Today’s topic is about skincare for all ages. Skincare is my favorite topic here on the blog because it can get pretty overwhelming if you factor in hundreds of thousands of products we see on TV, social media, online and more so in retail. It’s a multi-billion dollar business anchoring on the promise of smooth skin: from acne to wrinkles, scars, stretch marks, and even skin lightening for heaven’s sake! The question is, do we really need to slap several products on our face? burn hundreds of dollars? drugstore or luxury? the choices are as mind-boggling as it can get so let’s drill down to what our skin practically needs.
Across all ages: sunscreen that offers protection against UVA (aging rays) and UVB (burning rays). We all know that years of unprotected sun exposure can lead to photo damage, premature wrinkles, sun spots, exacerbation of melasma. But more than these aesthetic concerns, prevention of melanoma should be our number one priority. Here are important facts worth your utmost attention (source: American Academy of Dermatology):
- Skin cancer remains to be the most common form of cancer in the United States
- 1 in 5 will develop skin cancer in their lifetime
- Melanoma rates doubled from 1982 to 2011
- Melanoma is a young person’s disease, with diagnosis before the age 50 for women
- Experiencing 5 or more blistering sunburns between 15 to 20 years old increases risk with melanoma by 80%
- WHO estimates that 65,000 people per year worldwide die from melanoma
There is no hard and fast rule as when you should start wearing sunscreen but the sooner the better. Babies should wear sunscreen, anyone who are acne-prone should wear sunscreen (sun exacerbates acne and contribute to post-inflammatory hyperpigmentation), anyone with previous diagnosis of skin cancer (whether benign or malignant) should wear sunscreen, those with family history of melanoma should wear sunscreen, you have to wear sunscreen even if you work in the office (UV rays penetrate glass walls), there are UV rays even it’s gloomy outside, and yes, snow doubles the risk of exposure to UV rays. Hence, there is no excuse not to wear one. Sunscreen in makeup is not enough so layer up. Reapplication is crucial because this is where most people falter: reapply every two hours if you’re staying out longer in the sun or each time you get wet or sweaty. I discussed sunscreens lengthily here.
Teenage years:raging hormones, junk food, hello teenage acne! There is an increased sebum production during puberty related to stimulation of the hormones called androgen. This physiological response clogs the hair follicles found in the pores as well as contributes to hyperkeratinization (excessive shedding of skin cells) which becomes a breeding ground for bacteria called P. acnes. Genes also play a contributory factor so if mom or dad had or has acne, chances are you will have it, unfortunately. The important point here is to prevent risk of acne scars so if you have severe type of acne (cystic, inflamed), it is best to see a dermatologist. For mild to moderate cases, over the counter benzoyl peroxide (for acne caused by bacteria), salicylic acid (keeps oil at bay and helps with cell turnover), and adapalene (0.1% is now sold OTC, it’s a third generation retinoid that helps with cell turnover and inflammation, discussed lengthily here). All these can cause dryness so it is imperative to use a moisturizer. Stop if irritation occurs and see a dermatologist. Sunscreen is very important to avoid post-inflammatory hyperpigmentation and exacerbation of acne or in case of adapalene, sun affects its effectiveness. It is also important to note not to over-use and abuse these over-the-counter medications alongside toner and exfoliants. When the skin is overly-dry, the body will compensate by producing more oil. The correlation of acne and diet is debatable but it can’t be denied that foods rich in glycemic index (processed food, refined sugar) can cause a spike in the insulin which further contributes to the overly active sebum glands. In a 2005 study which appeared in the Journal of the American Academy of Dermatology, it has been found out that cows milk contains high level of hormones that can trigger oil glands to go haywire. Acne is caused by a multitude of factors so if you are not getting any result from over-the-counter or DIY concoctions you have found online, please consult a doctor.
The 20s: ghost from the past. If you suffered acne as a teen, chances are it will come back if you haven’t had it managed back then. Acne management is similar (as written above) but consider a referral to a gynecologist or endocrinologist if your dermatologist or primary care doctor exhausted all means and still couldn’t resolve the problem. Why? you may have PCOS or polycystic ovarian syndrome which is a hormonal disorder associated with irregular menstruation, hirsutism (excessive hair) and acne. Sunscreen is a must for the same reasons stated above, all the more that you should be more religious in application because sunscreen offers protection from photodamage or premature wrinkles including sunspots or age spots. Start using moisturizer even if you have oily skin. Opt for water-based if you have oily, combination and normal skin, or beauty oil if you have dry skin. I can’t emphasize enough the importance of healthy lifestyle! Smoking and alcohol contribute to early signs of aging! As someone who’s been treating patients aesthetically (RN here), I can tell if a patient is a smoker from the texture of their skin! Okay, the burning question, is it too early to get Botox at this age group? my answer is pretty straightforward: look at your face in the mirror, are you seeing fine lines without making any facial expressions? if so, yes you can because the principle behind neuromodulators like Botox, Xeomin or Dysport is to relax the muscles and by “training” them early to not make any movements, you are potentially minimizing these fine lines to progress to bigger ones as you age.
The 30s: hello gravity. So you’re thinking you’re getting older. Not just in age but your skin is actually undergoing some changes as a result of your previous lifestyle as well as decline in collagen and elastin, add hormonal problems that can either break you out (from normal to combination) or oily to oilier. For acne and hormonal issues, treatments mentioned above still apply. Sun spots when treated at the onset may respond to retinoic acid, alpa hydroxy acids, ascorbic acid, kojic acid, among others. If you worshipped sun as a teenager or spent countless hours in tanning beds, consider a referral to dermatologist because this increases your risk for melanoma. By now, sunscreen should be part of your daily skincare. You can introduce serum to your daytime and nighttime regimen if your skin is needing extra hydration. Adapalene (over the counter 0.1%) can help with mild to moderate non-cystic acne and since it’s from the retinoid family, it can help with cell turnover resulting to smooth and youthful looking skin. Consider non-invasive aesthetic methods that can rejuvenate sagginess and dull texture such as non-ablative laser skin resurfacing, photorejuvenation, even radiofrequency skin tightening and/ or radiofrequency microneedling. For immediate gratification, few units or neuromodulators (depending on the intensity of your dynamic expression lines of course) or fillers are also good options. Just remember not to overdo injectables because they will actually make you look older than you think. Go for natural enhancements.
The big 4-0: sun spots, age spots, wrinkles, sagging skin, eye bags, exaggerated pores, melasma, bring it on. Now if you haven’t practiced good skincare in your younger years, in particular, religious use of sunscreen, chances are your sun spots are more obvious and bigger now. Melasma is hormonally-related as well as triggered by unprotected sun exposure. You look haggard and tired because of those pesky dark circles or eye bags (redistribution of fat to lower face), pores are becoming a nuisance due to skin’s laxity, add the obnoxious crow’s feet, downturned smile, forehead lines, you thought 40 is gonna be fabulous right? the burning question, will those topical products work? unless they are prescription-based, I hate to be break it to you but if you are dealing with serious skin issues I mentioned, please save your hard earned money and go for real in-clinic treatments. Machines treat, products either prevent (when started early) or maintain. Eye creams won’t reverse eye bags, hyaluronic acid or collagen moisturizers are what they are, mainly moisturizers. AHAs (alpha hydroxy acids) and l- ascorbic acid can help lighten but they are often combined with other in-clinic treatments for optimal results. Retinoids can help with cellular turnover. But if you are really serious to tackle some obvious signs of aging, laser skin resurfacing, radiofrequency skin tightening, radiofrequency microneedling, and injectables like neuromodulators and fillers do help.
50s and above: defying age or losing it. Menopause is more than just not having to deal with menstruation. The drop in estrogen is the culprit to accelerated aging resulting to dry skin, thinning of the skin, redistribution of fat, pruritus (itching related to dry skin), hyperhidrosis (excessive sweating), brittle nails, and worse acne breakout (most commonly in the chin). Prescription- strength retinoids can help, moisturizers to prevent dryness and itching, spot treatments for acne breakouts (as mentioned above), and most important of all, sunscreen. By now, you should have already established yearly visits with your primary care doctor or dermatologist for skin surveillance, and any moles that look suspicious should not be ignored. Laser skin resurfacing helps with collagen and elastin formation, radiofrequency skin tightening can help tighten the face and neck area, laser and intense pulse light can with sun and age spots, and lastly injectables (neuromodulators and fillers) can help with wrinkles if you are not considering any facial surgery as option.