Classification of sun-damage
There are many schema that classify sun-damage and aging skin. Dr Caswell tends to use Dr Rubin’s methodology, as it best describes the skin that she encounters. (1)
Rubin’s Level One
- No wrinkles, early photo-aging
- Clinical signs are due to alteration in the epidermis only
- Most abnormalities are of pigmentation and texture: including freckles, lentigines, and a dull rough skin texture (due to the increased thickness of the stratum corneum)
Rubin’s Level Two
- Wrinkles in motion
- Early to moderate photo-aging
- Clinical signs are due to alternations of the epidermis and papillary dermis, and are also often related to abnormal pigmentation
- Damage may have all of the same clinical signs as those with Level I damage
- The textural and pigmentary changes are more marked. They may have actinic keratoses, liver spots (senile lentigines, or flat seborrheic keratosis) and definite increase in wrinkling (usually around the eyes and the naso-labial folds)
Rubin’s Level Three
- Wrinkles at rest (wrinkles have become folds)
- Advance photo-aging
- Obvious dyschromia, telangiectasia’s (broken capillaries)
- Changes have occurred in the epidermis, papillary dermis and reticular dermis, sometimes a yellowish tint to the skin
- Thickened leathery appearance
Though not definitive, for example individuals may experience telangesica but not necessarily have wrinkles at rest, it is a good general description.
In population groups that do not have Australia’s intense sun exposure from an early age, (from the northern hemisphere) it is not unusual for a women of 45 to fit Level Two. However in Australia, and perhaps more so in rural Australia, the same age group commonly fits into Level Three.
To help grade and measure treatment changes Dr Caswell utilizes Beau Visage technology, all photographs are free of charge to clinic users, to find out more about this technology go to:
To make an appointment with Dr Caswell phone 02 6752 1333.