Learning Center: SKIN REGIMEN

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FUNDAMENTALS ON SKIN MAINTENANCE

Frequently, people will focus their time and money on minor aspects of skin care while ignoring the much more important fundamentals. Cosmetic and “cosmeceutical” companies abound with high priced oils and herbal infused creams but with little to no scientific evidence supporting a benefit. Fragrance additives are common, which may add to the placebo effect, but may also create skin irritation. While the result may be positive, it may be neutral or even harmful to skin health. It is usually unhelpful for financial health. Here are the fundamentals for good skin care:

• Avoid sun (ultraviolet light) exposure.

• Avoid nicotine and tobacco

• Use proven skin care products:

Wash your face with a simple soap

Moisturize your face daily

Manage acne if needed

Manage pigmentation irregularities if desired

Use retinol

• Be diligent. Do the above every day. An ounce of prevention is worth a pound of cure.

• Also, consider using an injectable neurotoxin for facial wrinkles

SUN PROTECTION

Ultraviolet light, whether from the sun or a tanning bed, causes mutations in the DNA of the skin, leading to accelerated aging and possible cancer. Keep in mind that there is no such thing as a healthy tan, and the healthiest skin on a middle-aged or older individual is typically on the buttocks, where sun exposure has been truly minimal. Consider these facts:

  • An estimated 90 percent of skin aging is caused by the sun.

  • People who use sunscreen with an SPF of 15 or higher daily show 24 percent less skin aging than those who do not use sunscreen daily.

  • Sun damage is cumulative. Only about 23 percent of lifetime exposure occurs by age 18.

Sun ultraviolet intensity is greatest between 10 am and 2 pm. Distance from the equator not only reduces overall solar intensity, but it also increases the seasonal variation. In central Illinois, protection from solar radiation is most important from mid-Spring to mid-Fall.

ACNE

Acne, also known as acne vulgaris, is a long-term skin disease that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring.  It primarily affects skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to anxiety, reduced self-esteem, and, in extreme cases, depression or thoughts of suicide.

Genetics is the primary cause of acne in 80% of cases. The role of diet and cigarette smoking in the condition is unclear, and neither cleanliness nor exposure to sunlight appears to play a part. In both sexes, hormones called androgens appear to be part of the underlying mechanism, by causing increased production of sebum. Another common factor is the excessive growth of the bacterium Cutibacterium acnes, which is present on the skin.

Treatments for acne are available, including lifestyle changes, medications, and medical procedures. Eating fewer simple carbohydrates such as sugar may minimize the condition. Treatments applied directly to the affected skin, such as azelaic acid, benzoyl peroxide, and salicylic acid, are commonly used.  Antibiotics and retinoids are available in formulations that are applied to the skin and taken by mouth for the treatment of acne. However, resistance to antibiotics may develop as a result of antibiotic therapy.  Several types of birth control pills help against acne in women. Medical professionals typically reserve isotretinoin pills for severe acne, due to greater potential side effects.  Early and aggressive treatment of acne is advocated by some in the medical community to decrease the overall long-term impact on individuals.

In 2015, acne affected approximately 633 million people globally, making it the eighth-most common disease worldwide. Acne commonly occurs in adolescence and affects an estimated 80–90% of teenagers in the Western world. Some rural societies report lower rates of acne than industrialized ones. Children and adults may also be affected before and after puberty. Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties, and a smaller group continues to have difficulties in their forties.

ROSACEA

Rosacea is a long-term skin condition that typically affects the face. It results in redness, acne, swelling, and small and superficial dilated blood vessels.  Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

The cause of rosacea is unknown.  Risk factors are believed to include a family history of the condition. Factors that may potentially worsen the condition include heat, exercise, sunlight, cold, spicy food, alcohol, menopause, psychological stress, or steroid cream on the face. Diagnosis is based on symptoms.

While not curable, treatment usually improves symptoms. Treatment is typically with metronidazole, doxycycline,  minocycline, or tetracycline. When the eyes are affected, azithromycin eye drops may help. Other treatments with tentative benefit include brimonidine cream, ivermectin cream, and isotretinoin. Dermabrasion or laser surgery may also be used.  The use of sunscreen is typically recommended.

Rosacea affects between 1 and 10% of people. Those affected are most often 30 to 50 years old and female.  Caucasians are more frequently affected. The condition was described in The Canterbury Tales in the 1300s.

SMOKING

Smoking affects the skin in many ways, none of them good. Smoking causes accelerated skin aging, decreased wound healing, increased risk of skin infection, and an increased risk of skin cancer.

Here is a link for additional information on how smoking affects the skin.

WRINKLES

A wrinkle, also known as a rhytide, is a fold, ridge or crease in otherwise smooth surface, such as on skin or fabric. Skin wrinkles typically appear as a result of aging processes such as glycation, habitual sleeping positions, loss of body mass, sun damage, or temporarily, as the result of prolonged immersion in water. Age wrinkling in the skin is promoted by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors. In humans, it can also be prevented to some degree by avoiding excessive solar exposure and through diet (in particular through consumption of carotenoids, tocophenols and flavonoids, vitamins (A, C, D and E), essential omega-3-fatty acids, certain proteins and lactobacilli.

Development of facial wrinkles is a kind of fibrosis of the skin. Misrepair-accumulation aging theory suggests that wrinkles develop from incorrect repairs of injured elastic fibers and collagen fibers. Repeated extensions and compressions of the skin cause repeated injuries of extracellular fibers in derma. During the repairing process, some of the broken elastic fibers and collagen fibers are not regenerated and restored but replaced by altered fibers. When an elastic fiber is broken in an extended state, it may be replaced by a “long” collagen fiber. Accumulation of “long” collagen fibers makes part of the skin looser and stiffer, and as a consequence, a big fold of skin appears. When a “long” collagen is broken in a compressed state, it may be replaced by a “short” collagen fiber. The “shorter” collagen fibers will restrict the extension of "longer" fibers, and make the “long” fibers in a folding state permanently. A small fold, namely a permanent wrinkle, then appears.

DYSCHROMIAS- alterations of pigmentation

Dyschromia refers to an alteration of the color of the skin or nails.

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin. Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris.  People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.

Many forms of hyperpigmentation are caused by an excess production of melanin. Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing colour in the body in places such as the eyes, skin, and hair. As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.

Hypopigmentation is characterized specifically as an area of skin becoming lighter than the baseline skin color, but not completely devoid of pigment. This is not to be confused with depigmentation, which is characterized as the absence of all pigment. It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin. Some common genetic causes include mutations in the tyrosinase gene or OCA2 gene. As melanin pigments tend to be in the skin, eye, and hair, these are the commonly affected areas in those with hypopigmentation.

Hypopigmentation is common and approximately one in twenty have at least one hypopigmented macule. Hypopigmentation can be upsetting to some, especially those with darker skin whose hypopigmentation marks are seen more visibly. Most causes of hypopigmentation are not serious and can be easily treated.

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