Taking Care of The Outer You -Your Skin
Make Your Skin Look Young Again Without Surgery
It used to be that a face-lift was the only way to deal with skin that was wrinkled, sun-damaged, sagging or scarred. However, this is no longer true.
Today, while surgery is still required for serious problems, there are numerous safe, inexpensive nonsurgical techniques for rejuvenating your skin. Here's a look at your options...
Alpha Hydroxy Acids
Glycolic, lactic, citric and other alpha hydroxy acids (AHAs) are found in a growing number of cosmetics. Excellent moisturizers, they also seem to minimize wrinkling,, sun damage and acne-if used on a daily basis.
More effective: Prescription AI-IA products, which contain higher concentrations of the acid. These products are available from your dermatologist.
Sunscreens and Moisturizers
Sunscreens don't just prevent skin damage. They also help fade existing fine wrinkles. Moisturizers keep skin soft and supple and temporarily improve its appearance. But they neither prevent nor reverse wrinkles. In fact, wearing moisturizer without sunscreen can raise your skin's vulnerability to sun damage.
Vitamin A Derivative
Tretinoin (Retin-A) is a potent drug originally developed as a treatment for acne. Doctors may prescribe this vitamin A derivative to fade fine lines around the eyes ...and to get rid of stretch marks and liver spots.
It's surprisingly effective when used on a regular basis, although it can take a year or more for the effects to become apparent.
Tretinoin makes the skin appear smoother by thickening its outermost layer and "compacting" the layer of dead skin cells.
Caution : Tretinoin can cause redness and dryness ...and can raise your susceptibility to sunburn. Because of the possible risk of birth defects, it's inappropriate for pregnant women.
Another formulation of tretinoin, Renova, is the first drug developed specifically for wrinkle removal. It reduces fine facial lines, brown spots and surface roughness just as effectively as ordinary tretinoin - and it's less likely to irritate the skin.
Chemical peels involve the application of concentrated AHAs (40% to 70% acid vs. 0.5% to 10% acid for over-the-counter AHA products). Peels are administered in a doctor's office.
A series of light glycolic acid peels helps remove damaged skin and improves the appearance of crow's feet and minor acne scars. The peel may cause stinging, as well as slight pinkness for a day.
Deeper peels, using trichloracetic acid (TCA) or phenol, are needed to obliterate wrinkles around the mouth, eyes and fore-head, to correct irregular pigmentation and to eliminate liver spots.
The effects of a peel last for several years. However, peels may cause considerable pain, as well as persistent redness, skin tightness and scarring. Phenol peels are inappropriate for people with heart or kidney disease ...or with dark skin.
Warning : Recovery from a TCA or phenol peel isn't pretty. Crust-like scabs that appear immediately after the peel can take up to two weeks to heal. During this period, it's essential to avoid the sun.
This procedure involves use of a rotating wire brush to "sand" off the upper two layers of skin, smoothing its appearance. Results last for several years.
Dermabrasion is good for removing acne scars, pockmarks and small wrinkles around the lips. For severe blemishes, two procedures, six to 12 months apart, may be necessary.
Caution : Dermabrasion can cause infection, scarring, variations in skin tone and extreme sun sensitivity. As with peels, the skin crusts over. Full recovery can take several months. Also as with peels, dermabrasion works best for people with light complexions.
In this procedure-a new alternative to dermabrasion and chemical peels-the doctor uses a laser to "shear off" the epidermis. Laser peels are less likely than chemical peels to cause scarring and overlightening. They are also more precise.
Although crusting and redness still occur with a laser peel, recovery is usually faster. Laser peels are particularly effective against wrinkles around the eyes, age spots, scars and facial discoloration.
Doctors can inject you with a natural protein called collagen to plump up facial skin and help fill in severe (cystic) acne scars and deep wrinkles.
Effects are immediate and last for four to eight months, until the collagen is resorbed. Then a new round of injections must be administered.
Infection and sun sensitivity at the injection site can occur following the injections. And allergies to collagen can cause excessive firmness and purple discoloration: This can last up to six weeks.
To make sure you're not allergic: Have two collagen allergy tests prior to receiving the injections. Do not have the injections if you have rheumatoid arthritis, Graves' disease, lupus or another autoimmune disorder.
Instead of collagen, some doctors have begun injecting fat "harvested" from elsewhere in the body (buttocks, back, etc.). Because the injected material is part of the body, there's no danger of allergic reaction. Unfortunately, it's not clear just how long fat injections last.
Low-Fat Diets May Reduce Skin Cancer Risk
Skin cancer patients who were put on a diet that derived no more than 20% of calories from fat developed 70% fewer precancerous skin lesions (actinic keratoses) than similar patients whose diet remained above 36% fat. Implication: If you've had one skin cancer, adopting a low-fat diet can help you prevent a recurrence.
Help for Unsightly Scars
Red, raised scars (keloids) left on the chest following heart surgery can be made less visible-and less itchy-when treated with light from a pulsed-dye laser. The results from laser treatment appear to be long lasting, with no scar recurrence within the first year following treatment.
Does Your Hair Protect You from the Sun?
A full head of hair does not offer full protection against skin cancer of the scalp. Scalp skin is just as vulnerable to sun damage as skin elsewhere on the body. When cancer does occur on the scalp, it's often very aggressive.
Self-defense : If you are bald or have thinning hair, nib SPF-15 sunscreen on your scalp... and wear a hat with a four-inch brim that goes all around the head. Even if you have a full head of hair, it's best to use conditioner or hair spray that contains a sunscreen.
Vitamin C vs. Wrinkles
A prescription skin cream containing 10% vitamin C significantly reduced wrinkling and age spots in patients who used it for eight months. The vitamin "instructs" skin cells to produce new collagen, plumping the skin slightly. Called Cellex, the cream delivers 20 to 40 times the amount of the vitamin than can be absorbed from pills.
Skin Cancer -
How to Protect Yourself
The US is facing a growing epidemic of malignant melanoma, the deadliest form of skin cancer.
In the past 20 years, there has been a dramatic increase in the number of new cases reported. Why the increase? We don't know exactly to what degree sunscreen really protects us, and not enough people are using it.
These are the most common questions I'm asked about skin protection and skin cancer...
Do you continue to recommend that people wear sunscreen?
Absolutely. Over the past 20 years, countless studies have shown sunscreen to be effective at preventing both sunburn and skin cancer.
Of course, sunscreen is not 100% effective. And wearing it does not give you complete freedom to bask in the sun all day.
What type of sunscreen is best?
Look for a sunscreen that offers protection against both forms of ultraviolet light-UVA and UVB.
UVB rays pose a greater threat of sunburn and skin cancer than UVA rays do. However, UVA rays can still be harmful if you are in the sun for prolonged periods of time.
Your sunscreen should have a sun protection factor (SPF) of at least 15...and if you plan to go swimming, it should also be water-resistant. With an SPF-15 sunscreen, you can re-main burn-free for 15 times longer than you would with unprotected skin.
In regions where the sun's rays are particularly strong-such as in the South-use sun-block in addition to sunscreen.
Problem : Sunblock, which uses zinc oxide, talc or another opaque material to create a physical barrier to keep out rays, is messy and unattractive. Consequently, it is not appropriate for covering large areas of skin. I recommend using it only on two high-risk spots-the nose and the rims of the ears.
Avoid lotions containing mineral oil, cooking oil or cocoa butter. These products merely lubricate the skin. They do not block out harmful rays.
How should I apply a sunscreen?
Apply it liberally to all areas of skin that will be exposed to the sun. Do so at least 15 minutes before heading outdoors, so that it has a chance to be absorbed.
Pay special attention to easily overlooked areas-feet, earlobes, a bald spot, the backs of your hands, the tops of your ears, the nape of your neck and the tip of your nose.
Reapply at least once every three hours for as long as you're in the sun. Even with water-resistant sunscreen, it's prudent to reapply after going into the water or perspiring heavily.
I stopped sunbathing years ago. Do I still need sunscreen?
Yes. Your skin is at risk any-time you venture into sunlight-whether on the beach, in your backyard or on a brief walk. Sunscreens are not just for the beach!
In spring, fall and summer, applying sun-screen should become part of your daily routine. Rub it on just after your morning shower.
For office workers, a single morning application will suffice. If you work outdoors, reap-ply sunscreen frequently during the day. Even in winter, it's a good idea to wear sunscreen if you plan on being outdoors for more than a few minutes.
What else can I do to protect myself?
First of all, don't get too much sun too soon. On your first day in the sun, limit your exposure to just a few minutes. On each successive day, increase the length of exposure by a few minutes.
If repeated exposure to the sun is inevitable, your goal should be to tan gradually rather than burn. A tan offers some protection by absorbing LTV rays. Other helpful strategies...
Wear UV-blocking sunglasses.
Look for lenses that block at least 95% of UVB rays, 60% of WA and 92% of visible light. Check the manufacturer's label... or look for the words "Z-80-3 Standard." A good pair of sunglasses will help protect your eyes from sunlight-induced cataracts.
- Avoid sun exposure between the hours of 10 a.m. and 3 p.m. The sun's rays are strongest during this period.
- Always wear a wide-brimmed hat. It should provide shade for your ears, forehead and neck.
- At the beach, use an umbrella.
What if I burn easily?
People who are fair-haired, light-skinned and blue- or green-eyed are twice as likely to develop skin cancer as dark-haired, dark-skinned, brown-eyed people are.
And-people who have a family history of skin cancer are at increased risk.
There are no special rules for these people to follow, except to be extra diligent in protecting their skin. For fair-skinned people, wearing a hat and using sunscreen every day are not just good ideas-they are absolutely essential.
What if I develop skin cancer?
Malignant melanoma is generally curable-if caught in its early stages, when it's very shallow. The deeper a melanoma gets, the more lethal.
To improve your chances of spotting a skin cancer in its earliest stages, give yourself a total-body skin exam at least once every three months. Look for any new growth or change in your skin. Start today.
How do I perform this examination?
You will need a hand mirror, a full-length mirror and a blow-dryer.
Begin with your head and neck, where 80% of all skin cancers occur. Examine your face, nose, lips and mouth, and your ears-especially the rims and lobes.
Use a blow-dryer to part your hair section by section. Standing with your back to the full-length mirror, use the hand mirror to examine the back of your scalp and neck. It may be better to ask a friend or family member for help.
Then continue downward, examining your back, hands, fingers, buttocks, genitals, thighs, ankles-right down to your toes.
The exam should take no more than 10 minutes.
Consult a dermatologist right away if you notice...
- A skin growth that increases in size and/or appears pearly, translucent, tan, brown, black or multicolored.
- A mole, birthmark or beauty mark that changes color, grows in size or thickness, changes in texture or becomes irregular in outline.
- A spot or growth that itches, hurts, crusts, scabs over, erodes or bleeds.
- An open sore or wound that persists for more than four weeks-or which heals and then reopens.
A Day Without Sunshine?
Total sun avoidance is not healthful for you. The human body needs some sun exposure to synthesize vitamin D-merely five to 10 minutes a day is enough. And only a little skin need be exposed-even just a toe is enough.
Sunscreens Are Effective For Three Years After Purchase
After that, some chemists say they may still be effective for another year-but there is no way for you to safely test them.
Self-defense : Discard unused sunscreen after three years. Important.- Discard sunscreen immediately if it appears runny or starts to smell strange. This can happen if it's left in a hot car for too long.
Our Skin Would Change Very Little Over Time
The most exposed areas of the body-particularly the face, scalp and arms-are the most likely to develop spots, dryness, wrinkles and skin cancer.
The Best General Protection
Use sunscreen. It's cheap and available without a prescription. If men used sunscreen instead of aftershave, they'd prevent many skin problems. Use a sun protection factor (SPF) of 30 or 50 (preferably 50) whenever you go out in the sun.
Don't smoke. Smoking yellows the skin, dries it out and greatly increases wrinkling. especially around the mouth.
Dry, Itchy Skin
Complaints of dry skin are extremely common after age 50-for good reasons...
Less oil. Some oil glands in the skin stop producing the oil needed for lubrication. *Winter itch. In low-humidity areas such as the desert Southwest, and during the winter months elsewhere, water evaporates from the skin very quickly.
Overwashing. We are a nation of clean freaks. We routinely wash away the oil layer that normally acts like plastic wrap, sealing in moisture. Better: Bathe every other day and don't scrub too hard. Recommendations...
Bathe, don't shower. A shower equals an infinite number of rinsings. Sloshing around in the tub removes less oil.
Don't use bath oil. Most goes down the drain. The residue will make the tub slippery, encouraging a fall. Instead, step out onto an absorbent mat and apply moisturizer while your skin is still wet, sealing in water. Pat dry.
Good moisturizers : Domol, Lubriderm, Hermal, Moisturel, mineral oil and the cheapest of all-Crisco solid. Crisco is great for itching, too. Rub it on gently with your fingertips.
Use tepid water. Just as hot water flushes grease from dirty dishes, it flushes protective oils from your skin.
Choose a mild soap. A major cause of dry skin is the daily use of harsh soap. Good mild soaps: Basis ...Lowila...unscented Dove.
Liver spots. The only connection between the liver and flat, dark brown "liver spots" (usually on the backs of the hands) is their color-although the liver was once wrongly considered their cause. "Age spots" is a more accurate term. I prefer to call them "birthday presents." These brown flat spots (called lentigines--the singular is lentigo) don't darken in the sun, as freckles do.
If you don't like the way your age spots or lentigines look, a dermatologist can freeze them individually with a quick spray of liquid nitrogen (it stings briefly) and they peel off over a week or two.
Seborrheic keratoses. These look like drops of tannish to deep brown candle wax with superficial cracks ("splits"). They're hereditary, genetically timed to appear in later life. Seborrheic keratoses, which are extremely common, start small but can quadruple in size. Prime sites: The chest, back and temples.
If you have seborrheic keratoses that are flaky, itchy or unsightly, don't scratch or cut them off. A dermatologist can freeze them with liquid nitrogen. The crust that forms will fall off in two to three weeks.
Wrinkles are harmless but can be reduced if they bother you. Sleep creases run vertically from scalp to chin and become more prominent on the sleeping side. To minimize sleep creases, vary your sleeping position. Other ways to de-wrinkle...
Retin-A (tretinoin). This superb prescription cream is a good bet for keeping your skin fine and smooth as you age. Caution: Retin-A makes the skin much more sensitive to sun-light. Use sunscreen.
Caution : Many drugs besides Retin-A-most commonly the diuretics (water pills) taken for high blood pressure, heart problems and swollen legs-cause skin rashes or increase the burning effects of the sun. Results may be immediate or delayed for months-or years. If your skin gets red, a drug you're taking might be the culprit.
Collagen treatments. Leather from cattle is chemically processed, broken into its com-ponent parts until it forms a thick gel and is then injected into the skin. The injections act like bricks that reassemble a "wall" under the skin to replace the collagen lost with age, especially in postmenopausal women.
Typical site: The upper lip. Lacking the sup-port of a fat layer, the mouth folds in on itself.
The collagen treatment: Your dermatologist first tests a patch of skin on one arm. Thirty days later he tests near your hairline ...to test for an allergic reaction. If no redness or itching results in two weeks, you'll have one collagen treatment (or possibly two, a few weeks apart). Benefits last for six to eight months.
Mad cow disease isn't an issue with collagen, which is made from select herds.
Laser treatments. These one-time treatments, done in the doctor's office, are especially effective for wrinkles above the lip and crinkly lines around the eyes. Treatment involves an extremely well-controlled quick burnoff of the outer layer of skin (epidermis) in a precisely defined area. The skin contracts and looks smoother.
What to expect: Some pain ...weeks of healing ...months of redness. Be aware that in some cases there may be permanent loss of skin color in the treated area, which will be more obvious the darker your natural skin color. The lighter your skin, the more pleasing the results.
Beware Of Sun Spots
For many types of skin cancer, having one spot or lesion increases the risk of recurrence. If you have ever had skin cancer, report faith-fully to your dermatologist for follow-up visits.
"Sun spots," or actinic keratoses, are scaly red spots on exposed areas of the skin. They're generally harmless-but if left alone, up to 20% eventually turn into squamous cell skin cancers.
Although this typically takes three to 10 or even 20 years, the potential for a malignancy makes it crucial to have them removed promptly.
Most common sites: The nose ...face... tops of the ears ...backs of the hands and arms. How to tell if you have one. Close your eyes and run your fingers gently over your face. If you feel a scaly bump under the skin but can't see it, have it checked out. Actinic keratoses don't become visible for a while.
They usually start out smaller than a pencil eraser (less than six millimeters in diameter) and get wider and more elevated over time, evolving to a button-like texture with a hard (indurated) base.
This sometimes lethal form of skin cancer is dangerous at any age, but becomes increasingly likely over time, since its presence is closely related to accumulated exposure to the sun. Melanomas are flat to bumpy in texture, usually without cracks on the surface, and brown to black in color.
Bottom line: Any unrecognizable bump on your face-especially if it has any pigmentation at all-should be checked out by a dermatologist. If a biopsy reveals that its a melanoma, or the doctor can definitely identify it as such, it must be removed immediately.
Inspecting your skin thoroughly can significantly reduce your risk from melanoma. A study of 1,200 people found that those who closely examined the skin over their entire bodies had a 63% lower rate of dying from melanoma. Dermatologists use the ABCD rule to identify suspicious moles and freckles-asymmetric shape, irregular borders, unusual color, diameter bigger than a pencil eraser's.
Sunlight Is Not the Only Threat to skin
Skin cancer has also been linked to birth-marks, old scars and skin ulcers ...immuno-suppression caused by illness or chemotherapy ... human papilloma virus (the cause of warts) ... exposure to petroleum derivatives and other carcinogens.
Self-defense : Have birthmarks removed or checked annually ...seek advice if a skin ulcer fails to heal or if a scar develops a growth or sore. If a wart doesn't respond to routine therapy, you may need a biopsy. A patient who is immunosup-pressed or who has been exposed to carcinogens should seek advice if he/she develops a new growth or sore.
How to Tell When the Sun is Dangerous
Here are some little-known facts about the summer sun and ways to protect yourself.
Shadow’s length and sharpness. If your shadow is shorter than you are - or there is no shadow - the sun is oberhead and at its most powerful strength.
The same is true about the sun’s intensity when your shadow - or the shade made by trees and other objects - is very sharp, deep and dark.
Altitude. The higher you are in elevation, the thinner the ozone layer and atmosphere, and less protection against the sun’s ultraviolet (UV) rays.
Sand/grass traps. They reflet nearly 100% of the sun’s rays. If you’re at the beach or on a lawn when the sun is overhead, you get double the radiation.
Color. The deeper the colour blue of the sky, the less of a barrier there is between you and the sun’s rays.
JOSEPH P. BARK, MD
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