Whether from magazines, television, or social media, women are inundated with promises of younger-looking, healthier skin with the launch of every new skin care product. By 2019, the global anti-aging market, which includes skin care, is expected to reach $191.7 billion. The truth is that many of these products can be expensive and deliver results that fall short of the advertised claims.
As women age they experience a decrease in skin cell biological activity, regenerative processes, and adaptation. This aging of the skin is affected by internal factors (e.g., genetics, hormones, vitamin deficiencies) and externa factors (e.g., ultraviolet radiation [UVR] exposure, environmental toxins, smoking, improper care). The natural process of aging skin results in fine wrinkling and thinning, whereas sun exposure may cause aging skin to be dry and leathery with telangiectasia and coarse wrinkling.
There are numerous anti-aging approaches that include daily skin care, sun protection, aesthetic noninvasive procedures, topical agents, systemic agents, and preventive medicine.
Women often turn to health care providers for guidance on skin care and skin health. Although women may be searching for a quick and easy method to achieve younger-looking skin, it is imperative that all women be educated about the basic and most fundamental measures to protect skin from damage.
Avoiding UVR exposure is the key prevention strategy against photoaging and skin cancer. Photoaging is premature aging of the skin that results from repeated UVR exposure, primarily from the sun. Exposure to UVR produces both acute and long-term damage to the skin. This is true in both Whites and African Americans. Although African Americans are less likely to develop skin cancer, it is associated with greater morbidity and mortality in this population. Avoiding sun exposure, especially when the sun is directly overhead, and wearing protective clothing are the two most effective measures in reducing UVR exposure. Although use of sunscreen does not completely eliminate UVR exposure dangers, it is an effective adjunct to sun avoidance and wearing protective clothing. Women should be reminded that the face, neck, legs, and dorsal hands get the most sunlight exposure on a day-to-day basis. Daily moisturizers with sunscreen should be used.
Proper application of sunscreen is critical for maximizing protection. Studies have shown that users apply less sunscreen than required and fail to cover all exposed areas. It is important to choose a sunscreen that protects against both UVA and UVB radiation and has a sun protection factor (SPF) of 30 or higher. The SPF factor indicates protection against only UVB; therefore, using a sunscreen labeled broad spectrum helps to also prevent damage from UVA. Sunscreen should be applied 15 to 30 minutes before sun exposure and then every 2 hours for maximum effectiveness.
As women age, endogenous antioxidative mechanisms become less effective, and the ability to prevent DNA and cellular damage is reduced. Although the body has the ability to neutralize reactive oxygen species, which are known to damage the bases and backbone of DNA and ultimately to break down collagen, oxidative stress from UVR exposure can overwhelm these mechanisms. Human studies on exogenous dietary antioxidants such as vitamin C, vitamin E, carotenoids (found in winter squash, carrots, and sweet potatoes), lipoic acid (found in kidney, heart, liver, spinach, broccoli, and yeast extract), and selenium (found in Brazil nuts, plants grown in soil with high selenium concentrations, and some meats and fish) have suggested protective effects from ingestion at normal dietary recommendations.
It is important to remind women that excessive intake of supplemental antioxidants and certain antioxidant combinations can be dangerous and could have devastating effects. Other products with potential antioxidative properties that have shown some promise in the treatment of aging skin but require further investigation include soy, green tea, ginkgo biloba, and ginseng. Although there are numerous claims of benefit from antioxidant supplements, their role in cancer prevention is not
supported in larger, long-term human studies.
Topically applied products not considered drugs or cosmetics that are applied to make changes to the skin status are referred to as cosmeceuticals. In the United States, cosmeceuticals are commercialized as cosmetics and are not subject to regulation. Ingredients are generally derived from botanicals, marine extracts, vitamins, or minerals. The claims that these formulations have anti-inflammatory, antioxidant, and barrier-enhancing pathways all depend on the specific product. Because there are abundant variations and options, there is no way to speak to the effectiveness or safety of cosmeceuticals as a whole. Women should be cautioned that, although the claims may seem sound, there is little to no scientific research on these products.
Retinoids, derived from vitamin A, are known to decrease the appearance of fine wrinkles and freckles. Because topical retinoids can cause irritation to the skin, it is recommended to start using them in small quantities and use every other day. If tolerated, the quantity and frequency may increase. According to Sorg and Saurat (2014), irritation and burning are generally worse the first weeks to months of use and may subside with time. To minimize the stinging sensation, it is recommended that topical retinoids not be applied within 30 minutes of washing the face. Women should be reminded that topical retinoids can cause photosensitive reactions in the skin; therefore, they should not be applied right before sun exposure.
Moisturizers can be classified as humectants, occlusive, emollients, and constituents of natural moisturizing factor/essential proteins. According to Wan, Wong, Longaker, Yang, and Wei (2014), moisturizers are designed to impart or restore hydration and provide some form of temporary barrier, allowing time for repair of damaged skin.
However, it is important to stress that hydration of the skin primarily comes from within. The amount of water lost from the skin depends on temperature, humidity, skin cleansing, and barrier practices. Moisturizers may provide a barrier to water loss. Wearing a daily moisturizer with an SPF of at least 15, rain or shine, is one of the best methods of preventing drying and photoaging. Determining the best moisturizer is often a matter of personal preference and trial and error.
Health care providers should never miss an opportunity to talk to women about checking their skin regularly. The most common type of cancer in the United States is skin cancer, which can be cured if found and treated early. Routine self-monitoring is important in one’s own skin awareness and should start at an early age. Self-monitoring should be performed on a monthly basis, looking for any new moles or changes in existing moles. By their early 20s, women should receive an additional clinical skin examination during their usual routine checkup by a trained professional.
To perform a thorough self-examination of the skin, a woman will need a well-lit room (an extra light may be needed), a full-length mirror, a hand mirror, a place to sit, and a note pad for documentation (or the use of a body map such as the one found here: http://www.skincancer.org/Media/Default/File/File/scf-body-map-2016.pdf and https://www.llskin.jp). It is important to encourage a systematic approach, such as starting from the head and working toward the toes. A thorough examination of all skin surfaces including scalp, in between fingers and toes, and around genitals should be completed. Any abnormality or change from previous examination should be reported to the health care provider.
Knowing the ABCDEs (see Box 1) can also help guide women in self-examinations.
Despite efforts to control the aging process, the skin, like other organs, ages. Every year new skin care products are released with promises to turn back the clock. Women will have questions about the validity of these claims.
Although every product is different, providers have the ability to educate women about proven best practices and how to evaluate claims of seemingly magical treatments. Unfortunately, providers spend little time educating women on general skin care. The best advice is that a well-balanced diet, adequate hydration, use of a topical moisturizer, protection from the sun, and avoiding smoking and tobacco are the most effective measures for not only healthy skin but a healthful life.
The following are signs that warrant a closer look:
A: Asymmetry in the shape of the mole
B: Borders may be irregular
C: Color is not uniform with other moles or has different pigments in the same mole
D: Diameter greater than the size of a pencil eraser should be examined
E: Evolution or changes in the mole over time