Clive Anderson - AT THE DERMATOLOGIST IT IS true that we all are ageing but it is probably also universally true that we want to look younger than our chronological age.
There are two components to the ageing process intrinsic ageing and photoageing. These act to change our skin from the smooth, unblemished skin of youth to the dry, rough, mottled skin of old age.
Intrinsic ageing or natural ageing is a genetic process which has minimal effect on the appearance of the skin. This process results in damage to the skin's functions, specifically the ability of the skin to repair itself, increased water loss across the skin's barrier causing dry skin and the loss of lipids in the skin leading to increased sensitivity to environmental irritants.
Photoageing, on the other hand, has a major impact on the appearance of the skin. Photodamaged skin is coarse, wrinkled, darker or uneven in pigmentation and has a dry leathery look. Other features of sun-damaged skin include the appearance of fine blood vessels, prominent pores and the appearance of pre-cancerous lesions and skin cancers.
In addition to changes in appearance, photo ageing exaggerates the functional changes associated with natural ageing. Thus photo ageing is a form of accelerated ageing. The changes seen in sun-exposed skin vary widely from individual to individual depending on the degree of natural sun protection in the skin (skin colour) and the ability of the skin to recover from solar insult. Lighter skin tends to display freckling, precancerous lesions and skin cancers. Darker-skinned individuals will initially tan then develop uneven pigmentation and thickening of the skin. We sustain most of the damage to our skin before the age of 20 and only show the effects in our middle years.
Other environmental factors, like smoking, can also increase the adverse effect of photoaging on the skin. Sunlight contains two types of ultra-violet radiation UVA and UVB. UVB does not penetrate deep into the skin and is responsible for causing sunburn. Considerably more UVA reaches the skin, 18 times more UVA as UVB, and this type of radiation penetrates deeper into the skin. UVA penetrates glass so that even indoors and in our cars and buses we are exposed. Ultraviolet radiation causes significant changes to the cells in the skin. These changes include DNA damage that may lead to skin cancer and a reduction in collagen levels.
Dermatologists grade photo ageing into four categories, from type 1 or early photo ageing - no wrinkles, mild colour changes only, to Type 4 severe photoageing where the skin is yellow-gray in colour and wrinkled throughout. Often skin cancers are found on the skin in this grade.
REJUVENATE THE SKIN
The best approach for photodamaged skin is prevention. This means avoiding excessive sun exposure and the regular use of a sunscreen. In our climate all persons should use a sunscreen on exposed areas of the body as part of our daily regime. Apply the sunscreen after washing the face and patting dry. Replace the agent if you wash again or if sweating profusely. Use a sunscreen formulated especially for use on the face to avoid exacerbation of acne. Many manufacturers make facial moisturisers that contain sunblock. The Sun Protection Factor (SPF) will vary from 15 to 30. A SPF of 15 will be sufficient for a dark-skinned individual but fairer persons will require SPF 30.
Rejuvenation techniques include the following:
The use of Retinoic acids such as retinol or treinoin as present in some acne medicines
Skin peels using Glycolic acid, salicylic acid or trichloracetic acid
Microdermabrasion
Laser resurfacing
Fillers for lines
Botox injections for wrinkles
The rejuvenation techniques can only improve the skin by one grade, hence prevention and early treatment is key.
Dr. Clive Anderson is a Dermatologist and Venereologist.
