The Source Of Skin Damage

Most sun-related skin damage results from two specific wavelengths of ultraviolet (UV) radiation, UVA and UVB. When UV rays hit skin cells, they generate harmful free radicals that, in turn, alter the structure of proteins that form the skin and dry out the fats and water that naturally moisturize the skin. The consequence is that skin cells are damaged and cannot create healthy new cells. UV rays also damage the DNA in skin cells, preventing them from normal replication and increasing the long-term risk of skin cancer.

Excessive UV exposure accelerates normal age-related skin thinning and wrinkling and increases the risk of three different types of skin cancer—squamous cell, basal cell, and melanoma. People who are fair skinned have a higher risk of skin cancers compared with people who have dark complexions, and people with a lot of moles on their arms and legs have a higher-than-average risk of developing melanoma from sun exposure.¹

The most visible signs of sun damage usually appear on our faces, arms, and hands—a problem in a society that values youthful looks. Aside from smoking, excessive exposure to the sun has the greatest impact on our skin tone, causing hyperpigmentation, (“age spots”), deep lines and wrinkles, crow’s feet near the eyes, roughness, and redness.

As skin cancers go, basal cell and squamous cell skin cancers are easily treated with conventional medical procedures. Melanoma is far more serious because it can be aggressive and deadly. However, the research on UV exposure and melanoma risk is mixed. While UV exposure can increase the risk of skin melanoma, most melanomas develop where the body has little or no exposure to sunlight. UV rays don’t produce this damage immediately. It happens over many years, with repeated sun exposure, which gives us plenty of chances to correct and protect!  There’s some evidence—which is admittedly controversial—suggesting that sun exposure actually reduces the risk of dying from melanoma.

Eating Habits, Antioxidants, and Healthy Fats

Eating habits can strongly influence skin appearance and health, according to a study of people living in Greece, Sweden, and Australia. Mark L. Wahlqvist, M.D., of Monash University, Australia, and his colleagues investigated the diets and skin health of people age 70 years and older. People whose diets consisted primarily of fish, vegetables, olive oil, beans, and whole-grain cereals had significantly less skin damage and fewer wrinkles, regardless of their ethnic heritage or whether they lived in sunnier or cloudier climates. In contrast, people who ate a lot of full-fat milk, red meat (especially processed deli meats), potatoes, sugary soft drinks, and sweet pastries were more likely to suffer visible skin damage.

Wahlqvist wrote in the American Journal of Clinical Nutrition that polyphenolic flavonoids, a large family of antioxidants found in vegetables and fruit, “appear to be partially responsible for many of the protective effects against oxidative stress of the skin.”²

His findings are consistent with more detailed research on skin cells by Lester Packer, Ph.D., and Jens Thiele, M.D., at the University of California, Berkeley. The researchers carefully documented that skin cells contain a reservoir of antioxidants and fatty acids. These antioxidants protect against free radical damage, while the fatty acids help moisturize skin cells—both helping to keep the cells younger. Packer and Thiele found that antioxidants and fatty acids (think omega-3s and omega-6s) extend to protection against ozone and presumably other types of air pollutants.

Supporting Your Skin With Antioxidants

Considerable research has shown that taking antioxidant supplements—beta-carotene, lycopene, lutein, vitamin E, and Pycnogenol^®—offers some protection against sunburn and the consequential damage to skin. That’s significant because, according to Packer and Thiele, UV damage to the upper layer of skin cells begins after about two minutes of sun exposure.

In a study at the University of Arizona, Tucson, Ronald R. Watson, Ph.D., found that beta-carotene supplements reduced skin redness caused by exposure to UV rays.³ A similar study by German researchers found that taking a daily combination of 8 mg each of beta-carotene, lycopene, and lutein also reduced sunburn.⁴ Researchers have also reported that taking about 100 mg of Pycnogenol^®, an antioxidant complex derived from French maritime pine bark, also reduces the redness of sunburn and subsequent cell damage.⁵ Basically, the antioxidants reinforce the skin’s protection against UV damage.

Supplementing with lutein can help protect skin against damage from UV light. A 2020 study published in the Journal of Functional Foods had participants take either 20 mg of lutein or a placebo daily.⁶ After 12 weeks, the lutein group experienced a 22% increase in skin photoprotective activity, likely due to lutein’s antioxidant action and anti-inflammatory effects. Another study, published in the journal Clinical, Cosmetic and Investigational Dermatology, supplemented participants with 10 mg of lutein and 2 mg of zeaxanthin or placebo daily for 12 weeks.⁷ The group taking lutein showed a greater resistance to sunburn. Simply put, lutein supplementation increases the time it takes for UV exposure to cause a sunburn.

A study by researchers at the Technical University of Munich measured how daily supplements of vitamin E (1,000 IU) and vitamin C (2,000 mg) for eight days increased resistance to UV rays. They reported in the Journal of the American Academy of Dermatology that people taking the vitamins were about 34 percent more resistant to sunburn, compared with people taking placebos.⁸

Several studies have found that creams or lotions containing vitamin C can reduce fine wrinkles and the other damaging effects of UV radiation. In one of the studies, Steven S. Traikovich, D.O., of Phoenix, Arizona, found that a vitamin C-containing lotion reduced fine wrinkles and roughness and improved skin tone, compared with a lotion not containing the vitamin.^{9 10 11} Vitamin C is essential for the body’s production of collagen, one of the key skin forming proteins.

Vitamin D Influences Risk of Many Cancers

There’s quite a bit of controversy about sun exposure and vitamin D. When the skin is exposed to sunlight, it begins making vitamin D, and spending about 15 minutes in the summer sun, with arms and legs exposed, yields about 10,000 IU of vitamin D. But using any type of sunscreen blocks vitamin D production. Does that mean you should skip the sunscreen? The answer is complicated.

Of all nutrients, the “sunshine vitamin” appears to have the strongest protective effect on the risk of developing multiple types of cancer.¹² Vitamin D also gives the immune system a boost, likely countering the immune-suppressing effect of longer sun exposures. The catch, of course, is that exposure to sunlight can increase the risk of some types of skin cancer, such as basal and squamous cell carcinomas. However, recent studies have found that vitamin D can reduce the risk of melanoma, an especially aggressive form of skin cancer.¹³ And some research even suggests that vitamin D might play a role in reducing the risk of other types of skin cancer.¹⁴ So, with these apparent contradictions, what’s a person to do? Vitamin D expert Michael F. Holick, M.D. recommends “sensible” sun exposure plus vitamin D supplements, especially if you spend little time in the sun.

Michael Holick, M.D., of Boston University Medical School, and one of the top researchers and clinicians with respect to vitamin D, has pointed out that half of all Americans do not have optimal vitamin D levels. There are numerous reasons for this: Most foods (except for salmon and shiitake mushrooms) tend to be very low in vitamin D. Overweight people store much of their vitamin D in fat cells, so it’s not available to other tissues. People spend most of their time indoors, at work or at home, and they tend to apply sunscreens when outside. And about one-third of Americans have a genetic trait that reduces their vitamin D activity.

The implications are serious. Inadequate vitamin D increases the risk of osteoporosis, type-2 diabetes, heart disease, and many different types of cancer. Holick has pointed out that people with the greatest sun exposure have relatively low risk of developing colon, breast, and prostate cancer—presumably because vitamin D protects against these cancers. 

Holick has noted, controversially, that people who work in the sun have a lower risk of developing melanoma (but not basal or squamous cells skin cancers).¹⁵ Along these lines, a study by Marianne Berwick, Ph.D., of the University of New Mexico, Albuquerque, found that people who had a lot of exposure to the sun as children or young adults were less likely to die from melanoma, if they developed the disease later in life.¹⁶

Berwick suggested two possible reasons why sunlight might protect against the most deadly melanomas. One is that the sunlight-induced vitamin D curbs cancer proliferation, and the other is that tanning darkens the skin and increases DNA repair processes, possibly leading to less aggressive melanoma.

Another study by Berwick, published in the November 2009 Journal of Clinical Oncology, found that people with the highest blood levels of vitamin D at the time of their melanoma diagnosis had thinner tumors and lived longer, compared with people who had low vitamin D levels.¹⁷

The science is admittedly murky here, and it may seem like an unfair tradeoff between using the sun to make your own vitamin D and having a greater risk of skin cancer. However, there is a solution that many experts, including Holick and many dermatologists now recommend: use sunscreen if you’re planning to be in the sun for more than 10 minutes and take vitamin D supplements. Bear in mind that the inability to tan is the top risk factor for developing skin melanoma.

Dose: 2,000 to 5,000 IU daily.

Some Practical Advice

So much of the research on sunlight, vitamins, and cancer risk raises many more questions than answers. But I’ll offer some guidelines for you to follow.

First, if you’re light skinned, you’re more likely to burn than if you have a dark complexion. You’re also more likely to burn at high altitudes (think Colorado) because the thinner air does not block as much UV as the thicker air at sea level. Frequent sunburns, especially when you’re relatively young, increase the odds of skin damage and skin cancer later in life.

Second, if you have a lot of moles on your arms and legs, you have a higher risk of skin cancer if you are exposed to excessive UV rays. This risk applies to skin cancers at locations other than where the moles are located.

Third, think in terms of “inside-out” sun protection. Start by eating a Mediterranean-style diet, with fish and other healthy proteins and a lot of vegetables, which will help you maintain high antioxidant levels—not just in your skin, but throughout your body. This type of diet will lower your risk of most diseases.

Fourth, taking several supplements will further increase your “inside” defenses against UV rays. Mixed carotenoids (beta-carotene, lycopene, lutein), vitamin E, and Pycnogenol^® can bolster your skin’s defenses. Taking at least 2,000 to 5,000 IU of vitamin D daily—especially if you’re the indoors-y type—will reduce your risk of a wide range of cancers.

Fifth, Dr. Holick recommends always applying sunscreen to your face, which is only about 9 percent of your skin. He suggests moderate sun exposure, about 10 minutes, with sunscreen applied to other exposed parts of your body if you plan to be in the sun any longer.

A Topical Approach

Lathering on a natural sunblock is one step for protecting the skin. You’ll find hundreds of products on the market, but look for those that use minerals (e.g., titanium dioxide and zinc oxide) to physically block or deflect the sun’s rays.¹⁸ Some researchers have noted that chemical-based sunscreens have the potential to cause skin damage by creating cell-damaging free radicals. To combat this, look for sunscreens that contain antioxidants like vitamin C and E, or green tea extract.

To further protect the skin from damage, or to reverse some of the damage that has already been done, look for facial care products and body lotions that contain vitamin C—numerous studies have found that the topical application of vitamin C reduces damage from the sun.^{19 20 21 22} Other protective and rejuvenating ingredients to look for include retinol, a form of vitamin A that increases cellular turnover and prevents the breakdown of collagen²³ (look for it in a night cream, as retinol can cause sensitivity to the sun), and sea buckthorn, rich in the antioxidants A, C, and E and essential fatty acids that protect the skin from UV damage.

Topical products, however, are only part of the solution. It’s also important to nurture and protect the skin from within—nutrients travel via the bloodstream to the skin, where they boost our innate defenses against UV rays.

Antioxidants

The skin contains a reservoir of antioxidants that help protect against UV-induced free radicals and cell damage. In fact, some research has found that antioxidants can partially protect against sunburn.²⁴ Studies have found that vitamin E is the predominant antioxidant in the uppermost layer of skin cells,²⁵ but vitamin E levels decrease substantially when the skin is exposed to UV rays, so a little extra (internally or topically) can be helpful.²⁶ Other protective antioxidants include beta-carotene, lycopene, epigallocatechin gallate (EGCG, the primary antioxidant in green tea), and the antioxidant complex Pycnogenol^®.^{27 28 29}

Try: Choose individual antioxidants, opt for a multi-antioxidant formula, or look for lotions that contain them.

Astaxanthin

This antioxidant also stands out for protecting against and reversing sun damage. In studies of both men and women, astaxanthin supplements and topical applications of a liquid extract of the antioxidant, reduced crow’s feet and age spot size, while improving skin tone after six to eight weeks.³⁰

Try: 6 mg of astaxanthin daily, plus topical use of a cream containing astaxanthin.

Niacinamide

This form of vitamin B3 can reduce the numbers of actinic keratoses (AKs), a type of precancerous growth on the skin. AKs are crusty or rough areas of skin caused by many years of sun exposure, and they are most commonly found on the face, neck, and tops of hands. In a recent study, Australian doctors asked 76 patients (each with at least four AKs) to take either niacinamide or placebos twice daily for four months. People taking the vitamin averaged a 29 to 35 percent reduction in their numbers of AKs. The results were especially significant given that the majority of patients had previously been diagnosed with skin cancers.³¹

Try: 500 mg twice daily.

The take-home message is to enjoy some sun exposure while also minimizing UV damage to the skin. Adopting an inside-out approach to skin care before and after being out in the sun is without question the most sensible approach.

References

1. Rieger E, Soyer HP, Garbe C, et al. Overall and site-specific risk of malignant melanoma associated with nevus counts at different body sites: a multicenter case-control study of the German Central Malignant-Melanoma Registry. Int J Cancer, 1995;62:393-7.
2. Purba M, Kouris-Blazos A, Wattanapenpaiboon N, et al. Skin wrinkling: can food make a difference? Journal of the American College of Nutrition, 2001;20:71-80.
3. Lee J, Jiang S, Levine N, Watson RR. Carotenoid supplementation reduces erythema in human skin after simulated solar radiation exposure. Proc Soc Exp Biol Med, 2000;223:170-174.
4. Heinrich U, Gärtner C, Wiebusch M, et al. Supplementation with beta-carotene or a similar amount of mixed carotenoids protects humans from UV-induced erythema. J Nutr, 2003;133:98-101.
5. Saliou C, Rimbach G, Moini H, et al. Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract. Free Radic Biol Med, 2001;30:154-60.
6. Žmitek K, Žmitek J, Butina MR, Hristov H, Pogačnik T, Pravst I. Dietary lutein supplementation protects against ultraviolet-radiation-induced erythema: Results of a randomized double-blind placebo-controlled study. Journal of Functional Foods. 2020; 75: 104265. Doi:10.1016/j.jff.2020.104265
7. Juturu V, Bowman JP, Deshpande J. Overall skin tone and skin-lightening-improving effects with oral supplementation of lutein and zeaxanthin isomers: a double-blind, placebo-controlled clinical trial. Clin Cosmet Investig Dermatol. 2016;9:325-332. Published 2016 Oct 7. doi:10.2147/CCID.S115519
8. Eberlein-König B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol, 1998;38:45-8.
9. Humbert PG, Haftek M, Creidi P, et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol, 2003;12:237-244.
10. Farris PK. Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Dermatol Surg, 2005;31:814-817.
11. Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Archives of Otolaryngology, Head and Neck Surgery, 1999;125:1091-1098.
12. Grant WB. Update on Evidence that Support a Role of Solar Ultraviolet-B Irradiance in Reducing Cancer Risk. Anticancer Agents Med Chem. 2013;13:140-146.
13. Vinceti M, Malagoli C, Fiorentini C, et al. Inverse association between dietary vitamin D and risk of cutaneous melanoma in a northern Italy population. Nutr Cancer, 2011;63:506-513.
14. Tang JY, Fu T, LeBlanc E, et al. Calcium plus vitamin D supplementation and the risk of nonmelanoma and melanoma skin cancer: post hoc analyses of the women’s health initiative randomized controlled trial. Journal of Clinical Oncology, 2011;29:3078-3084
15. Lampe F, Snyder S. Conversations: Michael Holick, M.D., Ph.D.: Vitamin D Pioneer. Alternative Therapies, 2008;14:64-75.
16. Berwick M, Armstrong BK, Ben-Porat L, et al. Sun exposure and mortality from melanoma. Journal of the National Cancer Institute, 2005;97:195-199.
17. Newton-Bishop JA, Beswick S, Randerson-Moor J, et al. Serum 25-hydroxyvitamin D3 levels are associated with breslow thickness at presentation and survival from melanoma. J Clin Oncol, 2009;27:5439-5444.
18. Carrera C, Puig-Butillè JA, Aguilera P, et al. Impact of Sunscreens on Preventing UVR-Induced Effects in Nevi: In Vivo Study Comparing Protection Using a Physical Barrier vs Sunscreen. JAMA Dermatol, 2013;149:1-11. doi:10.1001/jamadermatol.2013.398.
19. Sauermann K, Jaspers S, Koop U, Wenck H. Topically applied vitamin C increases the density of dermal papillae in aged human skin. BMC Dermatol. 2004 Sep 29;4(1):13.
20. Raschke T, Koop U, Düsing HJ, Filbry A, Sauermann K, Jaspers S, Wenck H, Wittern KP. Topical activity of ascorbic acid: from in vitro optimization to in vivo efficacy. Skin Pharmacol Physiol. 2004 Jul-Aug;17(4):200-6.
21. Humbert PG, Haftek M, Creidi P, Lapière C, Nusgens B, Richard A, Schmitt D, Rougier A, Zahouani H. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003 Jun;12(3):237-44.
22. Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999 Oct;125(10):1091-8.
23. Wadyka, Sally. “The Thing About Retin-A: It Works.” The New York Times. Nov 30 2006.
24. Stahl W, Sies H. β-Carotene and other carotenoids in protection from sunlight. Am J Clin Nutr, 2012;96:1179S-84S.
25. Packer L, Valacchi G. Antioxidants and the response of skin to oxidative stress: vitamin E as a key indicator. Skin Pharmacol Appl Skin Physiol, 2002;15(5):282-90.
26. Thiele JJ, Traber MG, Packer L. Depletion of human stratum corneum vitamin E: an early and sensitive in vivo marker of UV induced photo-oxidation. J Invest Dermatol, 1998;110:756-61.
27. Rizwan M, Rodriguez-Blanco I, Harbottle A, et al. Tomato paste rich in lycopene protects against cutaneous photodamage in humans in vivo: a randomized controlled trial. Br J Dermatol, 2011;164:154-162.
28. Evans JA, Johnson EJ. The role of phytonutrients in skin health. Nutrients. 2010 Aug;2(8):903-28.
29. Marini A, Grether-Beck S, Jaenicke T, et al. Pycnogenol^® effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acidsynthase in women. Skin Pharmacol Physiol, 2012;25(2):86-92.
30. Tominaga K, Hongo N, Karato M, et al. Cosmetic benefits of astaxanthin on human subjects. Acta Biochimica Polonica, 2012;59:43-47.
31. Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL. Oral nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials. J Invest Dermatol. 2012 May;132(5):1497-500.