Skin Care

Trying to understand the skin-care

There is a lot of interest in skin care. Consumers spend billions of dollars every year trying to maintain or improve the quality of their skin. A lot of jargon is used by skin care manufacturers to persuade the consumer about the superiority of their product. In this page the priciples of good skin care will be discussed and the jargon will be explained. We will try to be as scientific as possible and try to demistify this whole area.

The skin and the sun
Excessive sun exposure is widely considered to be the most important factor in aging of the skin. The term that is used to describe this is photoaging. Soaking up the sun was considered healthy many years ago,this is not so any longer. Excessive sun exposure can cause changes in skin texture which may result in:

Wrinkles
Freckles
Pigmentation
Thinning of the skin
Prominent capillaries
Sun burn
Skin cancer

Clearly there are some skin types that are more prone to sun damage, however, people of all skin types need to avoid excessive sun exposure. Sun light contains the full spectrum of visible and invisible light. Part of the spectrum of light is Ultraviolet light which is considered responsible for the majority of damage caused to the skin. People attend solariums and tanning parours to get a sun tan without sun exposure, however, what they are receiving is artificially produced ultraviolet light. Proponents of solariums and tanning parlours have argued for many years that there are different types of ultraviolet light, some less harmful than others, and that there is a safe level of ultraviolet light exposure. The reality is that all ultraviolet light can cause damage to the skin if you are prone to it. Most people are aware that the sun's harmful effects can be increased by wind and reflection from water, sand and snow. Even on cloudy days the sun can damage the skin.

How can I protect myself from the sun?
Preventing sun damage involves avoiding sun exposure in the middle of the day, wearing clothes and applying sun screens. Most clothing will block or reflect ultraviolet light, however, white clothing and wet clothing will be less effective. Wide-brimmed hats and sun glasses are also helpful.

How effective are sun screens?
Sun screens are effective but they can not be relied upon completely. It has been known for many years that sun screens prevent or reduce sun burn. Recent studies have shown that sun screens reduce the incidence of skin cancer and decrease the formation of moles especially in children. There is no conclusive evidence that sun screens prevent melanoma . Sun screens are rated with a Sun Protection Factor (SPF). The higher the SPF, the more protective the sun screen is.

Sunscreens should be applied about 20 minutes before going outdoors. Even water-resistant sunscreens should be reapplied about every two hours, after swimming, or after strenuous activities.

Beach umbrellas and other kinds of shade are a good idea, but they do not provide full protection because UV rays can still bounce off sand, water, and porch decks. Remember, UV rays are invisible.

Effects of the Sun
Sunburn- Your chances of developing a sunburn are greatest between 10 amand 4 pm, when the sun's rays are strongest. It's easier to burn on a hot day, because heat increases the effects of UV rays, but you can get burned on overcast days as well.

Sun protection is also important in the winter. Snow reflects up to 80 percent of the sun's rays, causing sunburn and damage to uncovered skin. Winter sports in the mountains increase the risk of sunburn because there is less atmosphere at high altitudes to block the sun's rays.

If skin is exposed to sunlight too long, redness may develop and increase for up to 24 hours. A severe sunburn causes skin tenderness, pain, swelling, and blistering. Additional symptoms like fever, chills, upset stomach, and confusion indicate a serious sunburn and require immediate medical attention. If you develop a severe sunburn or begin to develop a fever, your dermatologist may suggest medicine to reduce swelling, pain, and prevent infection.

Unfortunately, there is no quick cure for minor sunburn. Cool, wet compresses, baths, and soothing lotions may provide some relief.

Tanning - A tan is often mistaken as a sign of good health. Dermatologists know better. A suntan is actually the result of skin injury. Tanning occurs when UV rays enter the skin and it protects itself by producing more pigment or melanin.

Indoor tanning is just as bad for your skin as sunlight. Most tanning salons use ultraviolet-A bulbs. Studies have shown that UVA rays go deeper into the skin and contribute to premature wrinkling and skin cancer.

Aging - People who work outdoors or sun bathe without sun protection can develop tough, leathery skin, making them look older than they are. The sun can also cause large freckles called "age spots," and scaly growths (actinic keratoses), that may develop into skin cancer. These skin changes are caused by years of sun exposure. Protecting children from the sun is especially important, since most of our lifetime exposure occurs before the age of 20.

Wrinkling of the skin from years of sun exposure.

Wrinkles- Wrinkles are directly related to sun exposure. They can be intensified by smoking. Your dermatologist and dermatologic surgeon can treat these with a variety of surgical methods including chemical peels, laser surgery, dermabrasion, and soft tissue fillers.

Skin Cancer- More than 90 percent of all skin cancers occur on sun-exposed skin. The face, neck, ears, forearms, and hands are the most common places it appears.

The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Basal cell carcinoma usually develops on the face, ears, nose, and around the mouth of fair-skinned individuals. It can start as a red patch or shiny bump that is pink, red, or white. It may be crusty or have an open sore that does not heal, or heals only temporarily. This type of cancer can be cured easily if treated early.

Squamous cell carcinoma usually appears as a scaly patch or raised, warty growth. It also has a high cure rate when found and treated early. In rare cases, if not treated, it can be deadly.

Melanoma is the most dangerous form of skin cancer. It usually looks like a dark brown or black mole-like patch with irregular edges. Sometimes it is multicolored with shades of red, blue, or white. This type of skin cancer can occur anywhere on the body and when found early, can be cured. If ignored, it spreads throughout the body and can be fatal.

Basal cell carcinoma and Malignant Melanoma

Allergic Reactions- Some people develop allergic reactions to the sun. These reactions may show up after only a short time in the sun. Bumps, hives, blisters, or red blotches are the most common symptoms of a sun allergy. Sometimes these reactions are due to cosmetics, perfumes, plants, topical medications, or sun preparations. Certain drugs, including birth control pills, antibiotics, blood pressure, arthritis, and depression medications can cause a skin rash with sun exposure. If this occurs, a dermatologist can help.

Photoallergic dermatitis

Diseases - Some diseases can be made worse by the sun, including cold sores, chickenpox, and a number of less common disorders such as lupus erythematosus. UV rays also can cause cataracts, a gradual clouding of the lens in the eye.

Tips for Sun Protection

Use a broad-spectrum sunscreen with a SPF of at least 15 on all exposed skin, including the lips, even on cloudy days.
If exposed to water, either through swimming or sweating, a water-resistant sunscreen should be used.
Reapply sunscreen frequently.
Wear a broad-brimmed hat and sunglasses.
Sit in the shade whenever possible.
Wear protective, tightly-woven clothing.
Plan outdoor activities early or late in the day to avoid peak sunlight hours between 10 amand 4 pm.

Everyone should be able to enjoy sunny days. By using a little common sense, as well as the guidelines developed by the AmericanAcademyof Dermatology, you can safely work and play outdoors without worrying too much about skin cancer or wrinkles. But if either should occur, your dermatologist has specific expertise in treatment options.

As we grow older, we see and feel certain changes in our skin, which is the body's largest and most visible organ. The skin becomes drier, more wrinkled, and spots and growths appear. Also, after an injury our skin tends to heal more slowly.Some of these skin changes are natural, unavoidable, and harmless. Others are itchy or painful, and some changes, such as skin cancers, are serious and require medical attention. Many of these skin problems can be prevented. Whether a danger to health or merely cosmetically unattractive, most of these skin problems can be addressed by therapies now available.Wrinkles
As skin ages, collagen and elastin, fibers that keep the skin firm, weaken. The skin looks loose and lax, becomes thinner, and loses fat, so that it looks less plump and smooth. While all these changes are taking place, gravity is also at work, pulling at the skin and causing it to sag.Can Wrinkles Be Avoided?
The sun is the major cause of unwanted changes in the skin with aging. How wrinkled your skin becomes depends largely on how much sun you have been exposed to in your lifetime. Cigarette smoking can also contribute to wrinkles. Wrinkles also depend on your parents - the tendency to wrinkle is inherited.The good news is that many wrinkles can be prevented. Beginning in childhood, to avoid wrinkles caused by the sun:

Always wear sunscreen with SPF of at least 15
A hat with a brim and other protective clothing
Don't deliberately sunbathe
Try to avoid sun exposure between 10 a.m.and 3 p.m.
Remember that sun exposure as a child or teenager makes a big difference to the appearance of the skin at the age of 30, 40, or 50. If you have already sun-damaged your skin, you will still benefit from beginning sun protection as an adult. It's never too late.
"Broken capillaries" or Telangiectasia - These dilated facial blood vessels may be related to sun damage. They respond to the same treatments as other broken blood vessels (angiomas).
Treatments for Aging Skin
There are some promising treatments for aging skin. Retinoic acid, available as a cream and also used successfully in treating acne, improves the surface texture of the skin, reduces irregular pigmentation, and increases dermal collagen if applied daily for several months. It is currently the only medication approved by the FDA as safe and effective for reversing some of the effects of sun damage. Alpha hydroxy acids also show promise in reversing some of the effects of the sun.
Creases caused by facial expressions such as squinting, frowning or smiling can be treated by a dermatologist, using what are called injectable soft tissue "dermal fillers" such as collagen or fat. These dermal fillers are injected into the skin under wrinkles and scars to puff out creases or scars. A naturally produced toxin, botulinum (Botox(tm)), can also be injected to "relax" the small muscles and thus eliminate fixed expression lines (frown lines). Broken blood vessels accompany these wrinkles and can be treated with lasers or cautery. Fat folds such as those under the chin, around the waist and hips, and on the thighs, can be removed by liposuction under local anesthesia. Liposuction is the removal of fat by suction to eliminate unwanted bulges.
None of these remedies can guarantee the appearance of youthful skin, but they can improve the overall appearance of your skin. Wrinkled skin may be improved by resurfacing with dermatologic surgery, lasers, dermabrasion or chemical peels. Before you undertake any home-treatment or surgery, discuss your options with your dermatologist.
Dry Skin
As we age, our skin becomes drier. This can result in flaky and itchy skin, especially in cold, dry, windy climates. Milder cases of dry skin can be managed with a moisturizer used immediately after bathing, while the skin is still damp. Oils added to the bath water can cause the tub to be dangerously slippery.
Petrolatum, an ingredient in many lotions, creams and ointments, is an excellent moisturizer. Many moisturizers contain chemicals such as urea, alpha hydroxy acids, lactic acid, or ammonium lactate to reduce scaling and help the skin hold water. Some of these chemicals can irritate the skin, however. Your dermatologist can help you decide which is best for you.
Bathing less often and using milder soaps or a soap substitute, or soaking in a tub of warm water without soap can help relieve dry skin. Hot water is more irritating to dry skin than warm water. After bathing and drying off, a moisturizer such as petrolatum or lanolin should be applied immediately to seal in moisture.
If dry skin continues to be a problem, consult your dermatologist. Severe flaky, itchy and cracked skin may be a sign of a more serious problem.
Skin Lesions
Skin growths and pigment spots become more common as we age. They may range from harmless "warts", "liver spots" or "age spots", to skin cancers that require treatment. Most are caused by years of sun exposure.
Among the most common are red or brown scaly spots called actinic keratoses. If ignored, they may become skin cancers that eventually need to be removed surgically. In the early stages they can be removed by freezing with liquid nitrogen, applying a chemotherapy cream, or by skin resurfacing.

Liver Spots
Squamous cell carcinomatypically develops on the rim of the ear, the face, the lips, or the back of hands. These skin cancers can destroy normal tissue and squamous cell cancers occasionally spread to internal organs. If left untreated, squamous cell carcinomas can be aggressive.
The most common form of skin cancer is a basal cell carcinoma. It usually appears as a small, shiny bump or pinpoint red bleeding area on the head, face, nose, neck or chest. It's more common in older fair-skinned people with blond or red hair and blue or green eyes. Untreated, these skin cancers can bleed and crust over. They grow slowly and rarely spread to other parts of the body. When treated early, squamous cell and basal cell skin cancers have a 95 percent cure rate.

Malignant Melanomais a less common but more serious form of skin cancer. This skin cancer usually appears as a dark brown or black mole-like growth with irregular borders and variable colors. Men over the age of 50 are at the highest risk for melanoma, but it can affect anyone of any age. Melanoma is more likely to strike people who had severe childhood sunburns. The most frequent sites for melanoma are the upper back in both men and women, the chest and abdomen in men, and the lower legs of women.

Melanoma
Any change in an existing mole or the rapid appearance of a new mole, could be a sign of melanoma and should be examined immediately by a dermatologist. Melanoma can spread to other organs and can be fatal.
Other Growths
Several other skin growths are very common in older individuals. These include:
"Age spots" or "liver spots"- These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available.Seborrheic Keratoses- These brown or black raised spots or wart-like growths look like they were stuck on the skin surface. They are not cancerous and are very common in older people. If annoying, they can be easily removed by a dermatologist.Cherry Angiomas- These are harmless, small, bright red raised bumps created by dilated blood vessels. They occur in more than 85 percent of middle-aged and elderly people, usually on the trunk. Electrocautery, laser surgery, or other surgical therapies remove these spots.
Skin Diseases
Some skin diseases more common in older people are shingles (herpes zoster), seborrheic dermatitis, varicose veins, and leg ulcers.
Shingles/Herpes Zoster- Shingles is an infection of a nerve caused by the same virus that causes chicken pox. Early symptoms are localized pain, headache, or fatigue. Shingles can affect people of all ages, but is more common (and painful) in older adults.
The virus attacks a nerve root and follows the course of that nerve, causing a line of painful blisters on the scalp, face, trunk, or extremities. The disease almost always affects one side of the body only ands lasts for several weeks. Anti-viral medication can reduce the severity of the attack and reduce the chance of lingering pain afterwards.
Shingles can become serious and cause complications. A dermatologist should be contacted immediately if shingles is suspected, especially if the condition appears near the eyes, as treatments are most effective if started within 3 days of onset.
Seborrheic Dermatitis- The signs of seborrheic dermatitis are redness and greasy-looking "scales" on the skin. Areas of the skin with a high concentration of oil glands, such as the scalp, sides of the nose, eyebrows, eyelids, behind the ears, and the middle of the chest are usually affected. Seborrheic dermatitis occasionally affects other areas such as the navel, breasts, buttocks and skin folds under the arms.

Seborrheic dermatitis
Seborrheic dermatitis can be successfully treated and may even go away on its own, but it tends to recur. Frequent shampooing and washing are very helpful and your dermatologist may prescribe topical medications, including low-strength cortisone preparations and special shampoos.
Varicose Veins- These are enlarged leg veins that appear blue and bulging. They are common in older individuals. The veins become twisted and swollen when blood returning to the heart against gravity flows back into the veins through a faulty valve. This condition is seldom dangerous. The aching associated with varicose veins can be eased by avoiding standing for long periods, by keeping feet elevated when sitting or lying down and by wearing support hose or elastic bandages. More severe cases can be treated with surgery or radio frequency treatments. Sclerotherapy injections or laser therapy may remove smaller varicose veins, also called "spider veins".

Varicose veins
Varicose Ulcers- A backflow of blood (reflux) in the veins may lead to sustained high pressure and can cause ulcers, called vericose ulcers. When a crack or cut occurs in the skin of the leg, it may fail to heal because of poor blood flow. The injury can develop into an ulcer or a shallow wound that may contain pus and become infected. The ulcers may last for months or even years. Special dressings and careful management of the wound may speed healing.
Varicose ulcers often develop at the ankles. They may be accompanied by swelling and red, itchy, scaly skin around the ulcer. Another cause of ulcers on the legs is poor blood flow in the arteries. This condition is associated with medical disorders such as arteriosclerosis, hypertension, diabetes, mellitus, and smoking. There are many other causes of ulcers. If you have an ulcer, see your dermatologist.
Bruising (Purpura)- Many seniors complain of "black and blue" marks or bruises, particularly on the arms and legs. These are usually a result of the skin becoming thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. If you put pressure on the area immediately after a bump, sometimes you can prevent the bruise. Bruising sometimes is caused by medications that interfere with blood clotting by certain internal diseases. Bruising in areas always covered by clothing should be evaluated.
Itching- A very common problem with aging skin is itching. Although often associated with dry skin, itching also has other causes. Elderly skin appears to be more sensitive to fabric preservatives, wool, plastics, detergents, bleaches, soaps and other irritants. Certain days may also make the skin itchy. Identifying and limiting exposure to the cause is important. Prolonged itching may lead to lack of sleep and fatigue. Your dermatologist can often offer some medical remedies for itching if moisturizing alone is ineffective and can perform tests to detect internal disorders that cause itching.
Although most of the changes we experience in our skin as we age are harmless, there are certain signs of more serious problems that shouldn't be ignored. See your dermatologist if you notice any of the following symptoms or signs:

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- These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make disappear, but effective prescription medications and surgical resurfacing treatments are available.- These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make disappear, but effective prescription medications and surgical resurfacing treatments are available.