New help for wrinkles
After decades of keeping company with bust enlargers and cellulite reducers in women’s magazines, anti-wrinkle creams have lately become respectable. Some family physicians and dermatologists now prescribe a wide range of products to repair sun-damaged skin and for facial “rejuvenation.” Do these formulas work? What can they do for sun-ravaged skin?
“There is wrinkling and there is wrinkling,” says one dermatologist. “Most of the withered, discoloured appearance of old skin is not due to normal or intrinsic aging processes, but to decades of burning, tanning and exposure to the sun’s harmful ultraviolet rays.” Ultraviolet skin damage or “photoaging” accounts for 90-95 per cent of cosmetic skin blemishes and wrinkling.
Close inspection of a habitually tanned person’s arms, legs, or face would probably reveal a mass of brown spots, mottled patches, horny bumps, finely etched lines, scaly plaques, rough (premalignant) keratoses, enlarged blood vessels and perhaps small cancerous growths. These unappealing changes result mainly from excessive sun exposure. The difference between sun-induced photoaging and natural cellular aging is easy to see. Even in elderly people, skin not exposed to the sun — for example on the belly and buttocks — usually has a fine, soft texture, in contrast to the sun-weathered parts.
Sunlight is enemy number one to human skin
In many ways the ancients, although superstitious, took a more prudent attitude towards the sun than modem sun worshippers — recognizing human dependence upon it for warmth and light, but shielding themselves from its piercing rays. Today, however, sun and sports lovers not only bake in the harmful ultraviolet radiation but also travel miles to soak it up. Although the sun makes us feel good, solar radiation is one of the most injurious environmental agents our skin ever encounters. To understand how the sun’s ultraviolet (UV) rays injure human skin, remember that sunlight is intense electromagnetic radiation. The UVB band — or “sunburn spectrum” — is the main cause of sunburn and tanning. Cumulative exposure causes premature aging, wrinkling and skin cancer. The UVA (longer wavelength) rays, including those from tanning salon lamps — formerly considered harmless — are now also known to cause photoaging and wrinkles, as they penetrate deep into skin layers.
Preventing photodamage and skin-aging
Nobody stays looking young forever and so far nothing much can be done to prevent the general sagging and creasing of skin with increasing age. But skin photoaging can and should be prevented, not only for cosmetic reasons but also for better health — to reduce the chances of getting skin cancer. The dermatological advice is all too familiar: in short — avoid exposure to the sun’s ultraviolet rays. Cover exposed areas of the body with sunscreens of SPF (sun-protection factor) No 15, wear long pants, long-sleeved shirts and protect the eyes with dark UV-resistant glasses; protect the face and head with a wide-brimmed hat. Above all, avoid exposure to the sun’s strongest rays — between 11 a.m. and 2 p.m. According to the American Academy of Dermatology, 80 per cent of UV photodamage to the skin occurs in the first two decades of life, so children should be taught sun-protection from an early age. It is never too late to start, and older adults can reduce sun exposure, not only to prevent further damage but also, to some extent, to reverse damage already done.
Skin rejuvenation: What’s possible and what isn’t
Although preventing sun damage is ideal, for many of us the damage is already done, and as the wrinkles creep in we start the search for skin rejuvenators. What are some of the newer options? What can realistically be expected? Many of the new skin-recovery products are “peels” that take off dead and dry surface cells. Some are plant acids — others are stronger chemicals that remove more layers. As one dermatologist puts it, “You won’t get a $20,000 face lift out of a $20 tube. Chemicals will not remove under-eye bags, wattles, jowls, deep furrows and folds. Creams and ointments won’t do much for the wrinkles around the mouth and crow’s feet around the eyes, either, although deeper peels and laser treatment might help.” What superficial peels and creams can do is improve skin quality, texture and “glow,” make the skin feel smoother and may — there are no guarantees — diminish fine wrinkles. Deeper chemical peels and laser contouring have a greater impact — useful for more extensive wrinkling. Lasers can be used for skin resurfacing and to remove some growths.
Retinoid creams might reverse some damage
Retinoid creams may reduce some photoaging and remove fine wrinkles. The retinoids or vitamin A derivatives, used with caution under medical surveillance, herald a new era of effective treatment for several skin problems. Their most dramatic achievement — taken by mouth — is the alleviation of severe acne and psoriasis (a skin disease with extensive scaling and inflammation). Used as creams, they can reduce some wrinkles and blemishes.
Topical tretinoin-A (SteivAA, Steivacream or Retin-A) cream, used to treat acne, is the best documented of the retinoid products. Several studies have shown that long-term use reverses some photoaging. The cream is available by prescription only, and its anti-wrinkling effect, which may take months to show, lasts only as long as treatment continues. The cream is first used only for an hour or so, then rinsed off, gradually increasing the time it’s left on. After daily use for four to six months the skin becomes noticeably smoother and less blotchy, some fine wrinkling disappears and some senile lentigos (brown “liver spots”) may fade. One University of Toronto dermatologist warns that “far from swiftly smoothing the skin, topical retinoids must be applied for many months before there’s any noticeable change. And they erase only very fine wrinkles; no amount can erase the crows’ feet and large laugh lines or sags around the mouth. Moreover, once their use stops, the wrinkles creep back.” (The anti-aging effect may be partly due to renewed collagen build-up that provides fresh skin support.)
Experts stress that retinoids are pharmaceutical drugs that need cautious use. They must be prescribed to suit individual skin types and their use medically monitored. Side effects include redness — minimized if the treatment is applied in slowly increasing concentrations — also some flaking, dryness or irritation and increased sun sensitivity, so sunscreens are a must. The product should absolutely not be used during pregnancy as it can cause fetal birth defects.
Alpha-hydroxy acid creams and ointments
Cleopatra bathed in sour milk, which contains lactic acid, one of the alpha hydroxy acids, rediscovered as an anti-aging skin remedy. These acids are reported to decrease seborrheic keratoses (blocked and thickened skin patches). Sometimes called “fruit acids,” other alpha hydroxy products (AHAs) include tartaric acid from many fruits, glycolic acid from sugar cane, citric acid from citrus fruits and malic acid from apples. A whole range of new cosmetic products contain AHAs. When purchased as dermatological creams and ointments at concentrations of about 4-8 per cent, effects are similar to those of tretinoin-A, namely a superficial smoothing of the skin’s texture. Side effects noted with tretinoin — dryness, flaking and irritation — are less severe with AHAs. Improvement may take months to appear and lasts only as long as the preparation is used. But AHAs have not been as well studied as the retinoids and long-term effects are unknown, although AHAs are hardly absorbed into the skin and presumably non-toxic.
AHAs are also used in stronger concentrations as a “chemical peel.” For quicker and more dramatic skin-rejuvenating effects, chemical peels are professionally applied by a plastic surgeon or dermatologist. The results depend on how deeply the chemicals penetrate the skin and how long the treatments last; peels can be deep, medium or superficial. For a superficial peel, AHAs or other products are painted onto the skin at concentrations of 30 to 70 per cent, left on for a short time and then removed. The peel is repeated for six sessions — once a month for six months. Superficial peels act as “exfoliants,” removing dead, dry surface cells. Results are similar to long-term use of AHA creams, but more immediate; after the first peel the skin should feel and look noticeably improved, although the full impact requires repeat treatments.
More extensive chemical peels using stronger chemicals such as phenol or trichloroacetic acid can more dramatically improve appearance. Extensive wrinkling and thickening may be smoothed out; thickened, discoloured lesions and growths, mild acne scarring and facial discolouration, such as melasma (mask of pregnancy) may be diminished. After a deep peel the skin is noticeably less wrinkled and old-looking. Side effects of deep phenol peels may be permanent loss of pigmentation, especially in dark-skinned people, creating light skin patches; there can also be some permanent scarring. These products can be dangerous for those with heart, liver or kidney disease. Medium and superficial peels with AHAs and trichloroacetic acid have fewer side effects, although they are less effective than phenol peels. Following a peel, the skin is extremely sun sensitive, so sunscreens are a must. The side effects of the deep peels make many dermatologists turn to laser therapy instead.
Phenol deep peels are gradually being replaced by special laser “resurfacing” treatments in some dermatology clinics. Lasers work by producing a slight bum, said to be especially effective for wrinkles around the upper lip and eyes — relatively untouched by other types of peel. Resurfacing is a recent use of laser technology so little is known about how long the effects last and how often the treatment must be repeated.
Cost of skin rejuvenation attempts
Laser treatments cost about $500 for a small area of face for example around the eyes, and $3,000-$4,000 for the entire face. Peels cost about $75-$100 per treatment, and creams and ointments vary in price, around $20-$25 a tube or bottle. Retinoids cost from $15 to $25 a tube.
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