Ageing skin

Preventing skin ageing
Stop smoking . One study found that wrinkles are five times more likely in smokers than non-smokers. The skin on the face of a smoker aged 40 resembles that of non-smokers in their 60s. Researchers in Japan have discovered that cigarette smoke reduces the ability of the skin to renew itself, so that less new collagen is produced by skin cells and the breakdown of existing collagen is encouraged (New Scientist 15 April 2000).

Avoid sun exposure. Staying out of the sun as much as possible, wearing a hat that shades the face and using sunscreens will prevent further damage and may also help the skin improve – there is evidence that the skin can repair itself to some extent, if given half a chance.

Check that your sunscreen filters out both UVA and UVB light – look for ‘broad spectrum’ on the label. UVB light is the most important in causing skin cancer. Both UVB and UVA cause the skin to age, but experts are still arguing about which is more important. The SPF (sun protection factor) number on the bottle indicates the amount of UVB protection a product provides, but it is difficult to know much UVA protection there will be. Most manufacturers use a star system, with four stars meaning maximum UVA protection.

Ideally, apply a sunscreen every day, not just on holiday or on sunny days, because even quite low but repeated doses of UVA and UVB can wreak havoc on collagen and elastin. Unfortunately, there is no such thing as a safe tan – a tan is a sign that the skin has already been exposed to too much light and is desperately trying to protect itself against further damage. Use fake tans and sunscreen instead.

Improving your diet may help to prevent wrinkles. According to New Scientist (14 July 2001), researchers in Australia studied 450 elderly people to see if there was a link between what they ate and how wrinkly they were. The least wrinkly people had been eating lots of vegetables, beans, fish, low-fat milk and tea. The most wrinkly had been eating lots of soft drinks, cakes, pastries, red meat and full-fat dairy produce.

Treatment
Moisturizers cannot prevent or really get rid of wrinkles. They coat the skin with a very thin layer of oil or silicone, which prevents it drying out. If skin is dry, wrinkles are more noticeable, so by keeping the skin moist and plump, moisturizers help to blank out smaller wrinkles. It is best to apply a moisturizer after washing in the morning, while your skin is slightly damp.

Do anti-ageing creams work? It is very difficult to get reliable facts about treatments for ageing skin. Most of the research is done by cosmetic companies, who often keep the results of their research secret. According to Anita Roddick, founder of the Body Shop, anti-ageing skin care products (except moisturizers) are “complete pap”. She said “there is nothing on God’s planet that will take away 30 years of arguing with your husband and 40 years of environmental abuse. Anything which says it can magically take away your wrinkles is a scandalous lie” (The Times 19 October 2000).

In 1998, the Consumers’ Association magazine Which? selected 12 ordinary moisturizers and 12 anti-ageing creams. Four women tested each product, according to the manufacturers’ instructions, for 4 weeks without knowing which product they were using. Most of the women did not notice any difference in the look or feel of their skin. Ten of the 48 women using anti-ageing creams reported an improvement, but even more of those who had used moisturizers – 18 out of 48 – noticed the same thing. Three-quarters of all the women thought that they had been using a simple moisturizer. Which? concluded that “some of the claims made for the ingredients of anti-ageing creams can be substantiated but, in the low concentrations used in the creams, they are unlikely to do more than moisturize your skin”.

However, cosmetic companies are doing a lot of research, so some of the recent products may help. Nevertheless, it is hard to know whether claims are justified.

Oestrogen m akes skin look younger. Doctors in Germany guessed the ages of women around the menopause and then measured their oestrogen levels. The higher their oestrogen level, the younger they appeared. The women with the highest levels looked 8 years younger than they really were, whereas those with the lowest levels were guessed to be 8 years older than their true age. Oestrogen makes the skin thicker and increases its collagen and water content, making it less dry and flaky. So hormone replacement therapy (HRT) containing oestrogen will probably help to minimize skin ageing. However, the risks of HRT (such as breast cancer and stroke) mean that it should not be taken for cosmetic reasons.

Retinoids, such as tretinoin and isotretinoin, are chemicals that are related to vitamin A. They make the skin produce new cells more quickly, so it becomes thicker and more compact. The skin also produces more collagen but less pigment (melanin). After a month or two of using retinoids, the skin becomes smoother, fine wrinkles are repaired, age spots fade and the skin colour becomes more even, but it does not produce totally wrinkle-free skin. If you carry on using the cream, the skin continues to improve for a few more months, but after 6 months of use there is no further change. If you stop using it, the skin gradually goes back to how it was before. Retinoids do not have any effect on very noticeable wrinkles, such as the deep lines that appear between the nose and mouth, or on thread veins.

Some anti-ageing creams contain retinoids (‘retinol’), but to obtain the most effective concentrations, you need a doctor’s prescription. However, doctors cannot prescribe tretinoin for sun-damaged skin under the National Health Service in the UK, so you will have to ask your doctor for a private prescription, which means you will have to pay for it. For the first 2 weeks, you apply it every other night, for the next few weeks you apply it every night and, after a few weeks, two or three nights a week is enough. If there is no improvement after 6 months, there is no point in continuing.

Retinoids irritate the skin, so that there may be dryness and flakiness, sometimes with itching, soreness, redness and a tight feeling. You have to avoid the sun and use a sunscreen. Some specialists worry that retinoids could increase the risk of skin cancer.

Alpha hydroxy acids (AHAs) are chemicals found in fruit juices (thus their name ‘fruit acids’), wine, sugar cane and milk. They may be the ‘magic ingredient’ of skin ancient recipes containing milk, lemons or wine. AHAs improve the appearance of the skin by speeding up the shedding of dead cells from the skin surface. AHAs have very little effect on wrinkles, though some researchers claim that they make the skin thicker, help it to hold moisture and improve the elastin.

Many face creams now include AHAs. When buying such a cream, check the concentration of AHAs. Any cream containing less than 5% is not very effective, but the safest to use. A cream containing 5–10% AHAs is probably more effective, but scientists worry that, in the long term, this concentration might damage your skin, and you might end up with more wrinkles rather than less. For the first few weeks of use, AHAs may make the skin slightly flaky. If the cream is very acid, it may cause more irritation, so look for a pH of 3.5 or higher (the higher the pH, the lower the acidity).

So are AHAs safe? The US Food and Drug Administration (FDA) is concerned about them and is doing more research (see useful contacts) and the European Commission (EC) is looking into the matter. So at the moment, we simply do not know. The main worries are that:

If you use an AHA product, use a SPF 15 sunscreen as well, every day, even if the weather is overcast, and choose a cream with a low AHA concentration.

Beta hydoxy acids (BHAs) are similar to AHAs, but may be less likely to irritate the skin. The most common is salicylic acid.

Vitamin C is essential for the production of collagen. It also encourages the renewal of skin cells and is an antioxidant, which means that it mops up free radicals. Free radicals are molecules produced by the body’s metabolism, particularly when it has to deal with pollution in the environment. Free radicals can be harmful and may contribute to skin ageing. Vitamin C is a very unstable vitamin that is broken down by light and does not penetrate the skin readily, so cosmetic companies have had great difficulty making a skin preparation containing it. They seem to have cracked the problem, and skin preparations containing vitamin C are now available. Whether they really do reduce ageing changes in the skin remains to be seen.

Botulinum toxin (Botox) injections have become a well-known anti-wrinkle treatment. Botulinum toxin is actually a powerful poison that blocks the action of nerve fibres. This causes a mini-paralysis of the muscles used for facial expression that crease the skin. By pinpointing a specific area, such as ‘crow’s feet’ and frown lines, the specialist can smooth out the skin – you do not have frown lines because you cannot frown. The effect is not immediate (it may take a week or two to show) and is mainly gone in 4 months.

Like any other procedure, it has some risks. If it is not done properly you could end up looking rather expressionless, or one side of your face could look different from the other. As with any cosmetic procedure, it is important to find a good doctor (look at the section on choosing a cosmetic surgeon for general advice).

Fillers, such as collagen, injected into the skin fill in hollows and can help smooth out lines, including deep wrinkles such as nose-to-mouth grooves and frown lines. Collagen is absorbed by the body, so the effect does not last and the treatment has to be repeated every 3 –6 months. It can be painful, and may cause bruising; there is often some redness and swelling on the day of the injection, which fades by the following day. Some people develop hard, red blotches as a result of an allergic reaction. The collagen comes from cattle, and there have been concerns that it could trigger an autoimmune reaction (in which the body attacks its own cells), but there is no evidence that this has ever happened to anyone.

Collagen is not the only type of filler – about 40 other substances are used (New England Journal of Medicine 2004;350:1526–34).

Chemical peeling with AHAs (glycolic peel) is another treatment provided by some private clinics. It went out of fashion for a while (when laser resurfacing seemed more promising), but is now regaining popularity. Chemical peeling works by producing a chemical burn on the surface of the skin. As the skin heals, some of the smaller wrinkles and irregularities are smoothed out and there is some improvement in the appearance.

Laser resurfacing of the skin removes part of the outer layer of the skin (the epidermis). This regrows in 3–6 weeks from the remnants left in the hair follicles and sweat glands. During this time, you will look as if you have severe sunburn, as your skin will be red and there may be some weeping. The repair process alters the skin collagen, ‘lifting’ mini-wrinkles from the skin during the subsequent 4 months. Afterwards, you must always use sunscreen to protect your skin.

There may be side effects, such as lightening or darkening of the skin. In people whose skin tends to form keloid scars, laser treatment is risky. There is also a risk of reactivating herpes (cold sores).

Because these skin techniques are so new, discoveries are still being made about the best methods, and what they can and cannot do, and their long-term effects. As with all cosmetic operations and procedures, try to choose a reputable clinic and a well-known doctor; your family doctor may be able to advise you. Ask to see ‘before and after’ photos, and check that the procedures were carried out by the person you are talking to, and are not simply promotional material supplied by the laser manufacturer.

Plastic surgery was the only option before retinoids became available. It can produce a big improvement in lines at the sides of the eyes and in sagging skin (which retinoids will not help), but will not improve the overall texture of the skin. As with all plastic surgery, make sure you choose a reputable clinic. Ask to see ‘before and after’ photos, and check that the doctor you are talking to actually did the work shown.