Sun damage symptoms include hyperpigmentation, premature aging (lines, wrinkles and loose sagging skin), rough skin texture and redness. These symptoms manifest in areas of chronic exposure, such as the face; ears; neck; back of hands; chest; arms; legs; forearms; lip and scalp. The buttocks and upper inner arms are usually preserved and a good way to see the difference between symptoms due to aging versus those that are due to damaging UV rays.
Hyperpigmentation from UV rays can manifest in those first childhood freckles (ephilides) on up to diffuse hyperpigmentation, dark spots (lentigines) and melasma (chloasma). While sun exposure is the primary cause of hyperpigmentation, there are a number of other causes as well. For more information see What is Hyperpigmentation and Its Causes.
Lines and Wrinkles
Lines and wrinkles are the first signs and symptoms of sun damage and aging. UVA and UVB rays from the sun and tanning beds destroy collagen—the protein that provides support and strength to the skin. It causes an influx of collagenase, an enzyme that breaks down collagen. Certainly, collagen becomes hard, stiff and breaks down as we age, but UV exposure speeds up this process. This creates fine lines around the eyes, then around the lips, on the forehead and eventually visible creases all over the skin.
Loose, Sagging Skin
Loose, sagging skin is a main sign of sun damage. Elastin, a protein in skin that enables it to snap back into place, begins to stretch and have less spring with age, but sun exposure hastens this process. UVA and UVB rays trigger an influx of elastase that breaks down and destroys elastin. Due to elastin and collagen loss, skin loses firmness, appears crepey and cannot withstand gravity. Creases develop alongside the mouth, called nasolabial folds and marionette lines, plus skin loosens along the jawline, commonly referred to as jowls. Abnormal elastin accumulates and manifests as solar elastosis; the skin yellows and has nodular alterations in sun-exposed areas.
Rough, Uneven Texture
Rough, uneven texture is another main sign of sun damage. Repetitive exposure to UV rays cause textural changes, such as varied skin thickness, enlarged pores, rough, scaly patches (Actinic Keratoses and actinic chelitis), dullness and a coarse, bumpy texture including solar comedones.
The outermost layer of the skin (epidermis) breaks down or atrophies, making it thin and fragile. The deeper layer of the skin (dermis) thickens as a result of overexposure to UV radiation. This thickened skin makes the wrinkles on the forehead and around eyes more pronounced, giving the skin a coarse or leathery appearance. (How ironic that the process of treating leather is called tanning.) How does this happen? Collagen fibers in the deeper layers of the skin (papillary dermis and reticular dermis) become increasingly replaced by thickened and curled fibers that form tangled masses.
Enlarged Pores result from continual sun exposure and excess oil production, which thickens the skin and creates a rim that exaggerates pore size. When UV rays damage collagen and elastin, the pore diameter stretches and dilates, the tissues beneath the skin shrink, pulling down the edges of the pores, causing them to appear enlarged. Oil, dead skin cells and bacteria clog the opening and expand the diameter of the pore and further heighten pore visibility.
Actinic Keratoses, also called solar keratosis or sun spots are rough, scaly, dry or horn-like patches resulting from sun damage. These can be as small as a pinhead to over an inch in diameter, and flat or raised. They can be the same color as ones skin, but are usually light or dark, tan, pink, red, or a combination thereof. Keratoses may itch or have a pricking or tender sensation, especially after being in the sun and may even bleed. They appear in mainly fair-skinned people on sun-exposed areas. Actinic keratoses can be precancerous and potentially turn into skin cancer if untreated. Actinic chelitis includes thickened, whitish discoloration at the border of the lip with possible scaling on the lips and is more common in males with fair complexions.
An additional sun damage symptom is solar comedones that may appear in the middle aged and elderly. These blackheads, whiteheads or cysts are seen with solar elastosis in smokers; referred as Favre-Raucouchot syndrome.
Redness and Dilated Capillaries
Dilated capillaries are a telltale sign of sun damage, also known as telangiectasia, couperose and mistakenly, “broken” capillaries. When UV exposure breaks down the collagen and elastin that comprises the thin capillary walls, they lose their ability to expand and constrict, becoming permanently dilated. These red or pink thread-like lines, are usually < 0.2 millimeters wide and primarily appear on the legs, face and nose. Several dilated capillaries clustered together may appear like a red patch or a bruise that never fades. Sun damage may also appear in fair skinned adults as Poikiloderma of Civatte—redness plus darkened and lightened skin.