The incidence of actinic keratoses (AKs), a common dermatologic diagnosis, is likely to continue to grow in the United States in coming years. AKs develop as a response to cumulative ultraviolet (UV) damage, so as the American population continues to age, Baby Boomers and members of subsequent generations are likely to develop these premalignant lesions. As an additional cause for concern, anecdotal reports suggest that some dermatologists are diagnosing precancerous and cancerous skin lesions in growing numbers of patients in their thirties or younger.Faced with growing incidence of skin cancers and precancerous lesions, American dermatologists tend to decry the public’s apathy toward sunscreen use and UV avoidance. While it may be the case that younger patients aren’t being UV savvy, we should reflect on the reality that many of our older patients lacked access to good quality, high sun protection factor (SPF) sunscreens with sophisticated technologies, for much of their lives. That means we have a population who have endured cumulative UV damage; thus, AKs have essentially become a hazard of aging.Because AKs are a disease of chronic UV exposure, we recognize that individuals who develop these lesions have photodamaged skin. As such, they likely already have pre-clinical AKs and/or can be expected to go on to develop additional AKs with time. The notion of field-directed treatment using topical AK therapies or destructive modalities aims to address these pre-emergent lesions, and the approach is gaining acceptance. Still, many clinicians and their patients prefer to use destructive modalities to target individual lesions in certain cases. Regardless of the type of treatment used, physical modalities or topical treatments, the cost of AK treatment has become a huge burden to our medical system, especially to Medicare. Therefore, it would be wonderful to prevent AK formation. We, as dermatology providers, have been trying to do that by continuously emphasizing the importance of using sunscreen to our patients all day, every day. I tell my patients “your sunscreen should sit next to your toothpaste and you should put it on right after brushing your teeth in the morning”. I also recommend that sunscreen use should not be reserved for special occasions such as hiking, biking, swimming, or only summer time use. I am happy to note that we have come a long way and become successful in our approach but apparently not one hundred percent since we still see a lot of patients with AKs every day.Wouldn’t it be a great idea if we had a product or an ingredient that would prevent AK formation before they became a problem? Ironically, the Nobel Prize in Chemistry 2015 was awarded jointly to Tomas Lindahl, Paul Modrich, and Aziz Sancar “for mechanistic studies of DNA repair”. Within the research of the Nobel team, a novel group of DNA repairing enzymes have emerged to do precisely that. Several products are now commercially available that contain the specific ingredient, photolyase, one of the DNA repairing enzymes shown to have clinical effect on human skin.1,2The basic research and clinical findings, which will be further discussed in this supplement, are very promising for dermatologists who recognize the very real challenge of managing actinic damage. The potential of a scientifically formulated product that provides a high SPF along with DNA repair enzyme photolyase is a welcome development for all our patients with actinic damage.2
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