Skin Care and Aging

Americans spend billions of dollars each year on skin care products that promise to erase wrinkles, lighten age spots, and eliminate itching, flaking, or redness. But the simplest and cheapest way to keep your skin healthy and young looking is to stay out of the sun.

Sunlight is a major cause of the skin changes we think of as aging — changes such as wrinkles, dryness, and age spots. Your skin does change with age. For example, you sweat less, leading to increased dryness. As your skin ages, it becomes thinner and loses fat, so it looks less plump and smooth. Underlying structures — veins and bones in particular — become more prominent. Your skin can take longer to heal when injured.

You can delay these changes by staying out of the sun. Although nothing can completely undo sun damage, the skin sometimes can repair itself. So, it’s never too late to protect yourself from the harmful effects of the sun.

Wrinkles

Over time, the sun’s ultraviolet (UV) light damages the fibers in the skin called elastin. The breakdown of these fibers causes the skin to lose its ability to snap back after stretching. As a result, wrinkles form. Gravity also is at work, pulling at the skin and causing it to sag, most noticeably on the face, neck, and upper arms.

Cigarette smoking also contributes to wrinkles. People who smoke tend to have more wrinkles than nonsmokers of the same age, complexion, and history of sun exposure. The reason for this difference is not clear. It may be because smoking also plays a role in damaging elastin. Facial wrinkling increases with the amount of cigarettes and number of years a person has smoked.

Many products currently on the market claim to “revitalize aging skin.” According to the American Academy of Dermatology, over-the-counter “wrinkle” creams and lotions may soothe dry skin, but they do little or nothing to reverse wrinkles. At this time, the only products that have been studied for safety and effectiveness and approved by the Food and Drug Administration (FDA) to treat signs of sun-damaged or aging skin are tretinoin cream and carbon dioxide (CO2) and erbium (Er:YAG) lasers.

Tretinoin cream (Renova), a vitamin A derivative available by prescription only, is approved for reducing the appearance of fine wrinkles, mottled darkened spots, and roughness in people whose skin doesn’t improve with regular skin care and use of sun protection. However, it doesn’t eliminate wrinkles, repair sun-damaged skin, or restore skin to its healthier, younger structure. It hasn’t been studied in people 50 and older or in people with moderately or darkly pigmented skin.

The CO2 and Er:YAG lasers are approved to treat wrinkles. The doctor uses the laser to remove skin one layer at a time. Laser therapy is performed under anesthesia in an outpatient surgical setting.

The FDA currently is studying the safety of alpha hydroxy acids (AHAs), which are widely promoted to reduce wrinkles, spots, and other signs of aging, sun-damaged skin. Some studies suggest that they may work, but there is concern about adverse reactions and long-term effects of their use. Because people who use AHA products have greater sensitivity to the sun, the FDA advises consumers to protect themselves from sun exposure by using sunscreen, wearing a hat, or avoiding mid-day sun. If you are interested in treatment for wrinkles, you should discuss treatment options with a dermatologist.

Light-Activated Therapy and Aging Skin

A study in the October issue of the Archives of Dermatology, supports that Photodynamic therapy appears to cause molecular-level changes in aging skin that increase collagen production and improve skin appearance, a U.S. study finds. Meaning, light-activated therapy seems to rejuvenate aging skin.

In photodynamic therapy, a light-activated medication is exposed to a light source. Photodynamic therapy for aesthetic treatments typically involves application of a topical medication, such as 5-aminolevulinic acid (5-ALA).

In this study, Dr. Jeffrey S. Orringer and colleagues at the University of Michigan Medical School in Ann Arbor, used photodynamic therapy to treat 25 people, aged 54 to 83, with sun-damaged skin on their forearms.

Prior to treatment, the patients’ degree of skin damage was rated, and tissue samples were taken from their forearms. A solution containing 5-ALA was applied to the damaged skin and left on for three hours. The skin was then cleaned and treated with a pulsed-dye laser. The patients were re-examined four to five times over the following six months.

Tissue samples showed that treatment resulted in a fivefold increase in levels of a protein called Ki67, believed to play an important role in the growth and development of new skin cells. In addition, there was a 1.4-fold increase in the thickness of the skin’s outer layer (epidermis) and higher levels of enzymes and other compounds associated with the production of collagen, the main structural protein in skin.

“Photodynamic therapy with the specific treatment regimen employed produces statistically significant quantitative cutaneous molecular changes [e.g., production of types I and III collagen] that are associated with improved appearance of the skin,” the researchers wrote.

The findings suggest that use of a photosensitive compound such as 5-ALA in combination with pulsed-dye laser therapy prompts more beneficial changes in skin than laser therapy alone.

“Although our molecular measurements cannot yet precisely predict clinical outcomes for a single given patient, taken together they are very much in keeping with the bulk of the clinical literature and thus lend substantial support to the conclusions reached by other researchers who have published purely clinically oriented work in this field,” the study authors concluded.

“We believe that the quantitative amount of dermal repair and regeneration induced by a specific therapeutic intervention very likely underlies the degree of clinical rejuvenation produced.” they wrote. “Thus, it is our hope that, with further development, our working molecular model may one day be used to predict the clinical value of new technologies in aesthetic dermatology.”