Dr Kopelson on Sun Spots, UVA/UVB, and Acne

At the Kopelson Clinic, I see patients every day that ask about sun damage, how to choose sun protection, and how to treat acne when Accutane and Retin-A don’t work. We’ve done a lot to help people repair sun damage, and reduce the effects of acne, and along the way encountered many difficult cases that required expert diagnosis and out-of-the box thinking. Here a few tricky questions and my answers. Hope it helps you!

1. I have little brown sunspots on my face, although I wear 15 SPF sunblock regularly. Though admittedly, I only started doing that in the last couple years—I am in my early 30s now. How can I get rid of these spots and prevent future ones?

Brown spots are the result of cumulative sun exposure over one’s lifetime and a hereditary predisposition to developing them. We can’t erase our past sun exposure but we can start to protect our skin from the sun on a daily basis in order to prevent further damage.

The SPF of a sunscreen is only a measure of its UVB protection. Proper sun protection must take into consideration the UVA blockage as well. Find a sunscreen with a UVB that is greater than 50 with one of the following UVA blockers: Avabenzone (Parsol 1789), Mexoryl, Titanium Dioxide, or Zinc Oxide. Apply this daily to optimize sun protection and to reduce the risk of developing more brown spots.

The 21st century has seen numerous technological advancements in the field of laser surgery. Many lasers and light machines can completely remove brown spots and return the skin to a more youthful, uniform tone. Many dermatologists can offer these treatments; many spas as well. BE CAREFUL. These machines are dangerous and can burn the skin. I would recommend that you have the procedure by a doctor you trust, not by a spa offering the best deal.

2. I have oily skin and can’t even use moisturizer — it makes me break out. I am concerned about sun damage though and would like to find one with ingredients my skin can handle. Over the last couple of years I’ve been hearing about mexoryl—could I use that?

Yes, you may try the chemical sun-blocking agent, mexoryl, approved by the FDA a couple of years ago (Best places). It is an excellent UVA blocker but the sunscreen containing it should and will most likely contain UVB protection as well. Also, be careful. It is often not the actual sun-blocking agent that is comedogenic (causing blackheads and whiteheads). It is the base of the sunscreen that will cause breakouts or oily skin. Look for products that are non-comedogenic, non-acnegenic, oil-free, water based and hypoallergenic.

3. I am in my late 30s and I still have acne! I tried Retin-A and it worsened. I’ve tried Accutane and the side effects were horrible. I am willing to get regular facials, exfoliate, and to do anything I can, given my skin is very sensitive, Do you have any suggestions for a regular routine that will calm down my acne without making me dry and irritated?

Yes. There are new lasers and light machines that are remarkably effective on patients that cannot use or do not want to use medications. Acne treatment is not as simple as it might seem. Lasers can biochemically address the inflammatory component of acne. There are several different kinds of acne, requiring different classes of medications and/or lasers. Many aestheticians do wonderful extractions but facials do not address all types of acne. Exfoliating is not always a good thing to do for the skin; acne does not come from dirt or oil that must be removed. Please be gentle with scrubs.

Acne treatment on sensitive skin is even more complicated than treating oily skin. In order to be given the best and safest advice and to see if you are a candidate for acne treatments using lasers, one should see a dermatologist (medical doctor) with scientific understanding of the skin and its medical conditions.