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By:  Dr. Benjamin Barankin, MD FRCPC
Toronto Dermatologist
www.torontodermatologycentre.com

Dr. Barankin & Dr. Anatoli Freiman launched the Toronto Dermatology Centre in 2010, the largest & most comprehensive medical, surgical, laser & cosmetic dermatology practice in Canada. It is located at Bathurst & Sheppard where they are always happy to accept new patients.

What is the invisible disease

That pains us day and night?
The disease of continuously aging
And watching health and youth fade
~ 7th Dalai Lama

Aging skin is inevitable. Changes affecting the face are of particular concern to anyone who wants to remain looking youthful. How the skin ages depends on years in the sun, environmental damage, the amount of pigment in your skin, and even your genetics. As skin ages, it becomes increasingly dry, thin, and less stretchy (more loose).

The most harmful and significant cause of skin aging is a result of exposure to the sun’s rays (ultraviolet light). This “photo-aging” results in both fine and coarse skin wrinkling, dryness, rough texture, loose, uneven and mottled pigment. exposed skin, which is a canvas to years of sun exposure, is also more prone to developing skin cancers. Our skin also shows more damaged blood vessels, sallowness, and brown spots.

As we get older, our facial appearance changes as a result of fat redistribution and bone loss. Post-menopausal women are likely more prone to skin wrinkling due to their reduced levels of estrogen.

Other common signs of aging include raised brown spots which are harmless, but unsightly and pre-cancer spots which should be treated by a physician.

If the effects on skin weren’t enough, age brings nail growth slowing, thickening, and brittleness, as well as hair loss.

Big Business:

The topical products market for ageing skin in the United States alone resulted in over two billion dollars in sales, and presumably about one 10th of that in Canada. Over the counter anti-ageing products are popular because of their availability, affordability, and because they don’t require a visit to the physician.  More and more products contain ‘natural’ ingredients such as vitamins, minerals, and botanical extracts.

Things We Do to Worsen Our Skin:

  • Years of unprotected sun exposure and wind damage.
  • Going to tanning booths and parlors.
  • Smoking. Wrinkling is far more common and severe in smokers, and even worse when combined with too much sun exposure.
  • Alcohol and caffeine. Too much will dehydrate the skin.

Things We Can Do to Improve Our Skin:

  • There is some evidence that creams (particularly sunscreens) that deliver antioxidants such as vitamin C, vitamin E, green tea extracts, soy proteins and/or coenzyme Q10 can improve the quality of skin.
  • Topical retinoids (tretinoin) appear to reduce ultraviolet light damage, even out skin pigment, smooth fine wrinkles, and improve skin texture. They also help reduce the number and size of skin pre-cancers called actinic keratoses (rough red scaly spots), and to lighten brown spots (“liver spots” or lentigines). These agents require a prescription from your physician, and have the most evidence of any topical drug for their benefit in human skin ageing.
  • Sunscreens today reach up to a sun protection factor (SPF) of 110. It is recommended that a SPF of at least 30 be applied liberally (most people apply half the amount required) and daily, be it summer or winter (especially if skiing high in the mountains). Sunscreens should be reapplied throughout the day, and they should not be considered a replacement for sun avoidance or use of protective clothing, hats, and sunglasses. Note that 10 minutes of sunlight daily without sun protection is beneficial, especially in our northern climate, for the production of vitamin D by the skin and thus for good bone health. Regular use of a good sunscreen and other forms of sun protection from an early age are considered the most effective way to avoid many of the problems of skin ageing.
  • Even after years of sun exposure and skin damage, there is good evidence that some of these changes can be reversed by improving your level of sun protection. Its never too late!
  • Alpha-hydroxy acids such as glycolic, lactic, and citric acid increase skin thickness, smoothness, and skin colour mottling. There is no evidence that high-cost creams are more effective than low-cost creams.

Common Problems in Ageing Skin & Their Treatment:

Spider veins (telangiectasia) Electrocautery (electric-current zaps the blood vessel; good for a few blood vessels; cheap) or laser (more expensive, but good idea if large areas being treated).

Dry, itchy skin This is a greater problem as we get older and in particular during the winter. The lower legs and feet are most commonly affected. Use bland moisturizing soaps (Dove or CeraVe Hydrating Cleanser Bar) or soap substitutes (CeraVe, Cetaphil, SpectroDerm), with repeated applications of moisturizers with no fragrance or additives. Moisturizers  should be applied immediately after a lukewarm bath or shower to trap moisture.

Sometimes dry skin can be more persistent and very itchy, and may in fact be a form of eczema. This often requires a short-term treatment with topical steroids or newer non-steroid creams (Protopic®, Elidel®).

Easy bruising and skin thinning Ageing skin is more prone to tearing and minor trauma. Unfortunately, there is no good treatment for this. Skin thinning is part of the natural ageing process, and is increased by years of exposure to sunlight. Bruising goes along with skin thinness, and is also more common in those people on blood thinners such as aspirin or coumadin.

Flat brown spots (“liver spots” or lentigines) Liquid nitrogen spray, some creams (vitamin A or bleaching), chemical peels, and laser.

Raised brown spots (“granny warts” or seborrheic keratosis) Liquid nitrogen spray, scraping or shaving with a sharp blade and local anesthetic.

Rosacea People with lots of blood vessels on the face, easy flushing and skin sensitivity, gritty dry eyes, and/or pimples may have this condition. Depending on the type of rosacea, the physician may use creams or oral antibiotics. For the redness aspect, lasers are the most effective treatment.

Seborrhea As we get older, we are more prone to redness and yellow-scaling in the scalp, in the eyebrows, and along the sides of the nose. This often requires a mild topical steroid or newer creams (Protopic®, Elidel®). The rotating use of over-the-counter Nizoral shampoo®, tar shampoos (e.g. Neutrogena T/Gel®), and Head and Shoulders shampoo® can be beneficial.

Skin cancers These are best diagnosed by a physician. New spots or bumps developing after age 40 that don’t go away on their own after a few weeks should be examined. In some cases, a small piece of skin (skin biopsy) is removed to determine if the spot is a cancer. If that is the case, most skin cancers are cut out or scraped off, although there are other treatment options. Sunscreen is a  must.

Rough red scaly spots (actinic keratosis) these pre-cancers require treatment with liquid nitrogen (if only a few spots); if many spots present,  chemical peels or creams (e.g. Efudex®, Aldara™) are more beneficial.

Varicose veins Sclerotherapy or laser therapy. Wearing pressure-stockings can help prevent new varicose veins, reduce leg swelling and ulcers, and make the legs feel less achy.

Wrinkles Retinol and prescription-grade vitamin A creams (tretinoin, tazarotene) help with fine wrinkles. Botulinum toxin type A (BOTOX®) paralyzes the muscles that cause forehead furrows, bunny lines between the eyebrows, and wrinkles around the eyes. For wrinkles due to loss of fat and gravity, or to increase lip size, skin fillers (Restylane™, Juvéderm™) are quite beneficial.

Dermabrasion (removes top layers of skin), chemical peels, and different types of lasers can help depending on the depth of wrinkles. A dermatologist should be consulted when considering treatment for the complexities of skin wrinkles. However, other physicians are now providing treatment as well.

Note that many of these treatments are being combined (BOTOX, skin fillers, and lasers) to give the best outcome since skin ageing involves many different kinds of changes.

Whatever skin problem you face or enhancement you desire, it makes sense to see your physician to rule out a serious problem such as a skin cancer. They can best answer questions about improving your appearance. Remember that dermatologists are the skin, hair and nails specialists, and are able to diagnose and treat medical diseases and skin cancers, as well as addressing cosmetic concerns.