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Introduction
There are a variety of ways to help you maintain a more youthful appearance. In the area of skin aging there is some useful information available on the internet, however there is also a vast amount of unproven and possibly unsafe treatments and product claims advertised. Many 'natural' remedies can still cause harm. Consider consulting your doctor or dermatologist before taking any new medication or buying an expensive product for skin rejuvenation (reversal skin aging).
This page summarises information from the scientific literature. There are some newer approaches of unproven value. Some of the more promising of these approaches are discussed.
Cosmetic Dermatology treatments and procedures are also used to reverse the visible signs of aging. These are covered in the cosmetic dermatology section.
What Causes Skin Aging?
In Australia and much of the world, sunlight plays a major role in the accelerated appearance of changes that we normally associate with skin aging. Chronic sun exposure is probably responsible for over 90% of the visible signs of aging in Australians. These changes include wrinkles, lines and creases, uneven or blotchy colour changes such as brown spots and freckling, 'broken or burst capillaries', other irregularities of the skin surface and even acne-like 'black heads' and cysts. Compare your skin in more sunprotected sights such as your buttocks to that on your face, 'V' of neck and arms to get a rough idea of some of the ageing affects the sun has caused on your skin.
Gravity, repeated movement of facial muscles, smoking and genetic characteristics also influence the appearance and severity of these changes. Some people are blessed with a genetic makeup that partially protects them from many of the changes associated with skin aging.
How Does Sunlight Damage the Skin?
Sunlight can dramatically increase skin changes associated with 'aging'. Damage to the top layer of the skin (the epidermis) leads to an uneven, scaling surface along with many growths or bumps. Damage to the pigment cells in this top layer also causes mottling colour changes, brown spots and freckles.
Damage to cells, collagen and elastic tissue of the dermis (the middle layer of the skin) contributes to wrinkles, which range from fine wrinkles to deeper creases and lines. It also reduces the skin's elasticity (ability to bounce back after stretching or movement of the skin), and can cause lumpy yellowish changes deep to the skin surface due to a process called 'solar elastosis'.
Sunlight can directly damage cells, and the other components of the skin. It leads to the generation of free radicals which can cause 'oxidant' damage to the skin. This leads to damage to the genetic material of cells, along with other components of cells and the skin.
Prevention
Sun protection is the most important measure you can take to maintain more youthful looking skin.
Ongoing excessive sun exposure can inhibit your immune system from removing damaged cells, along with other repair mechanisms. Therefore, making sun protection part of your daily skin care regimen, will also give your skin a chance to repair some (but not all) of the damage.
Photoaging is a chronic ongoing process. Low (and high) levels of sunlight exposure add up over the years. Even in Winter and on overcast days you can still receive significant levels of damaging UV light.
Visit our sun protection page, for ways to reduce sun damage. Avoid sunlight in the middle of the day, seek shade, wear a hat, protective clothing and make the application of sunscreen part of your general skin care regimen. The addition of a strong anti-oxidant to sunscreens and skin care products may also be of additional benefit in reducing the deleterious effects of ultraviolet light, time and other environmental stressors on the skin.
Smoking also accelerates skin aging and the damaging effects of excessive sunlight. Smoking contributes by damaging several parts of the skin including its elasticity and support. It is particularly associated with wrinkling, acne-like changes (comedones), and drooping of the face, these visible changes may take years or decades to occur. Never smoking or giving up smoking will help you age more gracefully.
Good Skin Care, Moisturisers and the Role of Water
Treating or preventing dry skin will usually smooth your skin's surface, reduce flaking and scaling changes, and assist the removal of dead cells from the top layers of the skin. The beneficial effects of treatments that preserve the skin's moisture may entirely reverse when they are stopped.
If you have dry skin, you should minimise the time you spend in hot showers (have shorter, warm showers instead). Use an emulsifiable bath oil, body washes with 'neutral' pH or 'soap' substitutes. All of these measures can help preserve the skin's natural moisturising factors.
Apply a moisturiser. This is usually more effective if used immediately after washing. Moisturisers work in several ways. 'Humectants' draw and hold water in the skin, while other moisturising factors help seal in the water. A large variety of moisturisers are available, try a few to decide which one feels best for you. Your local doctor or dermatologist can give you advice on suitable products for you skin. If you have acne or acne prone skin, moisturisers can worsen pimples, and many people with acne do not require a moisturiser as they have more than enough natural moisturising factors in their skin.
Drinking 'plenty' of water is good for the kidneys, and is especially important in hot weather, however, the skin's ability to hold the water is more important than the amount of water you drink for maintaining more youthful skin.
There are many face products that contain moisturisers and broadspectrum sunscreens. This is an ideal combination for a daily face cream. Daily face creams with microfine titanium dioxide and masking pigment can also cover up some of the signs of skin aging.
Don't forget to also protect your neck, chest, arms, or hands, which are also common sites of premature photoaging.
Should I use Anti-Oxidants and Vitamins?
The role of anti-oxidants in preventing or treating skin aging still requires more research. There are several reasons why they may reduce many of the changes we associate with skin aging, however these all remain largely unproven. Antioxidants have been shown experimentally to reduce some of the harmful effects of ultraviolet light, and theoretically may be beneficial in reducing many other changes associated with aging.
Anti-oxidants include: vitamin E (alpha tocopherol), vitamin C, coenzyme Q (ubiquinone), lipoic acid, along with a new generation of potentially more strong anti-oxidants on the way.
Although of unproven benefit, anti-oxidants may prove to be useful, particularly some of the newer and stronger agents. The main risk with these products is the rare occurrence of allergy, causing skin rashes. Many creams contain these products. You should talk to your doctor before taking high dose oral vitamins and anti-oxidants.
Some vitamin derivatives have beneficial effects / actions other than their role as anti-oxidants. The effects of some vitamin A derivatives (retinoids) are detailed below.
Creams That Reverse Some of the Signs of Skin Ageing
Creams are often useful for milder changes of aging including fine lines, wrinkles or roughness. Tretinoin creams (vitamin A derivative or retinoid) and alpha hydroxy acids (AHAs) are commonly used. They may also improve minor colour changes.
Tretinoin creams can provide long term benefits if used regularly. Tretinoin creams have been shown to improve facial wrinkles, and are especially useful for fine lines, and minor changes in colour. They can be successfully used on the face and also the back of hands. Their main disadvantage is they can cause skin irritation, redness, itching, dryness, or flaking and increased sensitivity to sunlight. Stringent sun-protective measures are required, as a sunburn could negate the cream's beneficial effects.
There are many formulations available, your doctor or dermatologist can recommend one most suitable for your skin. Tretinoin creams are only available by prescription in Australia. Your doctor can give you instructions on how and when to apply a tretinoin cream. Once you stop using a tretinoin cream, all its beneficial effects will potentially disappear with time.
Alpha hydroxyacids (AHAs) cause superficial peeling of dead skin cells, moisturise the skin, and possibly provide other benefits to rejuvenate the skin's appearance. These can be used as a cream and/or a chemical peel. Many over-the-counter products are available. It is usually recommended to start with a low concentration, and as the skin builds up tolerance, use increasingly stronger preparations for maximal benefit. A wide variety of AHAs are available. They may cause irritation and redness, along with a burning or stinging sensation shortly after application. Stronger AHAs are available from your doctor, along with AHA facial peels. Your dermatologist can give you advice and suggest an appropriate regimen, strength and formulation for your skin. There are AHA formulations for use on different parts of the body.
As AHAs, and topical tretinoin thin the top layer of the skin, they also make you more sensitive to the adverse effects of sunlight (the top layers of the skin are important for 'filtering' ultraviolet light and form your skin's major barrier or protective layer against environmental insults). Thus stringent sun protection is important if you use AHAs or tretinoin creams.
Hydroquinone cream is also known as fading or bleaching cream. It can be used to treat some pigment changes associated with aging and sunlight. It must be combined with stringent sun protection for maximum benefit. The down side is hydroquinone may irritate some people's skin and should only be used for short periods of time. Weaker preparations are available over-the-counter in Australia. Stronger formulations require a prescription and medical advice and assessment for their safe use. Inappropriate use may cause darkening or blotchiness of the skin.
Summary
Skin rejuvenation is an area attracting considerable ongoing interest. The cosmetic industry, dermatologists and the pharmaceutical industry are all actively researching new treatments and approaches. More scientific studies are required to help establish which treatments are most effective and which therapies are a waste of money and effort. Many claims by manufacturers remain unsubstantiated. By making sensible sun protection part of your daily skin care regimen, you will age more gracefully, and be in a better situation to benefit from new treatments and therapies.
Consider consulting your doctor or dermatologist before taking any new medication or buying an expensive cream for skin rejuvenation.
Related Topics
Cosmetic Dermatology Treatments and Procedures
Sun protection
Based on information provided to the Australasian College of Dermatologists
by Dr John R Sullivan
Last Modified 2 March, 2001 / © 2001 Australasian College of Dermatologists
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