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How to take care of your skin
The aims of effective home skin care are straight forward:
- Minimise sun damage (Photoageing)
- Exfoliate regularly
- Reverse some pre-existing age related changes
- Even out pigmentation
Sunscreens
Sunscreens and other barrier methods of avoiding sun exposure – such as hats, protective clothing, driving gloves and avoiding the midday sun – are essential for minimising the effects of sun damage. It is futile for patients to spend time and money in an effort to treat the effects of ageing if they aren’t using a broad-spectrum sunscreen daily in conjunction with other methods of avoiding sun exposure. It is important to remember that skin damage can occur in the absence of sunburn.
There are two categories of sunscreen – chemical and mineral. Chemical sunscreens are filters. Chemicals are absorbed into the skin before acting to prevent sun damage from within.
Mineral sunscreens such as titanium dioxide and zinc oxide are considered superior, because they sit on the surface of the skin and act as a physical barrier against the sun’s rays. These minerals are inert and therefore are used in sunscreens for children or for people with sensitive skin, because they are much less likely to cause irritation or allergy. There are a number of invisible zinc sunscreens commercially available. The main problems with mineral sunscreens are that they are often thick and uncomfortable to wear, and they give rise to an unattractive whitish sheen when applied to skin.
When choosing a sunscreen preparation it is important to make sure it is truly broad spectrum (that is, it covers both UVA and UVB spectrums). Although most sunscreens cover UVB, only a few cover UVA. These include titanium dioxide, zinc oxide and avobenzone. For example Rationale Intelligent suncare uses a nanonised Zinc oxide, which feels like air on your skin not like older zinc bases. It is completely light and sheer which reflects and scatters light as it reaches your skin recreating a look that is softer and more luminous. Neutraliser SPF 25 nanonised zinc sunscreen and anti-red concealer helps calm and conceal redness.
Another important factor to consider is the sunscreens sun protection factor (SPF). While a moisturiser containing SPF 15 may be adequate for a person who works indoors and has only brief incidental sun exposure, a sunscreen with SPF 30 is necessary for any one with longer sun exposure. It should be remembered that sunscreens should be applied liberally to all exposed areas – including for example the chest and the backs of the hands – and reapplied regularly.
There is growing recognition that excessive sun avoidance can lead to vitamin D deficiency, even in Australia. Therefore, advice on sun protection needs to take into account the patient’s lifestyle and skin type. Low vitamin D levels have been liked to lowered immunity and increased risk of certain chronic diseases such as osteoporosis and even an increased risk of developing certain cancers.
Cosmeceuticals
Cosmeceuticals are home skin care products and treatments in which the active ingredient is promoted as having a beneficial physiological effect. However, because these products are not classified as therapeutic drugs, they are not subject to rigorous trials and testing. The efficacy of Cosmeceuticals is dependent on various factors, including the main active ingredient (particularly its chemical structure, form, concentration and stability of the product base), as well as its packaging (as many of these products are light sensitive).
Patients are understandably confused by the plethora of “cosmeceutical” products on the market and easily misguided by flashy advertising campaigns and pushy sales representatives. Often they end up spending large sums of money on products and treatments, only to be disappointed by poor results.
It can be very difficult to assess the efficacy of these products because accurate labelling is not mandatory for manufacturers and distributors. However, the effectiveness of several products is supported by sound clinical evidence (including pre and post treatment biopsies).
Retinoic Acid
Retinoic Acid binds to receptors in your skin cells. Regular treatment over several months can lead to partial reversal of extrinsic photoaging.
Histological changes observable in the epidermis include reduction of thickening in the stratum corneum, reversal of damaged cells and uniform dispersion of melanin. Dermal changes include increased collagen synthesis and angiogenesis.
Clinically observable changes in the skin texture and pigmentation may be evident after 1-2 months of daily use. Improvement in fine wrinkling may be evident after four months of daily use. Some patients may experience irritation and redness, necessitating less frequent application or use of lower concentrations.
Retinoic Acid should not be used during pregnancy because it is potentially teratogenic. It is only available by prescription, either in standard commercial preparations (such as Retin A or ReTrieve Cream), or in variable preparations from a compounding pharmacist.
Rationale’s Retinaldehyde is a less irritating formula which is the gentlest form of topical Vitamin A. It is available over the counter at the Cosmetic & Laser Medical Centre.
Alpha Hydroxy Acids
Alpha hydroxyl acids (AHA), such as glycolic acid and lactic acid, are primarily used as chemical exfoliants. In low concentrations they cause desquamation of the stratum corneum by disrupting cellular adhesion, while higher concentrations cause epidermolysis. Long-term use of these leads to increased collagen and elastin synthesis, and increased glycosaminoglycan concentration in the dermis. Clinically, concentrations less than 10% improve skin texture and pigmentation, while higher concentrations lead to improvement in fine wrinkling.
AHA’s are considered safe in pregnancy and cause less skin irritation than tretinoin. They are available over the counter in concentrations of 2-20%. Many AHA products available form pharmacies display the AHA concentration on the label (eg Rationale – Skin Refining Serum). Concentrations of 20-70% are used as skin peels within the clinic. AHA’s may be used alone (especially in younger patients) or in combination with tretinoin and depigmenting agents.
Depigmenting agents
Depigmenting agents block melanin production, reducing the intensity of lentigos, freckles and melasma. Results may not be apparent for several months, and pigmentation may return within six months of discontinuing treatment. Patients should avoid sun exposure when using these substances.
Hydroquinone is the most commonly used depigmenting agent in Australia. It is available through pharmacies in over-the-counter concentrations of up to 2%. Higher concentrations require prescription. Care needs to be taken to avoid continuous daily use for more than six months. If hydroquinone has not worked in this time an alternative treatment may be better.
Kojic acid – a by-product of the rice wine industry – also blocks melanin production. It is not commonly used in commercial preparations, because it tends to be chemically unstable. Kojic acid is available on prescription usually in concentrations of 4-8%.
Both hydroquinone and kojic acid are more effective when used in combination with retinoic acid or glycolic acid. If pigmentation fails to respond to topical depigmenting agents then it may be necessary to have treatment with laser technology. For more information see Pigmentation
Exfoliants
Exfoliation involves the removal of the most superficial layer of the epidermis, the stratum corneum. This layer is acellular, giving the skin a dull appearance. There are two types of exfoliants – chemical exfoliants, such as tretinoin and AHA, and mechanical exfoliants, which include scrubs and microdermabrasion. For more information see Microdermabrasion
Other cosmeceuticals
There are countless other cosmeceuticals. Many of the active ingredients used in these products could prove to be effective in the future, but high quality trials are required to establish their efficacy.
Although some substances that are known to be beneficial in wound healing are also used in cosmeceuticals, there may be no correlation between their role in wound healing and their efficacy in treating ageing. Other substances that are useful in a laboratory become unstable and ineffective when exposed to light and air.
Examples of cosmeceuticals that future scientific studies may prove to be beneficial include retinols, copper, growth factors, vitamins C and E e.g. Rationale Rejuvenating Serum, amino acids, Coenzyme Q10, hyaluronic acid e.g. Rationale Delivery Serum, carotenes, alpha lipoic acid and other antioxidants.
