Skin Ageing

We all want to look young and fresh  but the ageing process is inevitable, however some factors we have complete control of. 

There are two types of ageing processes – intrinsic and extrinsic ageing.

• Intrinsic or chronological ageing affects the skin of the entire body, including sun-protected sites.
• Extrinsic ageing is induced by chronic ultraviolet (UV) radiation exposure, smoking, and other pollutants, and is superimposed on the intrinsic ageing process.

  Intrinsic ageing affects everyone, whatever their skin type. Extrinsic ageing affects people who are chronically exposed to sunlight — this is known as sun damage or photoageing.

  People who typically present with marked signs of photoaging include those who

• Have red/blond hair and blue eyes
• Live in the tropics or subtropics
• Live at high altitudes
• Work outdoors or spend long periods outdoors for recreation
• Have sometimes been exposed to artificial sources of UV radiation, such as indoor tanning
• Have a genetic predisposition to premature ageing (progeria)
• Premature ageing of the skin also affects tobacco smokers and those who have been chronically exposed to other environmental pollutants.

The features of ageing skin are diagnosed clinically. Lesions suspicious of skin cancer present as growing lumps or sores that fail to heal. Such lesions often undergo diagnostic biopsy before or as part of treatment.

        Cancerous and precancerous lesions

• Actinic keratoses and intraepidermal squamous cell carcinomas (SCCs) are most often removed by cryotherapy or treated topically.
• Basal cell carcinoma (BCC) is most often removed by minor surgery. Superficial BCC can be treated topically or by cryotherapy.
• Cutaneous SCC and melanoma are nearly always surgically excised.

  Dry and discoloured skin

• Moisturisers help improve dry and flaky skin.
• Alpha hydroxy acids, vitamin C, lipoic acid, soy isoflavones or retinoid creams applied regularly long term reduce dryness. They may also reduce the number of fine wrinkles and even out pigmentation.
• Many other products are under investigation, but their benefits are unclear.

  Facial Rejuvenation
  Procedures that aim to rejuvenate photoaged skin include

• Fillers (e.g. hyaluronic acid, polytetrafluoroethylene and fat grafts) to disguise facial expression lines
• Botulinum toxin injections to reduce frowning and lessen deep furrows
• Vascular laser treatment and sclerotherapy (the injection of inflammatory agent into veins) to remove facial veins and angiomas
• Resurfacing procedures (e.g. dermabrasion, chemical peels, and laser resurfacing)
• Cosmetic surgery to remove redundant sagging skin, including surgical or laser blepharoplasty for baggy eyelids, and meloplasty (face lift) to tighten jowls.

Intrinsic ageing is inevitable. In perimenopausal women, systemic hormone replacement may delay skin thinning. The skin is less dry, with fewer wrinkles, and wound healing is faster than prior to treatment. Hormone replacement is less effective at improving skin ageing in the postmenopausal decades. The effects of topical oestrogens, phyto-oestrogens, and progestins are under investigation.

Protection from solar UV is essential at all ages. There are several steps that can be taken to minimise or avoid UV exposure  

• Be aware of daily UV index levels
• Avoid outdoor activities during the middle of the day
• Wear sun-protective clothing (e.g. a broad-brimmed hat, long sleeves and trousers or skirts)
• Apply very high sun-protection factor (SPF > 30) broad-spectrum sunscreens to exposed skin
• Do not smoke, and where possible, avoid exposure to pollutants
• Take plenty of exercise — active people appear younger than inactive people
• Eat fruits and vegetables daily
• Many oral supplements with antioxidant and anti-inflammatory properties have been advocated to retard skin ageing and to improve skin health These include carotenoids, polyphenols, chlorophyll, aloe vera, vitamins B C  and E, red ginseng and omega-3 fatty acids. Their role in combating skin ageing is unclear