Skin Health

What Is It?

The skin is the largest organ in the body. It acts as the first defense against disease and infection, and it protects your internal organs from injuries.

The importance of keeping your skin healthy can't be overemphasized. It's the body's first defense against disease and infection, and it protects your internal organs from injuries. It is, in fact, the largest organ in the body. The skin helps regulate body temperature and prevents excess fluid loss, and it also helps your body remove excess water and salt.

Skin conditions can affect anyone—young and old, men and women. Acne, psoriasis and eczema are just a few examples of common skin disorders. The good news is that there are a number of simple ways to keep skin healthy, and there also are now many options available to treat skin conditions, if treatment is necessary.

If you think you may have a skin problem or need to learn how to better care for your skin, consultation with a dermatologist—a physician who specializes in treating the skin and keeping it healthy—may be in order. Skin problems can be difficult to diagnose because many skin conditions share similar symptoms. An evaluation is key to effective treatment.

The Structure of Skin

To understand how to keep your skin healthy, it may help to learn about your skin's structure.

Skin is composed of three layers: the epidermis (the outermost layer of skin—about the thickness of a piece of paper), the dermis (the middle layer) and the subcutaneous layer (the deepest layer). The thickness of the dermis varies depending on the location. For example, eyelid dermis is quite thin, but back dermis is about half an inch thick. The epidermis has three sub-layers: the stratum corneum, the squamous cell layer and the basal cell layer.

• The stratum corneum or outer layer of the epidermis is the layer of skin that can be seen and felt. Proteins known as keratin, a fatty, waterproof envelope, and flat, closely packed dead cells make up the stratum corneum. This layer is the barrier between your body and the outside world.
• The squamous cell layer produces keratin for the stratum corneum and also transports water.
• The basal cell layer is the lowest layer of the epidermis. This is where the skin cells are reproduced and give rise to the more superficial layers of the epidermis. The most common form of skin cancer, basal cell carcinoma, arises from this cell layer. Melanocytes, which produce melanin, or skin pigment, sit along this layer among these cells. Melanoma, one of the three most common forms of skin cancer, originates from these pigment-producing cells.

It takes about one month for skin cells to move from the basal cell layer to the top of the stratum corneum and slough off.

The dermis is the middle layer of skin. It is a diverse combination of blood vessels, nerves, hair follicles and sebaceous (or oil) glands. The proteins collagen and elastin are found in the dermis. They provide support and elasticity to the skin. The sun's rays can break down these proteins and, eventually, the skin begins to wrinkle and sag.

The subcutaneous layer, or subcutis, is a layer of fatty tissue that provides nourishment to the dermis and upper layers of skin. It also conserves body heat and cushions internal organs against trauma. Blood vessels, nerves, sweat glands and deeper hair follicles extend from the dermis into the fat (hypodermis).

Look Your Best—Limit Sun Exposure

Facial skin typically looks its best during a woman's 20s. As you age, your skin becomes thinner and often drier. Thinning skin is a result of a breakdown of collagen and elastin fibers. As it ages, skin loses elasticity—especially if it has been exposed to excessive sunlight—and becomes more fragile and drier. However, there are a number of dietary and lifestyle changes that you can make to help keep your skin healthy and young-looking.

Because exposure to the sun causes most of the skin changes associated with aging, protecting the skin from the sun is the single most important skin care practice you can adopt. Significant exposure to the sun will wrinkle and dry the skin. Uneven pigmentation—from freckles to small or large brown spots—is another side effect of frequent sunning. Melasma, commonly associated with pregnancy, is brought out by the sun and produces large brown patches on the forehead and cheeks.

The most serious consequence of sun exposure is skin cancer. Skin cancer is the most common type of cancer, making up nearly half of all diagnosed cases of cancer, according to the American Cancer Society (ACS). Most sun damage occurs prior to the age of 18, but skin cancer can take up to 20 or more years to develop; children who experience just a few serious sunburns are believed to have an increased risk of developing skin cancer later in life.

Primary care physicians are able to evaluate many skin conditions. They may be the first health care professionals you discuss your skin problems with. However, dermatologists are physicians with extensive training in skin care and skin disorders. Skin conditions can be difficult to diagnose because there are so many skin problems and symptoms may be similar. Consultation with a dermatologist is recommended to get an accurate diagnosis and treatment plan. It may be the more cost-effective means of diagnosing and treating skin disease.

• Acne. This aggravating condition may be mild with small blackheads and whiteheads; moderate, with some inflammation, pustules (closed pus-containing pockets) and red pimples; or severe, with large cysts or nodules. Severe acne can result in permanent scarring. Contrary to popular belief, greasy foods and dirt do not cause acne. Acne is caused by genetic influences—if your parents had acne, you are more likely to develop it. Hormones, specifically male hormones called androgens, of which testosterone is the best known, also play a major role in acne's development.
  
  Acne is a buildup of oil, microorganisms and dead skin cells in the hair follicles under the skin. When the hair follicle ruptures, the rupture triggers an "acne cascade," which inflames surrounding tissue. Androgens are a major influence on acne because they stimulate the hormone-sensitive sebaceous glands, which produce sebum. That's why you don't see acne before puberty. In women, birth control pills can either aggravate or improve acne. This probably depends on your response to progestin—one of the hormones used in many birth control pills. Greasy hair and skin products, perspiration, headbands and other things that can plug up pores make acne worse. Stress may trigger acne flare-ups. Squeezing pimples can make acne worse and more likely to leave scars.
• Rosacea. According to the National Rosacea Society, more than 16 million Americans have rosacea, but most of them don't know it. It is most common in fair-skinned women between ages 30 and 50, although it can occur in all races. Rosacea can present itself in different ways. It may appear as pink or red flushing or dilated blood vessels alone or with pus-filled bumps or deeper red bumps. It can also cause skin thickening and enlargement, usually around the nose. Rosacea may worsen with exposure to certain factors such as hot or cold temperatures, sunlight, alcohol, spicy foods, stress and heavy exercise. Chronic use of topical steroids on the face may lead to steroid rosacea. The cause of rosacea is unknown.
• Eczema. An estimated 15 million people in the United States have some form of eczema. Also known as atopic dermatitis, this condition causes an itchy, red, cracked, scaly rash that can occur anywhere on the body, but most commonly on the arms and the backs of the knees, as well as on the hands, feet, face and neck. It is hereditary and often occurs in individuals who suffer asthma or hay fever. Dry skin, certain soaps and bathing too frequently worsen the condition; moisturizers and humid air may improve it. Adults may get a form called nummular eczema, which tends to be scaly, coin-shaped spots on the arms and legs.
• Dandruff. Mistakenly attributed to dryness because of the flaking it causes, dandruff is caused by inflammation in the scalp. The microscopic scales accumulate and then fall off in visible flakes.
• Hives. Called urticaria, hives are an allergic reaction. It's rarely clear what triggers hives. They can be stress-related. These pink, itchy swellings are caused by the release of histamine and other chemicals in the skin. Eggs, chocolate, seafood, nuts, milk and medications are occasional triggers of hives for some people, as are exposure to cold temperatures or infections. Individual hive lesions generally fade in 24 hours or less. When hives develop in the throat, breathing can become difficult and may be life threatening, and immediate treatment is required.
• Psoriasis. A chronic disease affecting up to 7.5 million Americans, psoriasis causes the skin to become inflamed with red, thickened areas that become covered with flaky, silvery scales. The condition is not contagious, and the ultimate cause is not known, although it is thought to be an immunologic genetic disorder. Because of this immune stimulation, the uppermost layer of skin cells multiplies at an accelerated rate. A normal epidermis is replenished about every 28 days, but psoriasis causes the skin cells to multiply so quickly that it replenishes every two to four days. This new skin grows so fast the cells don't have a chance to slough normally. Psoriasis typically appears on elbows, knees and scalp, but it can also arise on your lower back, buttocks, palms, soles and genital region. Psoriasis can occur in areas of trauma such as severe sunburns or surgical scars. Psoriasis may be associated with a specific type of arthritis, known as psoriatic arthritis. Lesions can be triggered by stress, infection, climate changes and medications. There is no cure for this condition, but treatments can reduce skin inflammation.
• Stretch marks. During pregnancy, as a woman's skin stretches to accommodate her baby's growth, stretch marks may appear. They are initially light pink or purple lines that eventually fade to white. Stretch marks are most often found on the breasts, thighs, abdomen or hips. Stretch marks may also be caused by pubescent growth spurts or other rapid weight gain or muscle buildup.

Skin Cancer

An early warning sign of severe sun damage is the development actinic keratoses. Most common in people over age 40, this precancerous condition develops as a result of cumulative, extensive sun exposure and can lead to skin cancer, specifically squamous cell carcinoma. Actinic keratoses are responsible for more than 2 million visits to dermatologists each year in the United States. These lesions appear as scaly red/brown bumps on the face, ears, neck, lips and forearms or on the backs of the hands. These lesions may itch or feel tender, especially when exposed to sunlight.

There are two main groups of skin cancer: nonmelanoma skin cancer, the most common type of skin cancer, and melanoma (sometimes referred to as "malignant melanoma") skin cancer.

Basal cell carcinoma and squamous cell carcinoma are the most common forms of nonmelanoma skin cancers. There more than 1 million cases each year in the United States. These types of cancer start in the skin's basal cell layer or squamous cell layer. Men are at higher risk than women for basal cell carcinoma and squamous cell carcinoma.

Melanoma is the least common but most aggressive of the three most common types of skin cancer. Melanoma originates in the skin's melanocytes—the cells that produce pigment, or melanin. Melanoma typically appears in or around a mole, but it may also develop on clear skin. It may be a flat, brown, black or tan spot or a raised bump. Unlike a noncancerous mole, melanoma often is irregularly shaped.

About 68,720 new cases of melanoma were diagnosed in 2009—less than 5 percent of all diagnosed skin cancers. But melanoma accounts for a large majority of skin cancer deaths, according to the ACS.

Anyone may develop skin cancer, but people with fair complexions are more susceptible to precancerous conditions and skin cancer than people with darker skin tones. Caucasians have a tenfold increased risk of developing skin cancer than African Americans. Darker skin has more melanin, which provides some natural protection against the sun's damaging rays. In addition to fair skin, other risk factors for skin cancer include:

• exposure to toxic materials, such as arsenic
• radiation therapy
• chronic non-healing or scarred skin such as long-standing ulcers or severe burn scars
• a family history of melanoma skin cancer or other conditions that are more likely to develop into skin cancer (such as dysplastic nevus syndrome)
• a personal history of skin cancer
• a tendency to freckle or burn easily
• lots of sun exposure throughout your life
• many sunburns as a child or adolescent
• outdoor summer employment during adolescence
• burns
• tanning bed use (Frequent use of tanning beds may increase your risk of melanoma by 40 to 75 percent, depending upon frequency of use and age you began tanning.)

Check Your Skin Regularly

Precancerous skin changes and skin cancer are usually easy to recognize and are often curable when detected and treated in early stages.

The first step in detecting abnormalities that may be skin cancer begins with you. Examine your skin once a month for any suspicious changes. Sores that won't heal may also indicate skin cancer or precancerous conditions that need attention.

The American Academy of Dermatology has developed an easy-to-use method to evaluate your skin for melanoma. Look for the "ABCDEs":

• Asymmetry: One half of the spot is not shaped like the other half
• Border irregularity: Poorly defined or "scalloped" border
• Color: Shades of tan, brown, black and sometimes red, white and blue, vary across the spot
• Diameter: The spot is larger than six millimeters, the diameter of a pencil eraser, however, skin cancers can also be smaller
• Evolving: The mole looks different from the other moles on the body and is changing in size, shape or color.

A condition called dysplastic nevus/melanoma syndrome can increase a person's risk for developing melanoma. A "nevus" is a mole. These particular moles are often irregularly shaped and may be larger than other moles. They can appear anywhere on the body—sun-exposed or not. This condition tends to run in families. A person with this condition may have many moles on her body or just a few. Researchers believe that a genetic predisposition for dysplastic nevus syndrome may exist.

Diagnosing Skin Cancer

There are several types of skin biopsies that health care professionals may perform if you have suspicious-looking growths that could be skin cancer. A skin biopsy involves giving you a local anesthetic, after which a sample of skin will be taken for examination under a microscope. You may feel minor discomfort—a small needle stick and burning—for a few seconds. Types of biopsies are as follows:

• Shave biopsy. The epidermis and the upper part of the dermis are shaved off in a thin slice. This procedure is performed with local anesthesia.
• Punch biopsy. A sample of the entire thickness of the skin is taken (about 1/8 inch) with an instrument that takes a cylindrical core sample of the skin and a small part of the underlying fat layer.
• Incisional biopsy and excisional biopsy. With a scalpel, a wider and deeper sample of skin with various amounts of the underlying fat will be removed, and then the wound is closed with stitches or staples. Incisional biopsy removes a portion of the growth, and excisional biopsy is used to remove or sample broad or deep growths.

There are many new and refined treatment options available today for skin conditions. Consultation with a dermatologist is recommended to determine which option is best for your condition as well as for recommendations about how to keep your skin healthy. Here are a few treatment options for common skin conditions.

• Acne. Treatment can include topical or oral antibiotics and creams to remove plugs at the opening of the oil glands. Birth control pills can sometimes improve acne. When washing, you should use a mild soap and avoid scrubbing. Topical benzoyl peroxide can help reduce bacteria, and retinoic acid can help unblock pores. Acne washes and nonprescription preparations may also be helpful. Isotretinoin (Accutane), a prescription medication, can provide long-term remission of severe acne in some people. Accutane often causes side effects such as dry eyes, lips, nose, mouth and skin, itching, nosebleeds, muscle aches, sun sensitivity and poor vision at night. In rare cases, the drug may also increase risk of depression and suicide. Discuss these risks with your health care professional, and if you feel unusually sad or overwhelmed while taking Accutane, seek medical attention immediately.
  
  When not treated, moderate and severe acne can cause significant scarring. Cosmetic treatment for scarring includes chemical peels, dermabrasion, microdermabrasion and laser resurfacing. For deep, crater-like scars where laser resurfacing is ineffective, there is soft tissue augmentation. This is a procedure in which the patient's fat (from another part of the body) is used to correct the deep contour, or soft tissue fillers like collagen, hyaluronic acid or fascia lata may be used.
• Rosacea. While the cause of rosacea is unknown, there are a number of lifestyle factors, triggers and habits that may contribute to flare-ups. Your health care professional, specifically a dermatologist, can help you determine your personal triggers and provide guidance on the right skin care routines for you. Triggers may include stress, alcoholic beverages, spicy foods and intense weather conditions such as heat, humidity and wind. Practice "sun safety" whenever possible and use sunscreen; wear light-colored, tightly woven protective clothing; and avoid the sun. Using fragrance-free skin care and make-up products and avoiding deodorant soaps can help reduce skin irritation. Rosacea also may be aggravated by ingredients such as menthol, alcohol and peppermint. Consult your dermatologist on which products are best for your skin.
  
  Your dermatologist may also prescribe medications for your rosacea. There are topical creams and gels, as well as an oral anti-inflammatory medication FDA approved for rosacea. To treat persistent facial redness, the most common symptom of rosacea, a new treatment option is now available. Mirvaso® (brimonidine) topical gel, 0.33%, is the first FDA-approved medication developed to treat the persistent facial redness of rosacea. Mirvaso is thought to work by constricting dilated facial blood vessels that increase blood flow to the skin and cause the face to look red and flushed. Used daily, topical Mirvaso works quickly and reduces redness for up to 12 hours. Erythema, flushing, skin burning sensation and contact dermatitis are the most common side effects of brimonidine. Because Mirvaso is an alpha-2 adrenergic agent, it can lower blood pressure and should be used with caution in patients with uncontrolled cardiovascular disease.
  
  \r\nThere are several medications approved to treat the bumps and blemishes of rosacea, including topical metronidazole and topical azelaic acid. Common side effects of metronidazole include cold symptoms, upper respiratory tract infection, and headache. Other topical treatments may include sulfacetamide/sulfur cream or wash, but many find the odor unpleasant. An oral anti-inflammatory, doxycycline, is approved in a low-dose formulation to treat the bumps and pimples associated with rosacea. This once-daily pill is a convenient alternative to creams and gels and has not been shown to cause bacterial resistance. Common side effects include cold symptoms, sinus infection, diarrhea, hypertension and increased liver enzymes. \r\n
• Eczema. Treatment includes oral antihistamines for relief of the severe itching, as well as topical steroids to relieve inflammation and itchiness. The U.S. Food and Drug Administration has approved two ointments—tacrolimus (Protopic) and pimecrolimus (Elidel)—to treat eczema. Both are in a class of drugs called topical immunomodulators (TIMS), which are steroid-free and appropriate and effective for patients seeking an option to avoid the side effects associated with steroids. However, because the effect of extended use of these medications is unknown, the FDA recommends that Elidel and Protopic only be used when a person cannot tolerate other eczema treatments or when all other treatments have failed.
  
  Your doctor may prescribe a short course of oral corticosteroids, such as prednisone, to relieve inflammation. Low-potency corticosteroids are also available over-the-counter, but check with your doctor before taking them. Moisturizers are an essential part of eczema therapy but should be chosen carefully because they can inflame sensitive skin. Newer products called barrier repair creams have no topical steroids and may repair the skin disruption caused by eczema. These may be an adjuctive therapy or solo therapy. Petroleum jelly is an excellent bland lubricant for this condition. And anti-itch lotions like calamine lotion and Benadryl can also provide some relief.
• Dandruff. Medicated shampoos containing coal tar (Ionil T, T/Gel, Pentrax), salicylic acid (X-Seb T Plus, Meted), selenium (Selsun Blue), zinc (Head & Shoulders, ZNP) or sulfur (Sebulex) can help this condition. For best results, buy two or three types and alternate them. Prescription shampoos and topical steroid medications may be necessary in difficult-to-treat cases.
• Hives. Antihistamines and sometimes oral steroids are prescribed to treat hives. In the case of a severe attack of hives, an emergency adrenaline (epinephrine) injection and a trip to the emergency room may be necessary.
• Psoriasis. There is no cure for this condition, but treatments can reduce skin inflammation. Topical steroid medications are frequently prescribed, but the condition often returns quickly once treatment ends. UVB light therapy, sunlight, oral and topical vitamin A derivatives, coal tar, salicylic acid, hydroxyurea (which can be combined with light therapy), anthralin and topical vitamin D derivatives often help. Anthralin (Dritho-Scalp), a medication believed to normalize DNA activity in cells, can help improve smoothness of the skin. The oral medication tacrolimus (Prograf) and new injectable medications used for treating arthritis, such as etanercept (Enbrel) or infliximab (Remicade), seem to be very effective for some individuals with psoriasis. For more severe forms of psoriasis, methotrexate (Trexall), an immunosuppressant drug used to treat rheumatoid arthritis and other conditions, is sometimes prescribed. This medication, which can be taken by pill or injection, slows cell production by suppressing the immune system. Patients taking methotrexate must be closely monitored to avoid possible liver damage and/or decreased cell counts. Pregnant women or those who are planning to become pregnant should not use methotrexate. Cyclosporine, another immunosuppressant drug, is also sometimes prescribed. This medication increases risk for high blood pressure and kidney problems.
• Stretch marks. There is no cure for stretch marks, although topical retinoic acid and laser treatments may lighten them. Treatment may not be worth the cost since it won't completely eliminate stretch marks. Topical camouflaging makeup provides a quick cover-up for stretch marks.

Skin Cancer Treatments

There are three primary kinds of treatments your health care professional may use to treat your actinic keratoses (precancerous lesions) or your skin cancer:

• surgery, which removes the cancer, or destroys these abnormal cells
• chemotherapy, which uses drugs to kill these abnormal cells
• radiation therapy, which uses x-rays to kill cancer cells
• immunotherapy, which encourages a person's own immune system to recognize and destroy cancer cells

Most often, your health care professional will choose surgery. Common types of skin cancer surgery techniques include:

• Cryosurgery freezes the tumor, which kills it.
• Electrodessication and curettage involves your health care professional coring out the skin cancer with a special tool and using an electric current to burn the tumor and destroy any additional tumor cells.
• Simple excision cuts the cancer from the skin in a football shape, along with a border of some of the healthy tissue around it.
• Mohs micrographic surgery removes the cancer and is a tissue-sparing technique. The specialized surgeon removes the cancer and maps it out, then examines the skin under a microscope, only taking additional pieces if any cancer remains. This method allows a complex repair to be done that day and know that the cancer is gone and that a second procedure will not be required. This type of procedure is used for recurrent skin cancers or on delicate areas of the face such as the nose.
• Lymph node surgery. If the doctors are concerned that skin cancer may have spread to the lymph nodes, they will perform a lymph node dissection and check the nodes for signs of cancer under a microscope (a biopsy).
• Laser therapy uses a highly focused beam of light to destroy the cancer cells with minimal bleeding, swelling and scarring and little damage to surrounding tissue. Laser therapy is usually used to treat superficial skin cancers.

Removal of large tumors creates large defects, so sometimes skin is taken from another part of your body and grafted over the area where the cancer was removed.

Chemotherapy can be a topical cream or lotion placed on the skin to kill cancer cells, an orally ingested drug or a drug that is injected directly into the tumor or a vein or muscle.

Radiation therapy shrinks tumors with x-rays aimed at the affected area from outside the body.

And certain drugs called immune response modulators can cause an immune response to the cancer, which causes it to shrink.

A more recent and less common technique called photodynamic therapy uses a certain type of light and a special (light-sensitive) chemical to kill cancer cells. Photodynamic therapy can be used to treat actinic keratoses and is also used to treat or shrink non-melanoma skin cancers.

Skin care starts with you. Many simple lifestyle changes—such as improving your diet and learning basic skin care techniques can improve your skin's appearance. Discuss prevention tips with your health care professional, and consider these steps:

• good nutrition
• drinking six to eight glasses of water per day
• avoiding alcohol
• stopping smoking
• using sunscreen regularly
• avoiding sun exposure during peak sun hours between 10 a.m. and 4 p.m.
• wearing protective clothing when outside

Most health care professionals recommend a simple cleansing regimen as the best approach to keep skin healthy: a gentle cleanser using warm (not hot) water, no abrasive scrubs and, when necessary, a moisturizer with sunscreen protection. In addition, you should gently pat your skin dry rather than rub it vigorously after a bath or shower to help avoid irritation and itching.

Dry Skin

Moisturizers for dry skin come in three preparations: lotions, creams and ointments. Lotions are least effective at replacing and retaining lost moisture in very dry skin. But they disappear after application very quickly, making them the most convenient to use and possibly helpful for normal and oily skin. Creams are heavier than lotions and are therefore more effective at sealing in moisture for normal to dry skin. Ointments, such as Vaseline, are thick and are best for preventing moisture from escaping from the skin, but you may find that they are inconvenient to use regularly. Health care professionals advise women with very dry skin against using soap and also alcohol-based astringents (toners), which typically dry out the skin.

Making Skin Look Younger

Alpha hydroxy acids (AHAs) (AHAs, glycolic acid, lactic acid), antioxidants (vitamins A, E, C) and vitamin A derivatives (Retin-A, Renova and retinol) in moisturizers are frequently promoted as products that can make skin younger looking. Here's what to expect from these and other newly available products:

• AHAs. They contain lactic acid (found in milk), fruit acids and glycolic acids (found in sugar cane). AHAs, like tretinoin derivatives, work by peeling away dead and thickened areas of the skin. Cosmetic treatments containing highly concentrated AHAs, known as chemical peels, have long been available from dermatologists. AHAs used by trained cosmetologists contain 20 to 30 percent concentration of AHAs and provide a superficial smoothing of the skin's texture similar to microdermabrasion. These treatments must be repeated every three to six months to maintain results. Doctors can use AHA products with concentrations of up to 70 percent in chemical peels to erase fine wrinkles and remove surface scars; the results of these treatments can last up to five years. Over-the-counter (OTC) preparations are required by the FDA to contain less than 10 percent concentration of AHAs. They may provide a little improvement of scaly skin. Higher concentrations of the active ingredients in OTC products are buffered and therefore neutralized to prevent peeling. These OTC AHA products are not known to improve skin wrinkling. Improvements with these or prescription products last only as long as the product is used. Long-term effects of AHAs are unknown. They can irritate the skin and make it more sensitive to sunlight. Signs of sensitivity are redness and burning.
• Antioxidants. Vitamins A, E and C are known as antioxidants. Their claim to fame as skin health aides is in their ability to fight free radicals, the highly reactive molecules generated by oxygen, sunlight, smoking and pollution that can break down the collagen fibers of the skin. Some studies show some promise, but overall, research is inconclusive about how effective antioxidants are for improving the skin's appearance. Ingestion of large amounts of some of these vitamins can be toxic. High doses of vitamin A, when taken during pregnancy, are suspected of increasing the risk of birth defects. Topical treatments of antioxidants can cause rashes, but small amounts are probably not harmful for most skin types.
• Renova. This prescription cream is basically Retin-A in a moisturizing base that decreases the redness and burning associated with Retin-A. The active ingredient in Retin-A and Renova is tretinoin, a vitamin A derivative. You must use these products daily for months to notice improvement, and it will probably last only as long as the cream is used. Renova and Retin-A may make the skin sun-sensitive, so wearing sunscreen and protective clothing during treatment is important. Side effects include redness, dryness and sensitivity. Oral or topical use of retinoids during pregnancy or while planning a pregnancy should be avoided.
• Injectable wrinkle fillers. Botox is the best known of these, but there are several other injectable wrinkle fillers also approved by the FDA. Here's a look at some:
  • Botox injections. Botulinum (or botulism) toxin type A (Botox Cosmetics, Dysport) is a prescription drug that may be used to temporarily improve the appearance of moderate to severe frown lines between the eyebrows. Botulinum toxin type A is a protein produced by the bacterium clostridium botulinum. When used as an anti-aging agent, small doses of a purified, sterile form of the toxin are injected into certain facial muscles to temporarily paralyze and weaken them. When the muscles can't contract normally, frown lines disappear. According to the FDA, Botox treatments should not be injected more frequently than once every three months, and the lowest effective dose should be used. The most common side effects following injections include headache, dry eyes and mouth, flu-like symptoms, nausea and weakness of the muscles near the injection site. Check with your doctor if any of these side effects persist. Less frequent adverse reactions include fever, bleeding at the injection site, irregular heartbeat and vision changes. If you experience any of these side effects, seek medical attention right away. These reactions were temporary but could last as long as several months.
  • Restylane and Perlane are soft-tissue fillers used for moderate to severe wrinkles around the nose and mouth. They use a synthetic form of hyaluronic acid. Perlane contains more hyaluronic acid and therefore works better for filling deep lines, while Restylane is used in fine lines or in thin-skinned people. One injection is needed for six to 12 months of effectiveness, depending on the patient and the area being treated.
  • Juvederm, also a soft-tissue filler for moderate to severe wrinkles, is a natural hyaluronic acid, which works similarly to Restylane, but degrades more slowly and lasts longer. The treatment may last 12 months.
  • Hylaform is used for moderate to severe wrinkles and folds. It is a form of hyaluronic acid made from rooster combs.
  • Captique is used for wrinkles around the nose and mouth. Results are immediate. Two to three touchups a year are usually needed to maintain results.
  Juvederm, Restylane and Perlane now come with lidocaine in the product, which makes the procedure much more comfortable.
• Natural products. The pharmacological effects of materials such as seaweed and oatmeal, often used in face masks or peels, are unknown. Papain, an enzyme found in papaya, is helpful in sloughing off dead skin cells, but can be expensive.
• Synthetic fillers (Artefill, Radiesse, Sculptra). Synthetic fillers are used for filling facial wrinkles and folds. It takes less than an hour for synthetic filler injections, and the results can last anywhere from six months to five or more years, depending on the filler product. Synthetic fillers differ depending on the brand:
  • Artefill contains 20 percent polymethyl-methacrylate (PMMA) beads suspended in 80 percent collagen. A few months after injection, the collagen breaks down, sparking your body to produce its own natural collagen to fill in the space. Unlike other fillers, Artefill is not absorbed by the body.
  • Radiesse is an injectable calcium hydroxylapatite gel. Calcium hydroxyapatite is found in teeth and bones and is used for numerous medical applications including cheek, jaw, skull and chin implants. Another brand name is Radiance.
  • Sculptra is an injectable polylactic acid. This compound is used in numerous medical products, such as stitches and screws used to repair broken bones. Although Sculptra has only been approved to restore shape and contour to the faces of those with AIDS, it is often used "off label" for cosmetic treatments. Sculptra usually requires three monthly treatments to rebuild the lost volume. It may take up to four to six weeks to see the full effect, and while Sculptra is considered semi-permanent, you may need an occasional touch-up treatment.
• Collagen products. Collagen products have been on the market for over 20 years. Some of the most popular are CosmoDerm, CosmoPlast, Zyderm and Zyplast. Other collagens used in cosmetic procedures include Artefill, a mixture of bovine collagen and tiny plastic spheres; Autologen, collagen from your own skin; Isolagen, collagen taken from your own skin and cloned and processed into a liquid form; and Dermalogen, collagen from human cadaver skin that has been sterilized, purified and processed into a liquid form.

Protect Your Skin from the Sun

Reducing your exposure to the sun is the best way to keep your skin healthy. Here's why:

Sunlight consists of two main types of ultraviolet (UV) rays that damage skin—UVA and UVB rays.

UVB rays are the main cause of sunburn and skin cancer. This type of sunlight intensifies during the summer and can do more damage more quickly than UVA rays. The epidermis absorbs most of the intensity of UVB rays. UVB rays cannot pass through glass, although UVA rays can. UVC rays, another spectrum in sunlight, are also potentially harmful, but the ozone layer blocks them from reaching the earth. UVA and UVB rays are present all year and are hazardous whether they are direct or reflected.

When the sun's ultraviolet radiation reaches the surface of the skin, the skin reacts by producing melanin—otherwise known as a tan—to protect itself. UVA rays are milder than UVB rays, but because their wavelengths are longer, they penetrate deeper through the skin's layers. UVA rays contribute to wrinkling the skin, as well as to the development of skin cancer.

UVA rays also are used in tanning booths. UVA rays in tanning booths not only inflict damage similar to sunlight, they are also more intense in a tanning booth than the equivalent time spent in natural sunlight.

Sunscreens

Sunscreens should be an important part of your skin health routine because they absorb or block UV rays. Sunscreens are rated by how much sun protection factor (SPF) they offer. SPF calculations are based on laboratory comparisons of how much sunlight will cause mild sunburn on the unprotected skin of a person with a fair complexion and on the same skin area protected by sunscreen.

The effectiveness of a sunscreen is dependent on the types of sun protective chemicals used, the thickness of the cream or lotions and the amount of product applied to the skin. Not all sunscreens provide protection against UVA radiation. Be sure that the sunscreen you purchase states it provides UVA/UVB protection. While sunscreen use helps to minimize damaging sunburns, it doesn't completely prevent burning.

A sunscreen with SPF-30 or greater should be used all year for all skin types. If you develop a rash or other type of allergic response to a sunscreen, try a different brand or form (lotion vs. gel, or protective clothing, for example) or switch to a sunscreen containing the active ingredients of titanium dioxide or zinc oxide. These products don't require chemical interaction with the skin to be effective, provide a protective shield-like barrier and rarely cause rashes. All sunscreens need to be reapplied after water contact or sweating.

For the best protection from the sun's harmful rays:

• Apply sunscreen with an SPF of 30 or higher 15 to 30 minutes before sun exposure, with careful attention to sun-exposed areas such as the face, hands and arms.
• Apply lip balm that contains a sunscreen to protect sun-sensitive lips.
• Avoid the sun between 10 a.m. and 4 p.m., when its rays are strongest.
• Wear a large (three-inch), brimmed hat and sunglasses to protect your scalp and eyes.
• Reapply sunscreen at least every two hours, but you should apply it more frequently if you have been swimming or sweating. Use about 1 ounce of cream—about one shot glass—to cover your entire body with each application.
• Stay in the shade whenever you can.
• Limit the time you spend in the sun.
• Be aware that the sun's ultraviolet rays can reflect off water, sand, concrete and snow, and can reach below the water's surface as well as burn on an overcast day.
• If you are taking an antibiotic or other medication, ask your health care professional if it may increase your skin's sensitivity to the sun and what you should do about it.

Don't forsake the sun altogether. Learn how to protect your skin from the sun's harmful rays and practice "sun safety" whenever you can—cover up with sunscreen and wear light-colored, tightly woven protective clothing and be sensible about how much time you spend in the sun. These steps can help reduce your risk for developing skin cancer and keep your skin looking its best.

1. When the skin becomes dry it needs water and oil to help rejuvenate it.
2. The skin is your body's first defense against disease and infection. It is the largest organ in the body. It helps regulate body temperature and prevent fluid loss; furthermore, it helps your body remove excess water and salt.
3. The process of producing healthy new skin cells and removing or shedding old cells takes about 28 days.
4. As you age, your skin becomes thinner and often drier. Thinning skin is largely a result of a breakdown of collagen fibers. As it ages, skin loses elasticity and becomes more fragile, especially if it has been exposed to excessive sunlight.
5. Because exposure to the sun influences how well your skin ages, protecting the skin from the sun is the single most important practice in skin care.
6. Continuous exposure to the sun will wrinkle, dry out and age the skin, leaving it coarse. Uneven pigmentation—from freckles to brown spots—is another side effect of frequent sunning.
7. The most serious consequence of sun exposure is skin cancer. Skin cancer is the most common type of cancer, making up nearly half of all diagnosed cases of cancer, according to the American Cancer Society.
8. Skin cancer can take up to 20 years or more to develop; it's important to remember that a person's average lifetime sun exposure risk is determined by age 18.
9. Anyone can develop skin cancer, although people with fair complexions tend to be more susceptible to specific types of skin cancer and precancerous conditions than people with darker skin tones.
10. The earliest warning sign of severe skin damage is the development of actinic keratoses. Lesions appear as scaly red/brown bumps on the face, ears, neck, lips and forearms or on the backs of the hands.

Review the following Questions to Ask about skin health so you're prepared to discuss this important health issue with your health care professional.

1. How should I care for my skin, given my age and skin type?
2. What products do you recommend to keep my skin healthy?
3. What advertising claims can I believe about skin care products? Which claims are untrue?
4. How can I get rid of my acne?
5. How can I get rid of my dandruff?
6. What treatments may help improve my psoriasis?
7. What treatments may improve my eczema?
8. Am I at high risk for skin cancer? What can I do to minimize my risk?
9. What should I look for when examining my skin, and how often should I examine it?
10. What should I do if I find a suspicious spot on my skin?

For information and support on Skin Health, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Dermatology
Website: https://www.aad.org
Address: P.O. Box 4014
Schaumburg, IL 60618
Hotline: 1-866-503-SKIN (7546)
Phone: 847-240-1280
Email: mrc@aad.org

American Society for Dermatologic Surgery
Website: https://www.asds.net
Address: 5550 Meadowbrook Dr., Suite 120
Rolling Meadows, IL 60008
Phone: 847-956-0900

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Website: https://www.niams.nih.gov
Address: National Institutes of Health
Bldg. 31, Room 4C02 31 Center Dr. - MSC 2350
Bethesda, MD 20892
Hotline: 1-877-22-NIAMS (1-877-226-4267)
Phone: 301-496-8190
Email: niamsinfo@mail.nih.gov

National Psoriasis Foundation
Website: https://www.psoriasis.org
Address: 6600 SW 92nd Avenue, Suite 300
Portland, OR 97223
Hotline: 1-800-723-9166
Phone: 503-244-7404
Email: getinfo@psoriasis.org

National Rosacea Society
Website: https://www.rosacea.org
Address: 800 South Northwest Hwy., Suite 200
Barrington, IL 60010
Hotline: 1-888-NO-BLUSH (1-888-662-5874)
Email: rosaceas@aol.com

Skin Cancer Foundation
Website: https://www.skincancer.org
Address: 149 Madison Avenue, Suite 901
New York, NY 10016
Hotline: 1-800-SKIN-490 (1-800-754-6490)
Phone: 212-725-5176

Books

101 Questions About Your Skin That Got Under Your Skin ... Until Now
by Faith Hickman Brynie

The Beauty Bible: From Acne to Wrinkles & Everything in Between
by Paula Begoun

Dermatologist's Guide to Looking Younger
by L.J. Green

Naturally Healthy Skin: Tips & Techniques for a Lifetime of Radiant Skin
by Stephanie L. Tourles

Psoriasis Cure: A Drug-Free Guide to Stopping & Reversing The Symptoms of Psoriasis
by Lisa LeVan

RealAge Makeover: Take Years off Your Looks and Add Them to Your Life
by Michael F. Roizen

Skin Deep: A Mind/Body Program for Healthy Skin
by Ted A. Grossbart and Carl Sherman

Skin Deep: An A-Z of Skin Disorders, Treatments & Health
by Carol Turkington and Jeffrey S. Dover

Skin: Head-to-Toe Tips for Health and Beauty
by Charles B. Inlander and Janet Worsley Norwood

Spanish-language resources

National Cancer Institute
Website: https://www.cancer.gov/espanol/tipos/melanoma
Address: NCI Public Inquiries Office
6116 Executive Boulevard, Room 3036A
Bethesda, MD 20892
Hotline: 1-800-422-6237
Email: NIAMSinfo@mail.nih.gov