Sun damage is what years of ultraviolet light leave behind in the skin: brown spots, fine red veins, rough texture and lines. It behaves as four separate concerns rather than one, and most of it comes from ordinary daily exposure rather than deliberate tanning. Sun damage is assessed and treated at Coastal Dermatology + Aesthetics in San Luis Obispo.
It looks like one problem. It is really four.
People say sun damage as though it were a single thing. It is at least four, and they arrived together because they share a cause rather than because they are the same condition. Which of the four you actually have decides everything that follows, and most people have some of all of them.
The brown. Sun spots and age spots. Flat, tan to dark brown, with clear edges, across the face, chest, shoulders, forearms and the backs of the hands. If instead of separate spots you have a soft symmetrical patch across the cheeks or upper lip, that is a different condition with a different plan.
The red. A general flush across the nose, cheeks and upper chest, plus the fine broken veins you can pick out when you look closely at the sides of the nose.
The rough. Dry, coarse, uneven skin and pores that look larger than they used to. Sometimes rough, scaly patches that catch on a towel and come back after they flake off. Those are a separate matter entirely and they get examined rather than polished over.
The lined. Fine lines, deeper wrinkles, crepey skin and a jawline that has softened, because years of ultraviolet light wore down the support underneath.
The brown, the red, the rough and the lined. They came from one cause and they are not one problem, which is why a plan built around the mix you actually have beats any single treatment.
What causes it
Almost none of it happened at the beach
Ultraviolet light reaches past the surface into the living layers of the skin, wears down the collagen and the springy fibers that hold everything taut, and pushes the cells that make your color into producing it unevenly. None of that happens in one afternoon. Most of your exposure was incidental: the drive to work with one arm at the window, walking the dog, standing on a sideline, twenty minutes outside at lunch five days a week for decades. People picture sunburns and vacations. The bulk of what shows on a face was collected in unremarkable pieces.
Fog is not shade, and a tan is not protection
Cool air and a marine layer hide how strong the light is, so protection gets skipped and the exposure lands anyway. Most of the sun damage on the Central Coast is on people who would tell you they have never once laid out to tan. Color itself is the injury showing rather than a defense against it, and tanning beds do the same thing on a schedule.
Some of it is simply who you are
Fair skin, light eyes, freckling as a child and your family’s pattern all decide how early it shows. Deeper skin tones are not exempt. The damage shows up more as uneven color and less as lines, which is why it goes unnamed for longer and why it is worth having identified rather than assumed. Smoking and some medications that make skin sensitive to light both push it along.
Because it is four concerns, it is treated in categories rather than with one thing. Pigment, surface redness, texture and lines that stay when your face is still each respond to a different family of in-office treatment, with prescription-strength skin care and daily sun protection sitting underneath all of them. Which combination fits depends on how much of each you have and on your skin. The chips above are where each of those goes.
Skin aging over four and a half years in adults asked to use sunscreen every day, against those who used it at their own discretion. The daily group showed no detectable increase in skin aging at all across the trial. [1]
Your inner arm is the control group
Here is a comparison you can run right now, and it settles the question better than any before-and-after photograph. Look at the skin on the inside of your upper arm. Then look at the back of your hand, or your forearm, or your chest.
Same person. Same age. Same genes. Same diet, same sleep, same everything. The only meaningful difference between those two patches of skin is how much light they have taken over your lifetime. Whatever gap you can see is not aging. It is exposure.
| What to compare | Protected skin, inner upper arm | Exposed skin, back of hand or chest |
|---|---|---|
| Color | Even, one tone throughout | Scattered brown spots with clear edges, and a general unevenness |
| Texture | Smooth, fine surface | Coarser, drier, with pores that read as larger |
| Firmness | Springs back when you pinch it | Slower to settle, and thinner to the touch |
| Lines | Few, and only where the skin folds | Fine crosshatching that stays when the skin is still |
| Redness | None to speak of | Background flush and fine visible vessels |
Two things follow from that. The first is that a good part of what people call looking older is not a fixed inheritance, which is why treatment works as well as it does. The second is more useful: whatever the gap looks like today, protection from here changes how wide it is in ten years. In a trial of 903 adults over four and a half years, the group asked to use sunscreen daily showed no detectable increase in skin aging, 24 percent less than the group who used it when they thought of it. [1]
Broad spectrum, SPF 30 or higher, water resistant, applied before you go outside and reapplied every two hours out there. [2] That is the whole instruction, and it is the only part of this page you can start today.
Areas we treat
Face
All four at once, and where most people notice it first.
Chest and décolletage
Brown spots and background redness, on thin skin that shows everything.
Neck
Crepey texture and uneven color, often ahead of the face.
Shoulders and upper back
Where old sunburns concentrate, and easy to forget about.
Forearms and backs of hands
Steady exposure through a car window, year after year.
Scalp and ears
Especially where hair has thinned, and the most commonly skipped areas of all.
Dr. Kilcline and her staff are amazing to work with…everyone is always so friendly!
The Coastal difference
Two things get looked at, not one
Sun-damaged skin is exactly where skin cancers turn up, so this is a face that gets a medical eye on it before anything cosmetic is planned. If something in the area needs a skin check rather than a cosmetic plan, you are already in the right building. Rough, scaly patches can be an early precancer, and they are examined rather than resurfaced over. That order is not a preference. It is the correct sequence, and it is the practical difference between a dermatology practice and a treatment room.
The second job is telling the four apart, and telling them apart from the things that imitate them. A soft brown patch across the cheeks is not a cluster of sun spots and behaves differently. Background redness can be flushing rather than sun. Skin that has lost its firmness is not the same as skin that has lost its evenness. Sorting that out is the first ten minutes of the visit, and it decides everything after it.
The medical question and the cosmetic one, in the same appointment. Anything rough or scaly gets examined before anything gets treated, which is the order that matters on sun-damaged skin.
Is it right for you?
This is a good conversation to have if:
- You have brown spots, background redness, rough texture or fine lines you would like improved
- You have spent years outdoors on the Central Coast and your skin shows it
- You want to know which of the four you actually have before you spend anything
- Something has changed in your skin and you would like it looked at properly at the same time
- You want a plan rather than a product
Bring it in first if:
- You have a rough or scaly patch that flakes and returns in the same place
- A spot has changed in size, shape or color
- You have a soft, symmetrical brown patch rather than separate spots
There is no obligation attached to finding out. Some people come away with a course of treatment and some come away with a sunscreen recommendation and a plan to check back, and we will tell you plainly which one you are.
Holding onto the result
Whatever you have done, the thing that decides how long it lasts is what happens on ordinary days afterward.
Worth doing
- Broad spectrum, SPF 30 or higher, water resistant, before you go outside and reapplied every two hours out there [2]
- Every day, including the overcast ones, which on this coast is most of the point
- A hat with a brim, which covers scalp, ears and nose at once
- Sunglasses with UV protection, since the skin around the eyes shows it early
- Treat the backs of your hands and your chest as part of your face, because they age on the same schedule
Worth knowing
- A tan is the injury showing rather than a defense against it, and tanning beds do the same thing indoors
- Fog and cool air hide how strong the light is. The exposure lands regardless
- A car window blocks some ultraviolet light and not all of it
- Skin tone does not exempt anybody. On deeper tones sun damage shows more as uneven color than as lines
- Anything rough, scaly or changing gets looked at rather than treated cosmetically
Treatments we offer
Pigment, redness, texture and lines each have their own route, with daily protection underneath all of them. Pick a treatment to see how it works.
What treatment costs
What a plan costs depends entirely on which of the four you are treating and how much of each. That is worked out at the consultation, where you get a plan and the cost of it before anything is booked.
What it is
The brown, the red, the rough and the lined, all from the same cause
Where it collects
Face, chest, shoulders, forearms and the backs of the hands
Where most of it came from
Ordinary daily exposure rather than deliberate tanning
What protection is worth
24% less skin aging over four and a half years with daily sunscreen [1]
Sun damage frequently asked questions
The comparison that settles it. The skin inside your upper arm against the back of your hand, same person and same age. The gap between them is exposure rather than aging. The inner-arm comparison above walks through what to look at.
Offered at
Want to know which four you have? Request an appointment
Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form.
Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment.
Sources and medical review
1. Hughes MCB, Williams GM, Baker P, Green AC. “Sunscreen and Prevention of Skin Aging: A Randomized Trial.” Annals of Internal Medicine. 2013;158(11):781-790. Randomized, controlled, community-based intervention in 903 adults younger than 55, followed for four and a half years. States that “skin aging from baseline to the end of the trial was 24% less in the daily sunscreen group than in the discretionary sunscreen group (relative odds, 0.76 [95% CI, 0.59 to 0.98])” and that “the daily sunscreen group showed no detectable increase in skin aging after 4.5 years.” PMID 23732711. https://pubmed.ncbi.nlm.nih.gov/23732711/ · Peer-Reviewed Study
2. American Academy of Dermatology Association. “How to select a sunscreen.” Broad spectrum, SPF 30 or higher, water resistant, applied before going outside and reapplied every two hours outdoors and after swimming or sweating. https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice. Results vary with your skin, how much damage there is, which treatment you have and whether you keep up sun protection. Light and laser treatment carries risks including burns, blistering and lasting changes in skin color, and that risk is higher on deeper skin tones and on recently tanned skin. Rough or scaly spots are examined before any cosmetic resurfacing. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment.