Wrinkles In-Depth Report
Background
As you age, your skin undergoes progressive changes:
-The cells divide more slowly, and the inner layer of skin (the dermis) starts to thin. Fat cells beneath the dermis begin to shrink. In addition, the ability of the skin to repair itself decreases with age, so wounds heal more slowly. The thinning skin becomes vulnerable to injuries and damage.
-The deeper layer of the skin, which provides scaffolding for the surface skin layers, loosens and unravels. Skin then loses its elasticity (ability to stretch). When pressed, it no longer springs back into position. Instead, older skin sags and forms furrows.
-The oil-secreting glands atrophy (shrink), leaving the skin without a protective layer of fat. The skin's ability to stay moisturized then decreases, and it becomes dry and scaly.
-Frown lines (between the eyebrows) and crow's feet (lines that spread from the corners of the eyes) appear to develop because of permanent small muscle contractions. Habitual facial expressions also form characteristic lines.
-Gravity makes the situation worse, contributing to the formation of jowls and drooping eyelids. -Eyebrows, surprisingly, move up as a person ages, possibly pulled up by forehead wrinkles.
-Wrinkles can have a profound impact on self-esteem. The stigma attached to looking old is evidenced by the more than $12 billion Americans spend each year on cosmetic procedures to hide the signs of aging. Our society places a premium on youthfulness, and age discrimination in the workplace, although illegal, has stalled many people's careers. The emotional consequences of aging explain in large part why the cosmetics industry and plastic surgeons thrive.
Ultraviolet Radiation, Sunlight, and Photoaging
The sun is the most important cause of prematurely aging skin (a process called photoaging) and skin cancers. Overall, exposure to ultraviolet radiation from sunlight (radiation referred to as UVA or UVB) accounts for about 90% of the symptoms of premature skin aging.
-Most of these effects occur by age 20:
-Even small amounts of UV radiation trigger the processes leading to skin wrinkles.
-Long-term repetitive exposure to sunlight adds up, and likely is responsible for the vast majority of unwanted consequences of aging skin, including basal cell and squamous cell cancers.
-Intense exposure to sunlight in early life is an important cause of melanoma, a particularly aggressive type of skin cancer.
-Initial Damaging Effects of Sunlight. Ultraviolet radiation penetrates the layers of the skin. Both UVA and UVB rays cause damage that leads to wrinkles, lower immunity against infection, aging skin disorders, and cancer. Each of these rays appears to damage cells in different ways.
-UVB is the main cause of sunburns, and it primarily affects the outer skin layers. UVB is most intense at midday when sunlight is brightest. People receive slightly over 70% of their yearly UVB dose during the summer. They receive only 28% during the remainder of the year. Window glass filters out UVB.
-UVA penetrates more deeply and efficiently. The intensity of UVA rays is less dependent on the time of day and season of the year than that of UVB rays. For example, you receive only about half of your yearly UVA dose during the summer months, with the balance spread over the rest of the year. Window glass does NOT filter out UVA.
-Both UVA and UVB rays cause damage to the body, including genetic injury, wrinkles, aging skin disorders, and skin cancers. Exactly how they cause this damage is not yet fully understood.
-Processes Leading to Wrinkles.
Even small amounts of UV radiation trigger the processes that can cause wrinkles:
-Sunlight damages collagen fibers (the major protein that gives structure to the skin). Sunlight also damages elastin, a protein in the skin that normally maintains the springiness and strength of tissue beneath the skin.
-In response to this sun-induced elastin damage, the body produces large amounts of enzymes called metalloproteinases .
-Some of the these enzymes degrade (break down) collagen. The result is an uneven formation ( matrix ) of disorganized collagen fibers called solar scars . Repetition of this abnormal skin rebuilding causes wrinkles.
-An important event in this process is the over-production of oxidants , also called free radicals. -Excessive amounts of oxidants damage the body's cells and even alter their genetic material. Oxidation may contribute to wrinkling by activating the specific metalloproteinases that degrade connective tissue.
Other Factors Responsible for Wrinkles
In addition to sunlight, other factors may hasten the formation of wrinkles:
Cigarette Smoke . Smoking produces oxygen-free radicals, which accelerate wrinkles and aging skin disorders, and increase the risk for non-melanoma skin cancers. Studies also suggest that smoking and subsequent oxidation produce higher levels of metalloproteinases, the enzymes associated with wrinkles.
Air Pollution. Ozone, a common air pollutant, may be a particular problem for the skin, and deplete an important antioxident, Vitamin E.
Blemishes
This report covers three types of blemishes:
Liver spots,
purpura,
and seborrheic keratoses.
-Liver Spots
"Liver spots" (known as lentigos, or sun-induced or pigmented lesions) are flat brown spots on the skin. Despite the common name, these blemishes have nothing to do with the liver. Instead, they are almost universal signs of aging. Occurring most noticeably on the hands and face, these blemishes tend to enlarge and darken over time. The extent and severity of the spots are determined by a combination of skin type, sun exposure, and age. These spots are harmless, but they should be distinguished from lentigo maligna, which is an early sign of melanoma.
Liver spots or age spots are a type of skin change associated with aging. The increased pigmentation may be brought on by exposure to sun or other forms of ultraviolet light, or other unknown causes.
Treating Liver Spots.
Liver spots do not require treatment, although some people are distressed by their appearance. Treatments may include the following:
Trichloroacetic acid (a chemical peel).
Tretinoin (Retin A) alone, or in combination with Mequinol (Solag). Tretinoin is related to vitamin A, and is also effective in treating wrinkles.
Gentle freezing with liquid nitrogen (cryotherapy).
Laser treatment. Specific lasers, such as the Nd:YAG, are effective in eliminating 80% of liver spots in one treatment. Laser treatment may be more effective than cryotherapy and may have fewer side effects.
Bleaching creams are commonly available but are not as satisfactory as peels, and high concentrations can sometimes cause permanent loss of skin color.
-Purpura
Purpura occurs when tiny capillaries (blood vessels) break and leak blood into the skin. In older people, the condition (called senile or actinic purpura) is usually caused by fragile blood vessels. The capillaries appear as flat purplish patches. These patches are called petechiae when they are smaller than 3 mm (about a tenth of an inch). When they are greater than 3 mm, they are referred to as ecchymoses. Patients typically have a rash, which may appear reddish at first but gradually changes color, turning brown or purple.
Treatment.
Although there is no specific treatment for purpura, patients are advised to avoid trauma, including vigorous rubbing of the skin, which may damage the capillaries. Emollients that soften the skin may be helpful. Some doctors also recommend vitamin C, but its effectiveness is unproven.
Seborrheic Keratoses
Seborrheic keratoses are among the most common skin disorders in older adults. Their cause or causes are unknown. They usually appear on the head, neck, or trunk and can range in size from 0.2 - 3 cm (a little over an inch). They are well defined and appear to be pasted onto the skin, but their appearance can vary widely:
-They can be smooth with tiny, round, pearl-like formations embedded in them.
-They can be rough and warty.
-They can be brown or black.
Seborrheic keratoses sometimes look like melanoma, because they can have an irregular border, but they are always benign. A dermatologist can tell the difference between them, although experts warn that melanomas may "hide" among these benign lesions and go unnoticed without close inspection. In general, seborrheic keratoses have a uniform appearance, whereas melanomas often have a smooth surface that varies in height, color density, and shading. In some cases, keratoses may cause itching or irritation. They can be easily removed with surgery or freezing. Vitamin D3 ointment is also showing promise in clinical trials.
Risk Factors
Exposure to Sun in Childhood.
It is estimated that 50 - 80% of skin damage occurs in childhood and adolescence from intermittent, intense sun exposure that causes severe sunburns. In spite of this now well-known effect, many people still believe that a tan is a sign of good health in children. Even though many parents are concerned about sun exposure, they still rely too much on sunscreen and not enough on protective clothing.
The Elderly.
Most people over 70 have at least one skin disorder, and many have three or four skin disorders. Everyone experiences skin changes as they age, but a long life is not the sole determinant of aging skin. Family history, genetics, and behavioral choices all have a profound impact on the onset of aging-skin symptoms.
Activities Leading to Overexposure to Sunlight and Ultraviolet Radiation
Of all the risk factors for aging skin, exposure to UV radiation from sunlight is by far the most serious. The vast majority of undesirable consequences of aging skin occur in individuals who are repetitively exposed to the sun, including the following:
-Outdoor workers, such as farmers, fishermen, construction workers, and lifeguards
-Outdoor enthusiasts
-Sunbathers
-People who regularly attend tanning salons or use tanning beds
Skin Types
Experts have devised a classification system for skin phototypes (SPTs) based on the sensitivity to sunlight.
It ranges from SPT I (lightest skin plus other factors) to IV (darkest skin). People with skin types I and II are at highest risk for photoaging skin diseases, including cancer. It should be noted, however, that premature aging from sunlight can affect people of all skin shades.
Tanning and Burning History
I --Always burns, never tans, sensitive to sun exposure
II --Burns easily, tans minimally
III --Burns moderately, tans gradually to light brown
IV --Burns minimally, always tans well to moderately brown
V --Rarely burns, tans profusely to dark
VI --Never burns, deeply pigmented, least sensitive
Gender
The common belief is that women are at greater risk for wrinkles than men. Some evidence suggests, however, that given the same risk factors, men and women in the same age groups have comparable risks for skin photoaging. Some studies report that men are more likely than women to develop non-melanoma skin cancers.
Smokers
The skin of smokers in areas of their bodies not exposed to sunlight also seems to age more rapidly compared to nonsmokers in the same age group. In fact, heavy smokers in their 40s often have facial wrinkles more like those of nonsmokers in their 60s.
Studies of identical twins have found smokers to have thinner skin (in some cases by as much as 40%), more severe wrinkles, and more gray hair than their nonsmoking twins. Cigarette smokers are also more prone to skin cancers, including squamous cell carcinoma and giant basal cell carcinoma. Research has found that women who smoke have much lower levels of vitamin E secretions in their skin. Vitamin E is an antioxidant that may help protect the skin from sun damage.
Prevention
The best long-term prevention for overly wrinkled skin is a healthy lifestyle.
Eat Healthy.
A diet with plenty of whole grains, fresh fruits and vegetables, and healthy oils (such as olive oil) may protect against oxidative stress in the skin. Benefits from these foods may be due to high levels of antioxidants found in them.
Exercise.
Daily exercise keeps blood flowing, which brings oxygen to the skin. Oxygen is an important ingredient for healthy skin.
Avoid tobacco smoke.
Smoking not only increases wrinkles, but a smoker's risk for squamous cell cancers is 50% higher than that of a nonsmoker. Smokers should quit to prevent many health problems, not just unhealthy skin. Secondhand smoke is also dangerous.
Daily Preventive Skin Care
The following are some daily measures for skin protection:
-Don't wash your face too often with tap water. (Once a day is enough.) It strips the skin of oil and moisture. Chlorinated water, particularly at high temperatures, poses special risks for wrinkles.
-Wash your face with a mild soap that contains moisturizers. Avoid alkaline soaps, especially with deodorant.
-Pat the skin dry and immediately apply a water-based moisturizer.
-Always apply sunscreen, even if going outdoors for short periods of time. Research has shown that applying a cream containing a UVA and UVB protective sunscreen every day helps prevent sun-related skin damage.
-Avoid drinking alcohol within 3 hours of bedtime. Alcohol increases the risk for leaks in the capillaries, which allows more water in and causes sagging and puffiness. Capillary leakage increases when you lie down.
-Lie on your back when sleeping. This helps offset the effects of gravity.
-Avoid Sun Exposure
One of the most important ways to prevent skin damage is to avoid excessive sun exposure.
The following are some specific guidelines:
-Use sunscreens that block out both UVA and UVB radiation. However, do not rely only on sunscreen for sun protection. Also wear protective clothing and sunglasses.
-Avoid sun exposure, particularly from 10 a.m. - 4 p.m., when sunlight pours down 80% of its daily UV dose.
-Avoid reflective surfaces, such as water, sand, concrete, and white-painted areas. Clouds and haze are not protective and, in some cases, they may intensify UVB rays.
-Ultraviolet intensity depends on the angle of the sun, not its heat or brightness. The dangers are greater the closer to the start of summer. For example, in the Northern Hemisphere, UV intensity in April (2 months before summer starts) is equal to that in August (2 months after summer begins).
-The higher the altitude, the quicker you will sunburn.
-Avoid sun lamps and tanning beds or salons. They provide mostly high-output UVA rays. Some experts believe that 15 - 30 minutes at a tanning salon is as dangerous as a day spent in the sun.
-People should not be misled by advertising claims of "safe" tanning or promotions offering unlimited tanning.
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