic strengths.
- Sessions
- 2–4 nights a week
- Downtime
- Stinging; sun sensitivity
- Cost
- €10–40 / month
Part 02
Prescription and field treatments
Strong evidence Fluorouracil cream for the precancerous field
In 932 veterans with prior skin cancers, a single two-to-four-week course of 5% fluorouracil to the face and ears cut squamous-cell carcinomas needing surgery by 75% over the following year and cleared keratoses; two weeks of a raw red face is the price. The best-evidenced field treatment.
Fluorouracil cream for the precancerous field
In 932 veterans with prior skin cancers, a single two-to-four-week course of 5% fluorouracil to the face and ears cut squamous-cell carcinomas needing surgery by 75% over the following year and cleared keratoses; two weeks of a raw red face is the price. The best-evidenced field treatment.
In 932 veterans with prior skin cancers, a single two-to-four-week course of 5% fluorouracil to the face and ears cut squamous-cell carcinomas needing surgery by 75% over the following year and cleared keratoses; two weeks of a raw red face is the price. The best-evidenced field treatment.
Fluorouracil is a chemotherapy cream that selectively kills the sun-mutated cells of the field, visible keratoses and invisible ones alike; the skin reddens, crusts and peels over two to four weeks and heals smoother. The Veterans Affairs Keratinocyte Carcinoma Chemoprevention trial randomised 932 veterans with at least two prior skin cancers to a single course of 5% fluorouracil or placebo twice daily to the face and ears for up to four weeks: in the following year, squamous-cell carcinomas needing surgery occurred in 1% of the treated group against 4% of controls, a 75% reduction, with the effect fading over four years and no effect on basal-cell carcinoma (JAMA Dermatology, 2018; abstract). It also clears most keratoses in the field, and pre-treating with it doubles the effect of daylight photodynamic therapy (combination RCT). Prescription only, ugly for a fortnight, and the treatment with the strongest cancer-prevention evidence after sunscreen.
- Best for
- a field of keratoses on the face, scalp, ears or hands — the course that treats what you can feel and what you cannot
- Sessions
- 2–4 weeks twice daily; repeat every 1–3 years
- Downtime
- 2–4 weeks of redness, crusting and soreness
- Cost
- €20–60 per course (prescription)
Strong evidence Photodynamic therapy — the field, and photorejuvenation
A photosensitising cream activated by red or daylight clears keratosis fields with meta-analysis-grade evidence, 87% lesion clearance when primed with fluorouracil; combined with intense pulsed light it improved crow’s feet and roughness by 55% against 30% for light alone in a split-face study. One treatment, days of redness.
Photodynamic therapy — the field, and photorejuvenation
A photosensitising cream activated by red or daylight clears keratosis fields with meta-analysis-grade evidence, 87% lesion clearance when primed with fluorouracil; combined with intense pulsed light it improved crow’s feet and roughness by 55% against 30% for light alone in a split-face study. One treatment, days of redness.
A photosensitising cream activated by red or daylight clears keratosis fields with meta-analysis-grade evidence, 87% lesion clearance when primed with fluorouracil; combined with intense pulsed light it improved crow’s feet and roughness by 55% against 30% for light alone in a split-face study. One treatment, days of redness.
Aminolevulinic acid or its methyl ester is applied to the sun-damaged area, accumulates in the abnormal cells over one to three hours, and is activated by red light — or by daylight in the gentler outdoor version — to destroy them. For the precancerous field the evidence is pooled: a systematic review and meta-analysis finds it at least as effective as conventional therapies for keratoses with better cosmetic outcomes (meta-analysis); in a 60-patient randomised trial, priming with fluorouracil raised clearance from 74% to 87% (combination RCT); and daylight photodynamic therapy is reviewed as the field treatment with the least pain (daylight review). For looks, the split-face evidence is consistent: in 16 patients given three treatments, the side treated with the photosensitiser plus intense pulsed light improved crow's feet and tactile roughness by 55% against 29.5% for light alone, with better keratosis clearance (split-face study; earlier split-face). Strong for the field; the rejuvenation is a documented bonus rather than the indication.
- Best for
- a field of keratoses where fluorouracil’s fortnight is unacceptable, and the sun-damaged face that wants the field and the look treated at once
- Sessions
- 1–2 sessions
- Downtime
- 3–7 days of redness and peeling
- Cost
- €900–1,300 (UK £850–1,150)
Moderate evidence An annual dermatologist’s skin check
For anyone with keratoses, many spots, a sunbed history or a previous skin cancer: a yearly examination with a dermatoscope finds the carcinoma at the keratosis two years in, and the melanoma hiding among the lentigines. Not a treatment; the thing that makes the rest safe.
An annual dermatologist’s skin check
For anyone with keratoses, many spots, a sunbed history or a previous skin cancer: a yearly examination with a dermatoscope finds the carcinoma at the keratosis two years in, and the melanoma hiding among the lentigines. Not a treatment; the thing that makes the rest safe.
For anyone with keratoses, many spots, a sunbed history or a previous skin cancer: a yearly examination with a dermatoscope finds the carcinoma at the keratosis two years in, and the melanoma hiding among the lentigines. Not a treatment; the thing that makes the rest safe.
A keratosis takes about two years to become a carcinoma and a carcinoma can be cut out small; a lentigo maligna looks like a sun spot for years before it invades; and the sun-damaged patient carries both among a hundred harmless marks. A dermatologist with a dermatoscope sorts them in twenty minutes. The Swedish cohort of 17,651 people with a keratosis diagnosis carried a raised ten-year risk of squamous-cell carcinoma, basal-cell carcinoma and melanoma (Swedish cohort), and the lentigo that is actually a melanoma has a dermoscopic signature no laser clinic should miss (DermNet). Moderate because screening trials in the general population are contested; for the person with a damaged field, a previous cancer or a sunbed past, the yearly look is the standard of care and the precondition for treating spots with light.
- Sessions
- Yearly; sooner for any changing lesion
- Downtime
- None
- Cost
- €80–200 privately; free in many health systems
Part 03
Light, lasers and peels
Light for colour, lasers for texture — what each machine targets and at what depth
16:9 · to be supplied
Strong evidence Intense pulsed light for colour
A randomised split-face trial with blinded raters: three sessions improved telangiectasia on the treated side in 79–85% of faces through nine months and pigmentation in 59–71%, texture briefly, wrinkles not at all. The machine for red and brown; not for lines.
Intense pulsed light for colour
A randomised split-face trial with blinded raters: three sessions improved telangiectasia on the treated side in 79–85% of faces through nine months and pigmentation in 59–71%, texture briefly, wrinkles not at all. The machine for red and brown; not for lines.
A randomised split-face trial with blinded raters: three sessions improved telangiectasia on the treated side in 79–85% of faces through nine months and pigmentation in 59–71%, texture briefly, wrinkles not at all. The machine for red and brown; not for lines.
Intense pulsed light is a filtered flash absorbed by haemoglobin and melanin, so it closes dilated vessels and breaks up pigment without much effect on the dermis beneath. The controlled evidence is a randomised split-face trial of 32 women with photodamage, each given three treatments to one half of the face a month apart and assessed by blinded raters for nine months: telangiectasia improved on the treated side in 79% at one month and 85% at nine, irregular pigmentation in 71% falling to 59%, skin texture in 82% falling to 56%, and wrinkles showed no difference at any time; one patient developed a small atrophic scar (JAMA Dermatology RCT). Against a pulsed dye laser for facial vessels it was equivalent in a 16-person split-face comparison (IPL vs PDL). Strong for what it treats — colour — and the wrong purchase for the leathery type. Darker skin risks pigment change; the laser guide and the dark-spots guide cover the settings and the caveats.
- Best for
- blotchy colour — lentigines, mottling, red vessels — in fair to olive skin
- Sessions
- 3, a month apart; yearly maintenance
- Downtime
- Redness for a day; spots darken and flake for a week
- Cost
- €200–500 per session (UK £200–500)
4:5 · to be supplied
Strong evidence Q-switched and picosecond lasers for sun spots
Meta-analyses pool lasers against cryotherapy and picosecond devices for lentigines with high clearance rates; on the backs of the hands a Q-switched ruby laser beat fractional CO₂ in a side-by-side randomised comparison. One or two sessions per spot; the spot must be checked first.
Q-switched and picosecond lasers for sun spots
Meta-analyses pool lasers against cryotherapy and picosecond devices for lentigines with high clearance rates; on the backs of the hands a Q-switched ruby laser beat fractional CO₂ in a side-by-side randomised comparison. One or two sessions per spot; the spot must be checked first.
Meta-analyses pool lasers against cryotherapy and picosecond devices for lentigines with high clearance rates; on the backs of the hands a Q-switched ruby laser beat fractional CO₂ in a side-by-side randomised comparison. One or two sessions per spot; the spot must be checked first.
Nanosecond and picosecond pulses shatter pigment granules in a lentigo without heating the skin around them, and the pooled evidence is good: a meta-analysis of laser against cryotherapy for solar lentigines favours the laser on clearance and pigment complications (laser vs cryotherapy meta-analysis), the picosecond devices have their own meta-analysis (picosecond meta-analysis), and in an 11-patient randomised side-by-side comparison on the backs of the hands the Q-switched ruby laser cleared lentigines significantly better than fractional CO₂ (hands RCT). Two rules: a dermatoscope before the laser, because a lentigo maligna treated as a sun spot is a melanoma made invisible; and sunscreen afterward, because the spot returns to a face that keeps its habits. The dark-spots guide grades the whole ladder including the darker-skin caveats.
- Sessions
- 1–2 sessions
- Downtime
- Spots darken and flake for 7–10 days
- Cost
- €200–500 per session
4:5 · to be supplied
Strong evidence Ablative resurfacing (fractional and full-field CO₂, erbium)
The treatment for the leathery, coarsely wrinkled type: profilometry after three fractional CO₂ sessions found wrinkles reduced in every facial zone, a 2024 meta-analysis pools the class for photoaging, and full-field resurfacing held most of its gain at two years. Days to two weeks down, pigment risk in darker skin.
Ablative resurfacing (fractional and full-field CO₂, erbium)
The treatment for the leathery, coarsely wrinkled type: profilometry after three fractional CO₂ sessions found wrinkles reduced in every facial zone, a 2024 meta-analysis pools the class for photoaging, and full-field resurfacing held most of its gain at two years. Days to two weeks down, pigment risk in darker skin.
The treatment for the leathery, coarsely wrinkled type: profilometry after three fractional CO₂ sessions found wrinkles reduced in every facial zone, a 2024 meta-analysis pools the class for photoaging, and full-field resurfacing held most of its gain at two years. Days to two weeks down, pigment risk in darker skin.
Ablative lasers vaporise the elastotic surface and heat the dermis beneath, and the skin that regrows is thicker, with reorganised collagen and its keratoses gone with the surface. Fractional CO₂ reduced wrinkle size and depth significantly in every facial zone on profilometry after three sessions (BJD, 2014), a 2024 meta-analysis pools the class for photoaging (2024 meta-analysis), and a 16-study systematic review sets the fractional and non-ablative devices side by side (systematic review); full-field CO₂ held 87% of its wrinkle-depth reduction at two years in the perioral study cited in the lip-lines guide, and a pilot of fractional CO₂ on ten photoaged hands rated pigment 51–75% improved and wrinkles and texture 26–50% (hands pilot). The cost is downtime and, in darker skin, post-inflammatory darkening; the neck scars if treated like the face. The laser guide walks the ladder.
- Best for
- Glogau III–IV texture in fair skin, after the field has been treated and checked
- Sessions
- 1 full-field, or 2–3 fractional
- Downtime
- 5–14 days by depth; pink for weeks to months
- Cost
- €2,000–3,500 full face (UK £2,000–3,500); €800–1,200 for a zone
4:5 · to be supplied
Moderate evidence Non-ablative fractional lasers (1550 / 1927 nm)
A randomised double-blind comparison found 1550 nm non-ablative and erbium fractional resurfacing both effective for photoaged Asian skin; the 1927 nm thulium wavelength treats photopigmentation with days rather than weeks of downtime. Softer results, safer in darker skin, three sessions.
Non-ablative fractional lasers (1550 / 1927 nm)
A randomised double-blind comparison found 1550 nm non-ablative and erbium fractional resurfacing both effective for photoaged Asian skin; the 1927 nm thulium wavelength treats photopigmentation with days rather than weeks of downtime. Softer results, safer in darker skin, three sessions.
A randomised double-blind comparison found 1550 nm non-ablative and erbium fractional resurfacing both effective for photoaged Asian skin; the 1927 nm thulium wavelength treats photopigmentation with days rather than weeks of downtime. Softer results, safer in darker skin, three sessions.
Non-ablative fractional lasers heat columns of dermis under an intact surface, trading depth of effect for days of downtime and a wider margin in darker skin. In a prospective randomised double-blind comparison, 1550 nm non-ablative fractional and 2940 nm ablative fractional erbium resurfacing were both effective and safe for photoaged Asian skin over three sessions (randomised comparison); the 1927 nm thulium device targets the epidermis where photopigmentation sits, with a dedicated study of facial photopigmentation (JDD, 2014). The middle rung: more than a peel, less than ablation, three sessions instead of one, and the sensible choice for Fitzpatrick IV–VI. The laser guide grades the devices.
- Sessions
- 3–4, a month apart
- Downtime
- 2–4 days of redness and bronzing
- Cost
- €300–600 per session
4:5 · to be supplied
Moderate evidence Medium-depth chemical peels (Jessner’s–TCA)
A systematic review finds medium-depth trichloroacetic acid peels effective resurfacing for photodamage and superficial keratoses; a controlled study reported 73% global photoaging improvement at three months. Cheaper than a laser, more operator-dependent, and a week of peeling.
Medium-depth chemical peels (Jessner’s–TCA)
A systematic review finds medium-depth trichloroacetic acid peels effective resurfacing for photodamage and superficial keratoses; a controlled study reported 73% global photoaging improvement at three months. Cheaper than a laser, more operator-dependent, and a week of peeling.
A systematic review finds medium-depth trichloroacetic acid peels effective resurfacing for photodamage and superficial keratoses; a controlled study reported 73% global photoaging improvement at three months. Cheaper than a laser, more operator-dependent, and a week of peeling.
Jessner's solution followed by 35% trichloroacetic acid coagulates the epidermis and upper dermis across the whole face, taking mottled pigment, roughness, fine lines and thin keratoses with it as the skin peels over a week. The systematic review of trichloroacetic acid peeling finds medium-depth peels effective resurfacing agents for photodamage (systematic review), and the classic reviews place the combination among the standard tools for Glogau II–III skin (JCAD review). Less reach than a laser into elastotic dermis, more pigment risk in darker skin than the non-ablative lasers, and dependent on the hand holding the gauze. The peel guide grades the depths.
- Sessions
- 1–3
- Downtime
- 5–7 days of peeling
- Cost
- €150–500
4:5 · to be supplied
Moderate evidence The neck, chest and hands
Poikiloderma of the neck and chest cleared by more than 80% after three intense pulsed light sessions in a 175-patient series with 5% transient side effects; hand lentigines answer to a Q-switched laser, hand texture to gentle fractional CO₂. Thin skin, no follicles to heal from, low settings.
The neck, chest and hands
Poikiloderma of the neck and chest cleared by more than 80% after three intense pulsed light sessions in a 175-patient series with 5% transient side effects; hand lentigines answer to a Q-switched laser, hand texture to gentle fractional CO₂. Thin skin, no follicles to heal from, low settings.
Poikiloderma of the neck and chest cleared by more than 80% after three intense pulsed light sessions in a 175-patient series with 5% transient side effects; hand lentigines answer to a Q-switched laser, hand texture to gentle fractional CO₂. Thin skin, no follicles to heal from, low settings.
The neck, the V of the chest and the backs of the hands are where sun damage shows and where treatment goes wrong: thin skin with few sebaceous glands heals slowly and scars from settings the face tolerates. For the red-brown mottling of poikiloderma of Civatte, the vessel-and-pigment machine is the right one — in a series of 175 patients (mean age 49, skin types I–III) three intense pulsed light sessions cleared more than 80% of the vascular and pigmented components with minimal transient side effects in 5% (175-patient series; 135-patient series). For the hands, the randomised side-by-side comparison favoured a Q-switched ruby laser over fractional CO₂ for lentigines (hands RCT), and a fractional CO₂ pilot improved pigment more than texture (hands pilot). Moderate on series rather than trials; the neck guide covers the neck's other treatments and the scarring caveat.
- Sessions
- 2–3 sessions
- Downtime
- 3–7 days of redness or flaking
- Cost
- €250–500 per session
4:5 · to be supplied
Editor's choice
Our picks
One per problem — where the evidence is actually good.
4:3 · to be supplied
The base
Daily broad-spectrum sunscreen
Carcinomas down 39%, invasive melanomas down 73%, measured aging down 24% in the randomised Nambour cohort — and existing damage 40–52% better in a year.
View details4:3 · to be supplied
For texture
A prescription retinoid
The one cream licensed for photodamage: eight randomised tretinoin trials, a 563-patient tazarotene trial, collagen restored on biopsy.
View details4:3 · to be supplied
For colour
Intense pulsed light
Telangiectasia improved in about 80% and pigmentation in 60–70% of faces in a blinded split-face trial — and wrinkles in none of them.
View details4:3 · to be supplied
For the field
A course of fluorouracil
Two to four weeks of cream cut squamous-cell carcinomas needing surgery by 75% in the year after, in 932 veterans with prior cancers.
View detailsPart 04
Safety
The field is a cancer risk: what to watch and when to go
A keratosis becomes a carcinoma in about two years; 6–10% of people with keratoses get one over a decade; a lentigo maligna hides among sun spots. A patch that thickens, bleeds, hurts, crusts or will not heal, a spot with an irregular edge or several colours, or anything new after sixty is an appointment, not a laser booking.
The field is a cancer risk: what to watch and when to go
A keratosis becomes a carcinoma in about two years; 6–10% of people with keratoses get one over a decade; a lentigo maligna hides among sun spots. A patch that thickens, bleeds, hurts, crusts or will not heal, a spot with an irregular edge or several colours, or anything new after sixty is an appointment, not a laser booking.
Sun-damaged skin is a cancer field, and the cosmetic treatments on this page are safe only on skin that has been looked at. Actinic keratoses progress to squamous-cell carcinoma at rates that vary by study but average about two years per event in the kinetics analysis (kinetics study), with a lifetime risk for someone carrying them of roughly 6–10% (progression review); squamous-cell carcinomas on the ear, lip and scalp are the ones that spread. Melanoma's warning signs are asymmetry, an irregular border, more than one colour, a diameter over six millimetres and any evolution — and the lentigo maligna type looks like a sun spot for years (DermNet). The red flags for a keratosis: thickening, bleeding, tenderness, a horn or crust, failure to heal in a month (warning signs). A laser or light clinic that treats spots without a dermatoscope is treating blind; ask who looked first.
Sunscreen: the vitamin D question, the amount, and the filters
Daily SPF 50+ lowered vitamin D by 5 nmol/L and raised deficiency from 37% to 46% in a 628-person trial — real and fixed by a supplement. Most people apply a fraction of the tested amount. Modern filters are regulated; tinted iron-oxide products add visible-light protection for pigment-prone skin.
Sunscreen: the vitamin D question, the amount, and the filters
Daily SPF 50+ lowered vitamin D by 5 nmol/L and raised deficiency from 37% to 46% in a 628-person trial — real and fixed by a supplement. Most people apply a fraction of the tested amount. Modern filters are regulated; tinted iron-oxide products add visible-light protection for pigment-prone skin.
Sunscreen's harms are small and specific. The vitamin D effect is now measured: a year of daily SPF 50+ produced a 5.2 nmol/L smaller rise in vitamin D than discretionary use and left 45.7% of daily users deficient against 36.9% of controls (Sun-D trial) — a supplement costing pennies replaces it, and the 1995 trial with SPF 17 found no effect at all (1995 trial). The commoner failure is dose: the trials that prevented cancer used enough product to coat the skin, and most people apply a fraction, so the SPF on the label is rarely the SPF on the face. Filters are regulated on both sides of the Atlantic; mineral zinc and titanium suit reactive skin, and tinted iron-oxide formulations add the visible-light protection that pigment-prone and darker skin needs (iron-oxide study). Any sunscreen used is better than the best one left in the drawer.
Light, lasers and peels on sun-damaged skin: pigment, scars, the neck
Every device that treats colour can cause it: post-inflammatory darkening in Fitzpatrick IV–VI, permanent confetti-like lightening after repeated laser toning, an atrophic scar in one of 32 patients in the IPL trial, and neck scarring from face-strength settings. Sunscreen afterward is not optional.
Light, lasers and peels on sun-damaged skin: pigment, scars, the neck
Every device that treats colour can cause it: post-inflammatory darkening in Fitzpatrick IV–VI, permanent confetti-like lightening after repeated laser toning, an atrophic scar in one of 32 patients in the IPL trial, and neck scarring from face-strength settings. Sunscreen afterward is not optional.
Machines that target melanin and haemoglobin injure the cells around them when the settings or the skin type are wrong. Post-inflammatory hyperpigmentation follows intense pulsed light, lasers and medium peels far more often in darker skin, which is why the non-ablative devices and lower settings are the rule there; repeated low-fluence laser toning has produced permanent confetti-like hypopigmentation (JCAD); the randomised IPL trial recorded one atrophic scar in 32 patients and three withdrawals for pain (JAMA Dermatology RCT); and the neck, with few follicles to heal from, has scarred after fractional CO₂ at settings the face tolerates (neck scarring). Treated skin is photosensitive for weeks and re-pigments in sun; a course of light in June without sunscreen is a course of light wasted. The laser guide covers the settings by skin type.
Tanning beds and the "base tan"
First use of a sunbed before 35 raises melanoma risk by 75% in meta-analysis and any use by 15%; a tan is DNA damage made visible and protects about as much as an SPF of 3. No cosmetic treatment on this page survives a sunbed habit.
Tanning beds and the "base tan"
First use of a sunbed before 35 raises melanoma risk by 75% in meta-analysis and any use by 15%; a tan is DNA damage made visible and protects about as much as an SPF of 3. No cosmetic treatment on this page survives a sunbed habit.
Indoor tanning delivers UVA at intensities the midday sun does not, and the epidemiology is settled: a meta-analysis of seven studies found first use before age 35 associated with a 75% increase in melanoma risk and any use with a 15% increase, and the World Health Organization classes the devices as carcinogenic (indoor-tanning review; JEADV 2025). The "base tan" sold as protection is the skin's response to injury and shields about as much as an SPF of 3; the melanoma risk from tanning is highest in exactly the young, fair users who buy it. Every treatment on this page — the retinoid, the light, the laser, the field therapy — is undone by a sunbed, and a clinic that offers both is not reading its own literature.
Part 05
Frequently asked questions
Can sun damage actually be reversed?
Partly, in layers
Can sun damage actually be reversed?
Partly, in layers
Yes, in layers. Stopping the dose lets the skin repair: in the one-year sunscreen study every subject improved, with texture and pigmentation 40–52% better. Retinoids reverse the biology — collagen restored on biopsy, wrinkles and mottling reduced in eight randomised trials. Light and lasers remove the colour that sun switched on; ablative resurfacing removes the elastotic surface and grows a new one; fluorouracil and photodynamic therapy clear the precancerous field. What none of them reverses is the mutated clones in the cells that remain, which is why sun-damaged skin stays a cancer risk after it looks better, and why the yearly look is part of the treatment.
SPF 30 or 50, and how much?
Either, applied properly
SPF 30 or 50, and how much?
Either, applied properly
The Nambour trial that cut carcinomas and melanomas used an SPF 15–16 sunscreen applied daily, and the one-year reversal study used SPF 30. The difference between 30 and 50 is small if both go on generously; the difference between a generous layer and the thin smear most people use is large, because SPF is tested at an amount few reach. So: broad-spectrum, SPF 30 or above, roughly half a teaspoon for the face and neck, every morning regardless of weather, carried to the ears, chest and backs of the hands, reapplied after two hours outdoors or after sweating, and a tinted iron-oxide formulation for anyone whose complaint is melasma or spots. The best sunscreen is the one you will use every day.
Do I need sunscreen indoors, in winter, or in the car?
By glass and in cars, yes
Do I need sunscreen indoors, in winter, or in the car?
By glass and in cars, yes
UVA — the wrinkle wavelength — passes through ordinary window glass and through cloud, which is why the office worker by the window and the driver on the window side photoage on one side. Vehicle measurements found side windows blocking 89% of UVA against the windscreen's 99%, a tenfold difference in what reaches the driver's cheek and forearm; a UV film closes the gap. Winter sun in northern Europe carries little UVB, so it rarely burns, but the UVA that ages skin varies far less through the year. Deep indoors away from windows, the dose is negligible and sunscreen is optional; beside a window, on a commute, on a cloudy walk, it is not.
Will sunscreen make me vitamin D deficient?
A little; take the tablet
Will sunscreen make me vitamin D deficient?
A little; take the tablet
The honest answer changed in 2025. The older trial with SPF 17 found no effect on vitamin D; the Sun-D trial with daily SPF 50+ found a real but small one — a 5.2 nmol/L smaller rise over a year and deficiency in 45.7% of daily users against 36.9% of controls — and concluded that regular users may need a supplement. The arithmetic is simple: 1,000–2,000 IU of vitamin D a day costs a few euros a month and carries no mutations; the ultraviolet dose needed to make the same vitamin in skin is the dose this page exists to prevent. Use the sunscreen, take the tablet, and get the level checked if you are indoors most of the year anyway.
What is that rough patch that keeps coming back?
A precancer; get it seen
What is that rough patch that keeps coming back?
A precancer; get it seen
A rough, scaly, pink or skin-coloured patch on sun-exposed skin that flakes off and returns in the same place is almost always an actinic keratosis, the visible tip of a mutated field. Individual keratoses regress about a quarter of the time; the field does not, and the interval from a keratosis to a carcinoma at the same site averaged about two years in the kinetics analysis, with a lifetime risk of roughly 6–10% for someone carrying them. A single lesion is frozen; several mean a field treatment — a course of fluorouracil cream, which also cut carcinomas needing surgery by 75% in the veterans' trial, or photodynamic therapy — and a yearly check afterward. A patch that thickens, bleeds, hurts or crusts is seen this month, not next year.
Is a tan safe? Does a "base tan" protect me?
No; SPF 3 at best
Is a tan safe? Does a "base tan" protect me?
No; SPF 3 at best
A tan is the skin's response to ultraviolet injury — melanocytes producing pigment because DNA has been damaged — and the protection it gives is about an SPF of 3, which no dermatologist would sell you in a bottle. Sunbeds deliver UVA at intensities the sun does not: first use before 35 raises melanoma risk by 75% in meta-analysis, and the devices are classed as carcinogens. Self-tanning lotions colour the dead outer layer with a sugar reaction, involve no ultraviolet, and are the only tan this page endorses; they do not protect, so the sunscreen goes over them.
I have dark skin — does any of this apply to me?
Pigment, not burns
I have dark skin — does any of this apply to me?
Pigment, not burns
Melanin absorbs much of the ultraviolet dose, so darker skin burns rarely, keeps its texture longer and grows far fewer keratinocyte cancers. Its sun problem is pigment: melasma and dark patches triggered not only by ultraviolet but by visible light, which produced darker and longer-lasting pigmentation than UVA in darker phototypes and which only iron-oxide-tinted sunscreens block. The devices on this page carry more pigment risk in Fitzpatrick IV–VI, which is why the non-ablative lasers and lower settings are the rule and why the dark-spots guide exists. Melanoma is rarer but deadlier because it is found late — on palms, soles and under nails, where sun is not the cause and nobody looks; any new dark streak or spot there is a dermatologist's appointment.
How long until I see something?
12 weeks to a year
How long until I see something?
12 weeks to a year
Everything here works through repair, and repair is slow. Daily sunscreen showed measurable improvement in the one-year study from week 12 and kept improving to week 52. Retinoids change the surface over three to six months and the dermis over a year; the tazarotene trial was still improving at week 52. Intense pulsed light and Q-switched lasers darken spots for a week before they flake, and colour is judged at a month after each of three sessions. Fluorouracil and photodynamic therapy are red and raw for one to four weeks and smooth at six. Ablative resurfacing is pink for weeks and judged at three months. Photograph in daylight before anything, and again a year in.
What is the cheapest thing that works, and the most effective?
€15 / month to €3,500
What is the cheapest thing that works, and the most effective?
€15 / month to €3,500
The ladder in euros: sunscreen, a three-inch brim and a vitamin D tablet (€15–40 a month, the only rung with cancer-prevention trials) → a prescription retinoid or adapalene (€10–30 a month, the only cream licensed for photodamage) → vitamin C and niacinamide under it (€15–60 a month) → a yearly skin check for anyone with a field (€80–200) → fluorouracil for the field (€20–60 a course) or photodynamic therapy (€900–1,300) → intense pulsed light or a Q-switched laser for colour (€600–1,500 for a course) → non-ablative fractional laser or a medium peel (€150–600 a session) → ablative resurfacing for the leathery face (€800–3,500). Oral photoprotectants, nicotinamide for the high-risk and self-tanner sit beside the ladder; sunbeds sit under it.
I am 25 — what actually prevents this?
Ordinary days
I am 25 — what actually prevents this?
Ordinary days
Photoaging is cumulative and mostly incidental, so prevention is a habit rather than a purchase. The trial-proven habit is daily broad-spectrum sunscreen on the face, neck, ears, chest and hands, every morning, in every season, reapplied when outdoors — the Nambour cohort cut its carcinomas, melanomas and measured aging with exactly that. A three-inch brim and shade between eleven and three cut the rest; a film on the car's side windows removes the driver's asymmetry; sunbeds are the one thing on this page with no safe dose. A retinoid from the late twenties rebuilds what slips through, and vitamin D comes from a tablet. The 30s guide covers the decade, and the inner-arm test will tell you at fifty how well it worked.
Interactive
Match a plan to your skin
Open the situation that is yours — each link jumps to the graded section, in the order to try them.
Leathery, coarsely wrinkled, sallow skin
Brown spots and blotchy colour on my face, chest or hands
A red, veiny, mottled neck and chest
Rough, scaly patches that flake and come back
I've already had a skin cancer
Darker skin, and patches that keep getting darker
I'm 25 and want to avoid all of this
The action plan
The plan, month by month
What happens in which order — and when it is fair to judge it. Stop the dose, check the field, repair the surface, treat colour and texture by the sign, look again every year.
Week 0: the arm test, the fingertip test, the photograph — and the skin check
Texture, pigment, vessels or rough patches; a daylight photograph of face, neck, chest and hands; a dermatologist’s look for anyone with a field, a sunbed past or a previous cancer.
Day 1 onward: stop the dose, start the repair
Broad-spectrum SPF 30+ every morning to the face, neck, ears, chest and hands; a brim; vitamin D from a bottle; a retinoid two nights a week, building to nightly.
Months 1–3: treat the field, then pick the machine by the sign
Fluorouracil or photodynamic therapy for keratoses; then intense pulsed light for colour, or resurfacing for texture — never on skin that has not been looked at.
Every year: the look, the sunscreen audit, the maintenance
A yearly skin check for anyone with a field; a light session for colour that has crept back; the retinoid and the sunscreen that keep it from creeping.
References & further reading
All claims cite peer-reviewed studies, randomised trials, meta-analyses or clinical series, linked inline within each section. Primary sources: PubMed/PMC, The Lancet, the New England Journal of Medicine, the Journal of Clinical Oncology, JAMA Dermatology, Archives of Dermatology, the British Journal of Dermatology, Dermatologic Surgery and the Journal of Drugs in Dermatology.
Educational content, not medical advice. Sun-damaged skin is a cancer field: any patch that thickens, bleeds, hurts or will not heal, and any spot with an irregular edge, several colours or a recent change, needs a dermatologist before it needs a laser — and every light or laser treatment on this page belongs to skin that has been examined first.