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PREVENTION
Skin care starts with you. Many simple lifestyle changes—such as improving your diet and learning basic skin care techniques can help improve your skin's appearance. Discuss prevention tips with your health care professional, and consider these steps:
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good nutrition
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drinking six to eight glasses of water per day
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avoiding alcohol
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stopping smoking
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using sunscreen regularly
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avoiding sun exposure during peak sun hours between 10 a.m. and 4 p.m.
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wearing protective clothing when outside.
Most health care professionals recommend a simple cleansing regimen as the best approach to keep skin healthy: a gentle cleanser using warm (not hot) water, no abrasive scrubs and, when necessary, a moisturizer with sunscreen protection. In addition, you should gently pat your skin dry rather than rub it vigorously after a bath or shower to help avoid irritation and itching.
Dry Skin
Moisturizers for dry skin come in three preparations: lotions, creams and ointments. Lotions are least effective at replacing and retaining lost moisture in very dry skin. But they disappear after application very quickly, making them the most convenient to use, and possibly helpful for normal and oily skin. Creams are heavier than lotions and are therefore more effective at sealing in moisture for normal to dry skin. Ointments, such as Vaseline, are thick and are best for preventing moisture from escaping from the skin, but you may find that they are inconvenient to use regularly. Health care professionals advise women with very dry skin against using soap and also alcohol-based astringents (toners), which typically dry out the skin.
Making Skin Look Younger
Alpha hydroxy acids (AHAs) (AHAs, glycolic acid, lactic acid), antioxidants (vitamins A, E, C) and vitamin A derivatives (Retin-A, Renova and retinol) in moisturizers are frequently promoted as products that can make skin younger-looking. Here's what to expect from these and other newly available products:
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AHAs.
They contain lactic acid (found in milk), fruit acids and glycolic acids (found in sugar cane). AHAs, like tretinoin derivatives, work by peeling away dead and thickened areas of the skin. Cosmetic treatments containing highly concentrated AHAs, known as chemical peels, have long been available from dermatologists. Prescription creams contain approximately four percent to 12 percent concentration of AHAs and provide a superficial smoothing of the skin's texture. Over-the-counter (OTC) preparations typically contain one percent active ingredient, which may provide a little improvement of scaly skin. Higher concentrations of the active ingredients in OTC products are buffered and therefore neutralized to prevent peeling. These OTC AHA products are not known to improve skin wrinkling. Improvements with these or prescription products last only as long as the product is used. Long-term effects of AHAs are unknown. They can irritate the skin. Signs of sensitivity are redness and burning.
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Antioxidants.
Vitamins A, E and C are known as antioxidants. Their claim to fame as skin health aides is in their ability to fight free radicals, the highly reactive molecules generated by oxygen, sunlight, smoking and pollution that can break down the collagen fibers of the skin. Research is inconclusive about how effective antioxidants are for improving the skin's appearance. Ingestion of large amounts of some of these vitamins can be toxic. High doses of vitamin A, when taken during pregnancy, are suspected of increasing the risk of birth defects. Topical treatments of antioxidants can cause rashes, but small amounts are probably not harmful for most skin types.
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Renova.
This prescription cream is basically Retin-A in a moisturizing base that decreases the redness and burning associated with Retin-A. The active ingredient in Retin-A and Renova is tretinoin, a vitamin A derivative. You must use these products daily for months to notice improvement, and it will probably last only as long as the cream is used. Renova and Retin-A may make the skin sun-sensitive, so wearing sunscreen and protective clothing during treatment is important. Side effects include redness, dryness and sensitivity. Oral or topical use of retinoids during pregnancy or while planning a pregnancy should be avoided.
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Botox injections.
In 2002, the FDA approved botulinum (or botulism) toxin type A (Botox® Cosmetics), a prescription drug that may be used to temporarily improve the appearance of moderate to severe frown lines between the eyebrows. Botox was used "off-label," without FDA approval, in the mid-1990s by some health care professionals for this purpose. Botulinum toxin type A is a protein produced by the bacterium clostridium botulinum. When used as an anti-aging agent, small doses of a purified, sterile form of the toxin are injected into certain facial muscles, which temporarily paralyzes and weakens them. When the muscles can't contract normally, frown lines disappear. The treatment worked for up to approximately six months in a placebo-controlled multicenter randomized clinical trial involving 405 patients. According to the FDA, Botox treatments should not be injected more frequently than once every three months, and the lowest effective dose should be used. The most common side effects following injections included headache, respiratory infection, flu syndrome, nausea and droopy eyelids. Less frequent adverse reactions (less than three percent of patients) included pain in the face, redness at the injection site and muscle weakness. These reactions were temporary but could last as long as several months.
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Since the arrival of Botox, several other injectable wrinkle fillers have been approved by the FDA:
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Restylane in December 2003 as a soft tissue filler for moderate to severe wrinkles around the nose and mouth. A synthetic form of hyaluronic acid. One injection is needed for 6 months of effectiveness.
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Hylaform in April 2004 for moderate to severe wrinkles and folds. A form of hyaluronic acid made from rooster combs.
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Captique in December 2004 for wrinkles around the nose and mouth. Result is immediate and lasts up to one year.
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Collagen products have been on the market for over 20 years; the newest ones being CosmoDerm, CosmoPlast, Zyderm and Zyplast.
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Natural products.
The pharmacological effects of materials such as seaweed and oatmeal, often used in face masks or peels, are unknown. Papain, an enzyme found in papaya, is helpful in sloughing off dead skin cells, but can be expensive.
Protect Your Skin from the Sun
Reducing your exposure to the sun is the best way to keep your skin healthy. Here's why:
Sunlight consists of two main types of ultraviolet (UV) rays that damage skin—UVA and UVB rays.
UVB rays are the main cause of sunburn and skin cancer. This type of sunlight intensifies during the summer and can do more damage more quickly than UVA rays. The epidermis absorbs most of the intensity of UVB rays. UVB rays cannot pass through glass. UVC rays, another spectrum in sunlight, are also potentially harmful, but the ozone layer blocks them from reaching the earth. UVA and UVB rays are present all year and are hazardous whether they are direct or reflected.
When the sun's ultraviolet radiation reaches the surface of the skin, the skin reacts by producing melanin—otherwise known as a tan—to protect itself. UVA rays are milder than UVB rays, but because their wavelengths are longer, they penetrate deeper through the skin's layers. UVA rays contribute to wrinkling the skin, as well as to the development of skin cancer.
UVA rays also are used in tanning booths. UVA rays in tanning booths not only inflict damage similar to sunlight, they also may be as much as 20 times more intense in a tanning booth than the equivalent time spent in natural sunlight. UVA rays also can pass through window glass.
Sunscreens
Sunscreens should be an important part of your skin health routine because they absorb or block UV rays. Sunscreens are rated by how much sun protection factor (SPF) they offer. SPF calculations are based on laboratory comparisons of how much sunlight will cause mild sunburn on the unprotected skin of a person with a fair complexion and on the same skin area protected by sunscreen.
The effectiveness of a sunscreen is dependent on the types of sun protective chemicals used, the thickness of the cream or lotions, and the amount of product applied to the skin. Not all sunscreens provide protection against UVA radiation. Be sure that the sunscreen you purchase states it provides UVA/UVB protection. While sunscreen use helps to minimize damaging sunburns, it doesn't completely prevent burning.
A sunscreen with SPF-15 or greater should be used all year for all skin types. If you develop a rash or other type of allergic response to a sunscreen, try a different brand or form (lotion vs. gel, or protective clothing, for example) or switch to a sunscreen containing the active ingredients of titanium dioxide or zinc oxide. These products don't require chemical interaction with the skin to be effective and provide a protective shield-like barrier screen and rarely cause rashes. All sunscreens need to be reapplied after water contact or sweating.
For the best protection from the sun's harmful rays:
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apply sunscreen with an SPF of 15 or higher 15 to 30 minutes before sun exposure, with careful attention to sun-exposed areas such as the face, hands and arms
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apply lip balm with an SPF of 15 or higher to protect sun-sensitive lips
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avoid the sun between 10 a.m. and 4 p.m., when its rays are strongest
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wear a large (three-inch), brimmed hat and sunglasses to protect your scalp and eyes
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reapply sunscreen at least every two hours, but you should apply it more frequently if you have been swimming or sweating Try and use about 1 oz of cream, about one shot glass, to cover your entire body with each application.
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stay in the shade whenever you can
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limit the time you spend in the sun
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be aware that the sun's ultraviolet rays can reflect off water, sand, concrete and snow, and can reach below the water's surface as well as burn on an overcast day
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if you are taking an antibiotic or other medication ask your health care professional if it may increase your skin's sensitivity to the sun and what you should do about it.
Don't forsake the sun altogether. Learn how to protect your skin from the sun's harmful rays and practice "sun safety" whenever you can—cover up with sunscreen and wear light-colored, tightly woven protective clothing and be sensible about how much time you spend in the sun. These steps can help reduce your risk for developing skin cancer and keep your skin looking its best.
