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Objectives: Melanoma, SCC, BCC and rosacea should not be missed or taken mistakenly by similar presentation of sun damage lesions in initial assessment and consultation. Psychological assessment of client is paramount in treating the sun damage facial skin as well as exclusion of the above skin lesion in order to achieve a better result and outcome with patient compliance.

Introduction: An accumulation of an elastotic material is a major histological characteristic of sun‐damaged skin. This elastotic material consists primarily of elastin fibers. Histological studies show loss of collagen in the dermis of chronically sun‐damaged skin. There is a significant correlation between decreases in length, width and total area of oxytalan fibers and severity of wrinkles.

Materials / method: Peter, a 62 years old Caucasian man, presented with extensive sun damaged skin. On assessment his DLQI score was determined as 24. He was embarrassed of Lichenificationof facial skin appearance. His facial skin was covered in deep wrinkles and uneven brown patches. He was diagnosed with severely sun damaged skin, AK, possible Rosacea and depression. He underwent a psychodermatological management concurrently with dermatology treatment.
His dermatological treatment combined both: oral medications and cosmetic interventions. He was prescribed a Lymecycline 408mg OD followed by Metronidazole.

Results: His depression resolved within 4 months’ with taking Prozac 20mg OD and CBT therapy sessions. Peter regained his confidence with smother and more even facial skin as opposed at the beginning of his treatment with his combination facial skin rejuvenation therapy of ; a Lymecycline 408mg OD followed by Metronidazole,3 sessions of TCA-chemical peel , microneedling and one session PRP(Platelet Rich Plasma).

Conclusion: A holistic approach is necessary when multi- skin damage is presented with consideration of the effect of skin disorders and mental state. The DLQI was designed to be simple and easy to use in a busy clinical setting: wide experience of its use has confirmed the appropriateness of this concept. Combination facial skin rejuvenation therapy as above in severely skin damage provides a better result in comparison to mono-therapy. Physician should consider and provide such a combination therapy in sever sun damage case

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Objectives: The aim is to discuss how retinoids contribute to anti-aging, share tips of how to best use them, and point out recommendations for their use for impending facial resurfacing procedures, including ablative and non-ablative lasers, dermabrasion, microdermabrasion and chemical peeling.

Introduction: Retinoids comprise vitamin A and its natural and synthetic derivatives. They are used as therapeuticals and anti-aging cosmeceuticals by modulating cellular differentiation and proliferation. Tretinoin is used as a priming agent before facial resurfacing to optimize success, reduce the risk of postinflammatory hyperpigmentation and accelerate epidermal healing. However, is pre-treatment with retinoids necessary before all resurfacing procedures? Regimens for tretinoin use differ among the different resurfacing procedures, in terms of the dose, length of application and time of discontinuation.

Materials / method: Pubmed was used as a search engine to review the literature for the following keywords: retinoids, tretinoin, retinoic acid, retinol, isotretinoin, adaptalene, anti-aging, skin aging, facial resurfacing, lasers, chemical peeling, microdermabrasion and dermabrasion. The relevant articles, studies and books published between 2000 and 2018 were carefully selected and analysed.

Results: For the best results, it is advisable to use retinoids at night, start with small amounts 2x/week and slowly increase the usage. It is important to concomitantly use moisturizers, apply sunscreen and anti-oxidants in the morning, and avoid waxing and laser hair removal. Among the resurfacing procedures, ablative lasers, dermabrasion and deep chemical peels require use of the highest tretinoin concentration (0.1%) for the longest duration (3 months). Microdermabrasion does not require tretinoin pre-treatment. Regimens for chemical peels are divided into 3 categories depending on the peel depth.

Conclusion: The appropriate use of retinoids within a healthy skin caring regimen results in optimal skin rejuvenation. It is highly recommended to use them prior to certain, but not all facial resurfacing procedures to obtain the best outcomes. However, they should be discontinued one day prior to any procedure and should not be started sooner than 3–4 weeks prior to facial resurfacing. The greater the depth of injury caused by the resurfacing procedure, the greater the benefit of pre-treatment with tretinoin. Here, the guidelines for the pre-operative use of tretinoin in facial resurfacing are shared.

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Objectives: The first step in UV induced and other skin disorders involves the induction of DNA damage. DNA is a language that consists of 4 letters. Change in the sequence of these letters forms nonsense signals which will eventually create nonsense proteins which will subsequently either give nonsense instructions or skip important steps during the cell’s mitosis leading to healthy cellular regeneration. Nonsense signals emitted by incomplete or erroneous protein formation results in a large variety of skin symptomatology

Introduction: DNA has the capacity to repair itself, by regaining its correct order via a process completed by Chromatin. Chromatin is like a librarian putting the books back in sequence after they have been disordered by readers) -- in this case the "books" are the "genes." Frequent DNA breakages due to ROS or other contaminate to aid DNA repair or by enhancing agents (eg the PI3K/AKT/mTOR pathway is an intracellular signalling pathway important in regulating the cell cycle cellular quiescence, proliferation and longevity.

Materials / method: Clinical studies offer visible improvement on diabetic and other wounds and certain skin disorders such as acne, Herpes Zoster, burns, pigmentations and psoriasis as well as anti-aging effects. However, until recently there has been no effort to apply this technology to precancerous conditions that may be more responsive to reversal than cancer. Recently a Clinical Dermatologist Nuris Lampe MD has started utilising signalling procedures on precancerous
conditions. Signalling either donates missing signals to nonsense protein sequences or triggers mechanisms that eliminate systemic garbage.

Results: Both DNA and proteins are composed by specific sequences of letters. Such sequences represent signals. Incomplete protein sequences need signals that will make them functional. The way incomplete letter sequences need letters that will make a word meaningful. Signalling technology donates the correct signals. The body absorbs the signal aspects to repair dismantled DNA and protein letter sequences. Bio-compatible signals are transmitted via electrons through the skin at extremely miniscule specific energies that have been mathematically proven to control the gates of cellular ion channels.

Conclusion: There are challenges with Signalling technology that is more advanced conceptually than the State of the Art in Electronics. Molecular research in proteins and DNA is progressing fast but studies often adopt a very limited perspective that does not quite fill in the gap between in vitro observations and clinical data. Additionally, molecular research often gives contradictory results, mostly because of methodology limitations or differential components in the context of each study’s experimental design. Continuous efforts both by clinical and histological studies is necessary.

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