28 Apr April is the Cruelest Month
APRIL is the cruelest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
Winter kept us warm, covering
Earth in forgetful snow, feeding
A little life with dried tubers.
Summer surprised us….
T.S. Eliot’s vaunted lines come to mind as we in central Oklahoma brace for an onslaught of severe weather including strings of tornados and destructive hail. There is little in the way of moderation when it comes to weather in this neck of the woods.
Nor has April been kind to me as concerns opportunities to write. Lest I find that my summer surprise is a complete absence of blog posts I had better get busy.
It is always surprising how quickly we find our lives sun-drenched, enjoying outdoor activities, and lingering in the warmth of long summer days. It’s time to think and behave proactively to protect our skin.
What are those mottled reddish-brown pigment and vascular changes that are accompanied by textural changes (sometimes referred to as “chicken skin”) found on the sides of so many people’s necks often with involvement of cheeks and anterior chest? Why is the area under the chin spared? Is treatment available?
Collagen, vascular, and pigment changes associate with chronic sun exposure of head, neck, and chest comprise a constellation called poikiloderma of Civatte (POC). The condition is more common in women than in men. In addition to cumulative sun exposure in genetically susceptible people there may be hormonal components such as estrogens and photosensitizing ingredients in cosmeceuticals that contribute to the development of POC. The area under the chin and over the Adam’s apple is spared as it receives far less UV exposure than affected skin surfaces. Not infrequently, early changes of POC can be detected in adolescence.
Treatment of POC is often unsatisfactory. Prolonged use of retinoids may improve the growth of damaged, thinned epidermis and dermis, but changes occur very slowly and are rarely dramatic. Additionally, retinoids are photosensitizing and can accelerate pathological changes and damage if used incorrectly.
Bleaching agents such as hydroquinone have been used in hopes of correcting pigment changes. They are of limited value in that the lacy red-brown pigment is due to the dilation of existing blood vessels and the development of new blood vessels.
Lasers and intense pulse light systems may offer some relief to textural and vascular changes. Vascular lasers and IPL systems address the enhanced vascularity, but their usefulness is limited by the fact the neck and chest are unforgiving tissues with little reserve. The potential of treatment induced pigment changes and scarring must always be considered.
While neither Fraxel nor PicoSure lasers directly addresses vascular components of the process they can be successful in ameliorating collagen changes that are at the root of the “chicken skin” textural changes seen in POC. These devises can also be helpful in correcting pigment changes associated with chronic sun exposure. Because of PicoSure’s ultra-short pulses and delivery of energy, treatment can be delivered more precisely with a far greater safety margin and with significantly less discomfort than with other form of fractionated laser energy.
Regardless of treatment options, selected sun avoidance, aggressive use of sunscreens and protective clothing, and avoidance of midday sun are critical for maintenance of treatment benefit and halting of continuance of the process of POC. Find your summer surprise in being smart as concerns summer sun exposure.