Health Jun 2007

The skin is one of the first body parts to show age. While many of these age-related changes are inevitable, some can be reduced with healthy lifestyle choices and good skin care. Many people accept that changes to their skin are part of the normal aging process. If, however, you want to try one or more of the anti-aging treatments on offer, consult with an experienced cosmetic dermatologist and make sure you understand all the potential risks, complications and side effects of the treatment.

Skin layers explained

The uppermost layer of the skin is called the epidermis. This layer contains pigment-producing cells (melanocytes) that give skin its colour. New epidermal cells are born in the basal cell layer of the epidermis - the living layer of the epidermis. The stratum corneum, also known as the ‘horny layer’, is the outer layer of the epidermis. It contains keratin and is made up of dead cells. Cells of the epidermis start in the basal cell layer and then gradually rise to the surface, while older dead cells are sloughed off.

Beneath the epidermis is the dermis, which contains blood and lymph vessels, nerves, sweat glands and oil glands. Hair follicles are extensions of the epidermis into the dermis. The dermis is made up of networks of elastic fibres (elastin) for suppleness and dense fibres (collagen) for strength. Finally, a layer of fatty tissue lies below the skin and gives it structure.

The skin is one of the first body parts to show age and, while many of these age-related changes are inevitable, some can be reduced with sensible lifestyle choices and good skin care.

Signs of aging

Some of the signs of ageing skin can include:

• Thinning - the basal cell layer of the epidermis slows its rate of cell production and thins the epidermis. The dermis may become thinner. Together, these changes mean skin is more likely to crepe and wrinkle.

• Sagging - older skin produces less elastin and collagen, which means it is more likely to sag and droop. Older skin is particularly vulnerable to the effects of gravity - for example, jowls along the jaw and bags under the eyes are simply skin that has yielded to gravity.

• Wrinkles - reduced elastin and collagen, and the thinning of skin, mean those ‘high traffic’ areas of the face (like the eyes and mouth) are especially prone to lines and wrinkles.

• Age spots - the remaining pigment cells (melanocytes) tend to increase in certain areas and cluster together, forming what’s known as age or liver spots. Areas that have been exposed to the sun, such as the backs of the hands, are particularly prone to age spots.

• Dryness - older skin has fewer sweat glands and oil glands. This can make the skin more prone to dryness-related conditions, such as roughness and itching.

• Broken blood vessels - blood vessels in older, thinner skin are more likely to break and bruise. They may also become permanently widened. This is commonly known as broken vessels.

Age-related skin conditions

Some skin conditions are more likely to develop as we get older. These can include:

• Seborrhoeic keratosis - a type of benign skin tumour that looks like a brown wart.

• Solar keratoses - spots of skin that are inflamed, scaly and dry. Common sites include the bridge of the nose, cheeks, upper lip and backs of the hands. Skin cancer (squamous cell) can develop in them, so examination by a doctor is advised.

• Bowen’s disease - a type of slow-growing and scaly skin patch. It may be a pre-cancerous change. Sun exposure is thought to be a cause.

• Skin cancer - including basal cell carcinoma, squamous cell carcinoma and melanoma.

Risk reduction strategies

Ways to reduce the signs of ageing include:

• Limit sun exposure - sun exposure leads to premature aging of the skin, known as photoageing. If you want proof, compare the skin on your hands with that on your buttocks. Wear a hat, loose fitting clothes, sunglasses and SPF15+ sunscreen when outdoors, and avoid sunbathing.

• Don’t smoke - cigarette smoking promotes skin wrinkling and is thought to accelerate the damage caused by sun exposure. The action of puckering up for each drag on a cigarette increases the likelihood of wrinkles around the mouth.

• Eat a healthy diet - a healthy, well-balanced diet is as important for healthy skin as it is for a healthy body.

• Care for skin gently - avoid harsh skin irritants such as perfumed soaps, heavily chlorinated swimming pools and long hot showers. Use neutral pH balanced soaps, body washes or equivalents.

• Moisturise regularly - dry skin is more likely to show fine lines and wrinkles. Moisturise regularly if you have dry skin.

• Seek medical advice if necessary - skin complaints, such as acne or eczema, can be diagnosed and treated by your general practitioner or dermatologist.

Anti-aging treatments

There is a range of anti-aging treatments available; however, they are not without risk and you should consult with an experienced cosmetic dermatologist to make sure you understand all the potential risks, complications and side effects of the treatment. Some of the anti-aging treatments offered by cosmetic dermatology include:

• Topical lotions - creams (such as tretinoin creams) are only available on prescription. These creams have been shown to visibly reduce fine lines and uneven skin colouration when used regularly.

• Injections - for example, synthetic collagen or body fat harvested from other areas of the client’s body can be ‘piped’ along wrinkles via a small hypodermic needle.

• Facial peels - chemicals are applied to the face to ‘burn off’ the top layer of skin. This removes the wrinkles and encourages faster regrowth of newer, younger-looking skin.

• Botox - wrinkle-prone areas, such as around the eyes and between the eyebrows, are injected with the Botulinum toxin. The resulting paralysis prevents the muscles from wrinkling the skin.

• Vascular laser - to remove broken blood vessels from the face or other areas of the skin.

• Laser resurfacing - laser can be used to treat wrinkles, age spots, scars and skin growths.

Cosmetic surgery

Some cosmetic surgeries that are designed to reduce the signs of aging include the eye lift (blepharoplasty) and face lift (meloplasty). Consult with an experienced plastic surgeon and make sure you understand all the potential risks, complications and side effects of surgery.

Moisturisers - be wary of outrageous claims

Manufacturers of over-the-counter moisturisers can sometimes make impressive claims. Remember that a moisturiser can keep the skin moist and reduce the appearance of fine lines, but no product has so far been shown to turn back the clock. Consult with your dermatologist before buying an expensive moisturiser - you may be advised not to waste your money.

Where to get help

• Your doctor

• Dermatologist

• Cosmetic surgeon

Things to remember

• Signs of aging skin include thinning, sagging, wrinkling, age spots, broken blood vessels and dryness.

• Some age-related skin changes can be reduced - limit sun exposure, don’t smoke, avoid harsh skin irritants and moisturise regularly.