Like it or not, your skin tells a story--about the sun you've been exposed to, the nutrients you ingest, the quality of your blood (which relates to a healthy, rosy glow), and the amount of restorative sleep you get. It even reveals where you carry your worries (between the eyebrows in a deep furrow, for example) and hints at how often you smile.
By most definitions, healthy skin should be blemish-free, smooth (wrinkle-free), toned, and uniform in color. It shouldn't sag or look sallow or be mottled with age spots. In youth, such qualities are more or less easy to come by. But, as with other parts of the body, over time the skin starts to reflect all the hits and assaults that come with daily living.
The 6-pound, multi-tasking organ we call our skin is composed of three layers. The outermost layer, the epidermis, is made up of tightly packed cells that create a barrier between the internal organs, tissues, and skeleton, and the rest of the world. Squamous cells on the top of the epidermis are continuously shedding and then being replenished by underlying basal cells; these are the hard-working and constantly dividing cells just beneath that are designed almost exclusively for this purpose.
Below the epidermis lies the first swath of connective tissue so crucial for supporting the skin. This layer, called the dermis, houses the blood vessels that nourish skin cells and the nerve tissues that relay sensation. The dermis is a busy place, packed with industrious sweat glands, collagen bundles, hair follicles, lymph vessels, and other key structures. It's through tiny openings from the dermis up through the skin surface (known as pores) that sweat, sebum (an oily substance), and hair follicles travel up and out of the body.
The third and deepest layer of skin is called the subcutaneous layer, which literally means "under the skin." This is where a type of connective tissue called adipose (fatty) tissue resides. It keeps skin cushioned and the body protected from the cold.
Skin also contains a tough and fibrous protein called collagen, which helps to knit together cells and tissues throughout the body. Bones, tendons, and other connective tissues contain collagen as well. In terms of skin, it's collagen that helps to seal wounds and form scar tissue.
When your skin is healthy, all three layers, along with the collagen, work smoothly and in concert. The daily measures you take in caring for your skin, from cleansing gently to protecting it from sun damage, help ensure that it can continue to function well and radiate health and well-being the way you want it to.
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Excessive dryness Wrinkles Sagging, loss of firmness and tone Uneven skin color Slow healing Susceptibility to infection
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During childhood, the layers of skin typically work together efficiently, endowing youthful skin with an enviable smoothness and buttery-soft feel. But over time, different factors can alter the situation. Put simply, skin ages both from within (due to the passage of time) and from without (due to such factors as sun exposure, air pollution, and contact with chemicals).
Some aging factors can't be altered. For example, the genes we inherit contribute to the rate at which our skin weathers and withstands the effects of time. It's impossible to significantly alter the natural aging process and the gradual loss of skin oils and muscle tone from the dermis, a depletion that leaves aging skin thinner and dryer.
Over time, the skin's epidermis also loses its silky feel as a result of exposure to environmental elements, ranging from damaging UV radiation in sunlight to harmful manmade airborne pollutants. Throughout the layers of skin, the underlying web of collagen fibers loosen up as well, leaving the skin less elastic and less able to heal. Added to this is the gradual loss of fat cells from the subcutaneous layer, which renders the skin less plump and rosy looking.
The situation is not entirely hopeless, however, because there are factors that are under your control. The most critical by far is your ability to limit your exposure to sunlight, which can seriously damage and prematurely age your skin. Often referred to as "photoaging," this process largely reflects the havoc wreaked by altered oxygen molecules called free radicals. Unless they are neutralized, free radicals and other high-energy rogue molecules corrupt the skin's cell membranes, DNA, and protein structure.
Over time, every exposure to sunlight that results in the actual burning of the skin, i.e. sunburn, also raises the risk that the free radicals will overwhelm the skin's antioxidant defense mechanisms and cause a cancer in the epidermis. Untreated, some of these cancers can go deeper, passing through the skin layers and spreading throughout the body. It's quite unlikely to get this far, however, if precautions against sunburn are taken. For more information on sunburn (from how to protect against it to how to minimize its effects) see the WholeHealthMD Healing Center entry on Sunburn.
Ultimately, collagen, the underlying tissue that gives skin its support, is the part of the skin most susceptible to sun damage. And when collagen is destroyed, wrinkling and age lines develop.
If you have a medical problem that you feel is undermining your skin's health, such as acne, eczema, rosacea, psoriasis, or varicose veins, see the WholeHealthMD Healing Center entry on the subject for specific advice.
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Specialized doctors (primarily dermatologists and plastic surgeons) are trained to deal with more serious skin problems, be it acne, eczema, or a suspicious-looking mole. A number of these specialists, however, also treat essentially healthy skin to help it look better. To reduce fine lines and shallow wrinkles, for instance, they may prescribe exfoliants, topical medications that remove the top layer of damaged skin and allow new skin to grow.
For more serious issues, doctors may suggest different procedures (from smoothing out wrinkles and scars to eliminating sagging skin and other problems) to enhance the skin's appearance.
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Two topical products have been shown to reduce the appearance of fine wrinkles and make skin appear more healthy. The first is the prescription topical cream tretinoin (Retin-A, Avita, Renova), a form of vitamin A that reduces the number of large wrinkles on the skin and also minimizes discoloration. It even smooths out rough skin, which can often result from cases of serious acne. Not all users notice a benefit, however. Follow the doctor's instructions carefully when taking tretinoin; it's very irritating to the skin, and makes it far more vulnerable to sunburn and other damage.
Some cosmetics sold over-the-counter are formulated to contain retinol and make the claim that they can reduce the appearance of wrinkles. However, it's still not clear whether the skin actually can convert the active ingredient (retinol) into sufficient retinoic acid to work as effectively as the prescription drug.
The other well-known topical substance for minimizing wrinkles is alpha hydroxy acids (AHAs). Sold over-the counter, products containing AHAs prompt the skin to shed its outer layer and therefore lessen the appearance of age spots, surface wrinkles, and other sun damage. AHAs are good moisturizers but ultimately have never been shown to erase deep wrinkles. One serious drawback is that creams containing AHAs make the skin quite sensitive to sun damage.
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For deeper wrinkles, techniques related to skin resurfacing may be needed; these involve actually burning or stripping off the top layer of damaged skin. Fresh, new skin then forms. To improve the appearance of wrinkles and small scars, for instance, chemical peels are a popular option. The peel entails simply applying a chemical solution to the face. The down side is that it can take a while for skin redness and irritation to resolve.
Another technique, dermabrasion, can reach deep layers of skin that have been altered by severe wrinkling or more serious scars. A rotating brush is used to literally clear and smooth the area. Microdermabrasion polishes the skin with tiny crystals and is less traumatic.
Laser resurfacing literally shortens collagen fibers in the skin to restore elasticity. Wrinkles evaporate and skin appears more taut. Various laser approaches are available. Another option may be implants using materials derived from cow or human collagen and compounds taken from cadavers. Implants are often very effective for filling in deep scars and wrinkles but unfortunately, they don't offer permanent results.
The focus of much publicity and consumer popularity, Botox treatments were recently approved by the FDA to temporarily improve the appearance of moderate to severe lines between the eyebrows. Actually a purified and diluted form of the botulinum toxin that causes food poisoning, Botox is injected into muscles to paralyze them, with results lasting up to six months.
Beyond lines in the eyebrow-region, popular "wrinkle" areas often treated "off-label" with Botox include the forehead, lower eyelids, crow's feet, and the area between the nose and upper lip. The down side of the Botox equation is the fact that injections are expensive and sometimes risky, since doctors' shots do occasionally miss their mark, temporarily leaving the wrong muscle paralyzed and the face disfigured. (For more detailed information, see Botox Therapy in the WholeHealthMD Reference Library.)
Finally, facelifts, complicated and expensive surgical procedures known as rhytidectomies, are still very popular options for alleviating sagging skin.
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No matter what therapeutic or medical measures you take, the natural aging process and inescapable exposure to environmental factors will take their toll on your skin. You can delay the inevitable and reduce its effects, however, by regularly protecting and maintaining your skin's health and appearance. Experts say you should:
Follow a skin-healthy diet. To counter free-radical damage to skin cells, consume lots of antioxidant-rich fruits and vegetables, such as citrus fruits and dark, leafy greens. Since fiber is key to internal detoxification, also eat plenty of whole grain breads, cooked dried beans, and cereals. "Good" fat sources (flaxseeds and flaxseed oil, walnuts, and cold-water fish such as wild salmon) provide important anti-inflammatory and skin-replenishing benefits. Recent findings indicate that eating fruits, vegetables, and unsaturated fats (such as olive oil) boosts the skin's natural defense against sun damage.
In addition to eating healthy foods, it's also critical to avoid junk foods. These high-fat, often sugary, snacks provide little in terms of nutrients, can clog up your system, and add calories (and pounds!) that make your skin look unhealthy.
Consider dietary and topical supplements. Since it's probably impossible to get all the nutrients you need through foods alone, consider taking or applying skin-friendly dietary supplements as well. (See "How Supplements Can Help," below.)
Care for your skin properly. Cleanse regularly but gently, using a nonalkaline soap and tepid (never hot) water. Gently pat the area dry. Use a moisturizer to improve the skin's appearance, soften its texture, protect it from the elements, and minimize wrinkles due to dryness.
Respect your skin type. Some skin-protective techniques are specific to naturally dry, oily, or combination skin types.
For dry skin, always use a soap-free liquid cleanser and a glycerin-based moisturizer applied while the skin is still moist. Avoid harsh soaps, rough or grainy cleansers, or alcohol-containing creams or lotions (confine soap use to face, underarms, genital area, hands, and feet). Buy oil-based cosmetics. Bathe in warm (not hot) water and shun long showers and bubble baths; they'll dry your skin even further. Use a humidifier to add moisture to the air.
For oily skin, cleanse frequently (twice a day is best) using products formulated for oily skin. Dry thoroughly. Only if you feel you need it, apply a water-based (oil-free) moisturizer. Opt for oil-free, water-based cosmetics and sunscreen/block products. Take care to avoid scrubbing excessively; you'll only end up irritating the outermost protective skin layer. Use face powder to absorb oil and shininess.
For combination skin types, think strategically and in terms of combination products. Buy different cosmetics to use on different areas. If you do need a moisturizer, apply it only to non-oily areas.
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A good nutritional supplement program should include all the nutrients that you may be find difficult incorporating into your daily diet, as well as a few other specialty items geared to skin health.
Just a reminder: If you have a serious medical condition, it's always a wise idea to talk to your doctor before you begin a supplement program.
An increasing number of clinical studies are showing that topically applied antioxidants can actually slow down and even reverse the skin's aging process, presumably by deactivating the free oxygen radicals that can cause so much cell damage. However, antioxidants are inherently fragile compounds, and incorporating them into a stable formulation that will actually penetrate the skin effectively remains a problem. Popular new antiaging antioxidants that can be applied to the skin as part of a cream, ointment, or lotion (and that may or may not help your skin) include vitamin C, alpha lipoic acid, and alpha hydroxy acids (see "Medications," above).
Vitamin C is an antioxidant that helps the body to repair and maintain itself by reinforcing cell walls and strengthening the tiny blood vessels called capillaries. There's evidence that it helps boost skin health when used orally or topically. Another antioxidant, vitamin E, works well when it's applied topically to reduce the length and depth of fine wrinkle lines on the face.
Known as a "universal antioxidant" because it is soluble in both fat and water, alpha lipoic acid is a powerhouse of anti-inflammatory and antioxidant might. It helps protect collagen from enzymes that can damage skin fibers and keeps the skin surface smooth.
To get the essential fatty acids (EFAs) that help keep your skin smooth and moist, incorporate nutrients rich in omega-3s every day. Fish oils are good as is flaxseed oil, which can added to salad dressings or mixed into juice. Flaxseed oil also contains omega-6s. There's evidence that EFAs reduce skin inflammation and thus revitalize its appearance.
Amino acids (and antioxidants!) such as L-carnitine and coenzyme Q10 keep skin healthy by helping to prevent free-radical damage. The form of carnitine naturally produced in the brain is acetyl-L-carnitine (ALC), and it's a good choice for a skin supplement. Coenzyme Q10 levels drop with age, which is part of why it makes sense to boost your levels of this potent antioxidant with supplements.
Levels of the skin-protective amino acid L-glutamine plummet with age as well. Dietary supplements can help to keep the concentrations needed for healthy collagen at beneficial levels.
DMAE, or dimethylaminoethanol, is a chemical that can be applied topically to counter age-related loss of skin tone. Researchers are hoping that upcoming studies will shed light on just how this compound, which is found in anchovies and sardines, as well as naturally produced in the human brain, manages to have this anti-sagging effect. Although available in oral form for other uses, DMAE is best used topically for skin-care purposes.
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The way you live your life, from the foods you eat to the habits you do (or don't) develop, can make a big difference in the health and appearance of your skin. The following are proven skin-friendly strategies:
Radically limit sunlight exposure. A small amount of sun is good for you, raising levels of vitamin D and a neurotransmitter called serotonin in your system. But any daily exposure longer than a few minutes can cause problems and pave the way for wrinkling and skin damage. So don't go outside, even on overcast or wintry days, without slathering on sunscreen (SPF 15 or above). Your skin will thank you for years to come.
Stop smoking. Cigarette smoke is the most concentrated source of free radicals discovered so far. Just think about the skin of any smokers you know. Picture the deep furrows around their mouths and the lines marring their foreheads. Smoking compromises circulation in the skin, thins its outer layer, radically reduces its ability to heal after an injury, and ups the risk of skin damage.
Control alcohol consumption. Liquor serves to indirectly open up the tiny blood vessels beneath your skin and may predispose you to developing excessive redness and an uneven skin tone.
Avoid rapid weight loss. A drastic change in weight adds to the shrinkage of fat cells in the face, resulting in baggy-looking skin. Get to a healthy weight in a measured way, and stay there.
Exercise regularly. Moving your body revs up circulation, leaving you energized and your skin fresh and rejuvenated. Sweat pouring off your body also cleanses it.
Get the most from your moisturizer. Smooth it on while your skin is still slightly damp. And realize that your skin actually absorbs very little from a moisturizer, no matter what the price or the claims on the bottle. What it does accomplish is to keep your skin's own moisture from evaporating.
Know your moisturizer. Read the label carefully. Products known as "occlusives" slow moisture loss by coating and protecting the skin. These include petroleum jelly and oils. Humectants attract moisture and temporarily hold it against the skin; glycerine is an example. Save your money by avoiding so-called "DNA creams," which makers claim will benefit your individual skin type, based on genetic analysis; more research and evidence is needed.
Shave with care. To avoid razor bumps on the face (for men) or legs (for women), wash with hot water, apply cream or gel, and let it soften up the area for five minutes or so. Only then shave, using slow and downward strokes on the face and upward strokes on the neck and legs.
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Limiting stress is often suggested as a way to improve your skin. While de-stressing can't directly give you a youthful glow, it can set the stage for such positive changes to occur. Try a relaxing massage, biofeedback, or meditation. Other relaxation techniques such as yoga and tai chi can help to make you more sensitive and conscious of the expression you are conveying to the world.
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If signs of an infection develop, or a cut or wound refuses to heal
If skin becomes pale, a sign of possible anemia
If skin takes on an unusual tint; yellowing can be a sign of liver trouble, for example
If you experience new-onset adult acne
If your normal skin texture (oily, dry, or combination) changes significantly, despite no alteration in climate, altitude, or clothing.
If a rash develops
If a skin spot develops, or an existing one starts to bleed or change in color, shape, or size
If excessive dryness or itching fails to respond to moisturizers