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Skin Wrinkles

Description

An in-depth report on the treatment and prevention of wrinkles.

Alternative Names

Alpha Hydroxy; Chemical Peels; Plastic Surgery

Treatment

Needless to say, the best long-term prevention for overly wrinkled skin is a healthy lifestyle including the following:

Eat Healthily. A diet with plenty of whole grains, fresh fruits and vegetables, and the use of healthy oils (such as olive oil) may protect against oxidative stress in the skin. In fact, a 2001 study reported that people over 70 years old had fewer wrinkles if they ate such foods. Diet played a role in improving skin regardless of whether the people in the study smoked or lived in sunny countries. Benefits from these foods may be due to high levels of anti-oxidants found in them.

Exercise. Daily exercise keeps blood flowing, which brings oxygen to the skin, an important ingredient for healthy skin.

Reduce Stress. Reducing stress and tension may have benefits on the skin.

Quit Smoking. Smoking not only increases wrinkles, but smokers have a risk for squamous cell cancers that is 50% higher than nonsmokers' risk. Smokers should quit to prevent many health problems, not just unhealthy skin.

Daily Preventive Skin Care

Some daily measures for skin protection are as follows:

  • Don't wash face too often with tap water. (Once a day is enough.) It strips the skin of oil and moisture. In addition, chlorinated water, particularly at high temperatures, poses special risks for wrinkles.
  • Wash the face with a mild soap that contains moisturizers. Alkaline soaps, especially with deodorant, should be avoided.
  • Pat the skin dry and immediately apply a waterbased moisturizer.
  • Always apply sunscreen, even if going outdoors for short periods.
  • Avoid drinking alcohol within three hours of bedtime. Alcohol increases the risk for leaks in the capillaries, which allows more water in and causes sagging and puffiness. Capillary leakage increases when one is lying down.
  • Lie on the back when sleeping. This helps offset the effects of gravity.

Antioxidant Products: General Information

Antioxidants are substances that act as scavengers of oxygen-free radicals, the unstable particles that can damage cells and which are implicated in sun damage and even skin cancers. Antioxidants in the skin are depleted when exposed to sunlight and must be replaced.

  • Topical Products. Antioxidant topical products (such ointments, creams, and lotions) may help reduce the risk of wrinkles and protect against sun damage. Unlike sunscreens, they accumulate in the skin and are not washed away, so the protection may last. The antioxidants marketed for skin protection include vitamins A, C, E, selenium, coenzyme Q10 (CoQ10), and alpha-lipoic acid. Many are proving to be very beneficial for the skin.
  • Oral Vitamins and Supplements. Some research has been conducted on the effects on wrinkles using oral antioxidant supplements. One small study found that taking a combination of vitamins oral C and E supplements may help reduce sunburn reactions, although the protection is much less than from sunscreens. Taking the vitamins singly did not have any effect. In fact, a 2002 study reported that oral vitamin C had no effect on sunburn reaction. Of concern, in the same study some natural antioxidants in the body were reduced in people who took the vitamin.

Vitamin A. Vitamin A is important for skin health and UV radiation produces deficiencies in the skin. Topical products containing natural forms of vitamin A (retinol, retinaldehyde) or vitamin A derivatives called retinoids (tretinoin, tazarotene) have proven to be beneficial for skin damaged by the sun and also by natural aging.

  • Tretinoin (Retin-A). Tretinoin (known commercially as Retin-A) is the only topical agent approved for treating photoaging and is available in prescription form (Avita, Renova, Differin). The June 2004 journal Dermatology Surgery reported that tretinoin (0.25% concentration) was an effective and well-tolerated treatment for photodamaged facial skin. This agent produces a rosy glow and reduces fine and large wrinkles, liver spots, and surface roughness. It also may help prevent more serious effects of ultraviolet radiation. Tretinoin may be applied to face, neck, chest, hands, and forearm and should be applied at least twice a week. Noticeable improvement takes from two to six months. Because Retin-A increases a person's sensitivity to the sun, a thin coat is best administered at bedtime. A sunblock should be worn during the day, and overexposure to the sun should be avoided. Almost all patients experience redness, scaling, burning, and itching after two or three days that can last up to three months. In women who experience irritation, a daytime moisturizer or low-dose corticosteroid cream, such as 1% hydrocortisone, may help. There is some concern that overuse of high-dose tretinoin may cause excessive skin thinness over time. Studies now suggest that low concentrations (as low as .02%) of tretinoin can produce significant improvements in wrinkles and skin color, with less irritation than at higher doses.
  • Retinol. Retinol, a natural form of vitamin A, could not, until recently, be used in skin products because it was unstable and easily broken down by UV radiation. Stable preparations are now sold over the counter. In the right concentrations, retinol may be as effective as tretinoin and studies indicate that it has fewer side effects. An animal study suggests that adding antioxidant creams (such as those containing vitamins C or E) may offer added protection against degradation of retinol, but not tretinoin. The FDA warns that over-the-counter retinol skin products are unregulated; the amount of active ingredients is unknown, and some preparations, in fact, may contain almost no retinol.
  • Tazarotene. Tazarotene (Tazorac, Zorac, Avage) is a retinoid used for acne and psoriasis. It has now been approved for treating wrinkles, skin discoloration, and blemishes due to photoaging. One short-term study suggested that it may be as effective as tretinoin and even slightly better at high doses. At such high doses, however, it can cause very severe irritation. Redness and peeling may be reduced by administering tretinoin first to get the skin acclimated. A randomized study of 562 patients with facial photodamage found that a daily application of tazarotene 0.1% cream resulted in a minimum 1 grade improvement in fine and coarse wrinkling, pigmentation discrepancies, pore size, skin roughness, and overall photodamage. More research is needed to determine if it produces any long-lasting significant benefits.

Warning: Any vitamin A derivative, it should be avoided by pregnant women and those who may become pregnant. For example, oral tretinoin causes birth defects, and women should avoid even topical Retin-A when pregnant or trying to conceive.

Vitamin C. Vitamin C, or ascorbic acid is a very potent antioxidant and most studies on the effects of antioxidants on the skin have used this vitamin. In laboratory studies, large amounts reduced skin swelling and protected immune factors from sunlight. It may even promote collagen production. Vitamin C by itself is unstable, but products that solve the delivery problem are now available (e.g., Cellex-C, Avon's Anew Formula C Treatment Capsules, Physician Elite, and others). Studies using these formations in 2002 (one using Cellex-C) reported reduction in wrinkles and appeared to improve skin thickness. In one of the studies, wrinkle improvement with a time-released vitamin C product was as effective as with topical retinoids and some laser treatments. Of concern, according to one 2002 study, ascorbyl palmitate, a vitamin C derivative found in many skin products, may actually increase skin damage from UV rays. More research is needed, since other studies have found this chemical to be protective.

Other Antioxidants. Other antioxidants are also being investigated for their value in skin protection Even with these antioxidants, however, most available brands contain very low concentrations of them. In addition, they are also not well absorbed and they have a short-term effect. New delivery techniques, however, may prove to offset some of these problems.

  • Vitamin E. Studies suggest that topical vitamin E, particularly alpha tocopherol (a form of vitamin E) cream decreased skin roughness, length of facial lines, and wrinkle depth. Studies on mice have also reported reductions in UV-induced skin cancer with its use.
  • Selenium in the form of L-selenomethionine has protected against sun damage and even delayed skin cancer in animal studies. It is not known if such benefits apply to people.
  • One 1999 study found that topical application of the antioxidant Coenzyme Q10 (CoQ10) improved the skin's resistance to the oxidative stress of UV radiation, and when applied long-term, could reduce crows feet.
  • Both green and black tea may provide some protection against skin cancers and photoaging. A 2001 study using extracts of topical green tea suggested that it might protect against ultraviolet damage. Of interest was a study in which caffeine and caffeinated green and black tea had some preventive activity on skin tumors in mice. Decaffeinated tea, however, provided no benefits. Thus, while antioxidants in tea may be helpful, caffeine may also be important. In a 2002 study, researchers applied topical caffeine to mice that were exposed to UVB for 20 weeks. At the end of the study there was a small reduction of skin cancer activity.
  • The substance silymarin, found in the milk thistle family (which includes artichokes), may inhibit UVB-promoted cancers in animals.
  • Aloe, ginger, lemon oil, grape seed extract, and coral extracts contain antioxidants and are promoted as being healthy for the skin, although evidence of their effects on wrinkles is weak.

Alpha Hydroxy Acid and Home Exfoliation

One of the basic methods for improving skin and eliminating small wrinkles is exfoliation (also called resurfacing), which is the removal of the top layer of skin to allow regrowth for new skin. Methods for doing this run from simple scrubs to special creams to intensive peeling treatments, including laser resurfacing. People with darker skin are at particularly higher risk for scarring or discoloration with the more powerful exfoliation methods.

Abrasive Scrubs. Scrub gently with a mildly abrasive material and a soap that contains salicylic acid to remove old skin so that new skin can grow. The motion should be perpendicular to the wrinkles. Use textured material or cleansing grains with microbeads. Organic materials, such as loofahs or sea sponges may harbor bacteria. Avoid cleansing grains that contain pulverized walnut shells and apricot seeds, which can lacerate skin on a microscopic level. Cleansing grains with microbeads dont have sharp edges and remove skin without cutting it. Exfoliation using scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels.

Topical Alpha Hydroxy Acid and Similar Substances. Alpha hydroxy acids facilitate the shedding of dead skin cells and may even stimulate the production of collagen and elastin. They are found naturally as follows:

  • Lactic acid (milk).
  • Glycolic acid (sugar cane).
  • Malic acid (found in apples and pears).
  • Citric acid (oranges and lemons).
  • Tartaric acids (grapes).

Lactic and glycolic acids are used most often in commercial products. The preparations containing lactic acid may be slightly more effective than those made with glycolic acid. Products have also been developed that are made from larger molecules called poly-alpha-hydroxy acids and others from beta-hydroxy acids or BHAs (usually containing salicylate acid, the primary ingredient in aspirin). Manufacturers claim that such products are less likely to irritate the skin.

Acid concentrations in over-the-counter AHA preparations are 2% to 10%. One clinical study suggested that 8% concentrations showed modest improvement. Some examples include Avon's Anew Intensive Treatment (8% glycolic), Pond's Age Defying Complex (8%), Elizabeth Arden's Alpha-Ceramid Intensive Skin Treatment (3% to 7.5%), and BioMedic's home product (10%). Prescription strength creams contain at least 12% glycolic acid, and glycolic acid peels of 30% to 70% concentration may be administered in a doctors office at weekly or monthly intervals.

Response to AHA varies, and the treatment is not without risk, particularly in high-concentration products. Side effects from over-the-counter creams, prescription products, and professional AHA peels can include burns, itching, pain, and possibly scarring. Studies also suggest that AHA may increase susceptibility to sun damage, even at concentrations as low as 4%. Such effects can persist up to a week after the products have been stopped. Experts advise that people should purchase products with AHA concentrations of 10% or less. (Chemical peels of up to 60% are available without prescription on the Internet. Such concentrations are not recommended except in consultation with a physician.) If any adverse effects occur, the product should be stopped immediately. In all cases, people are advised to avoid sunlight or use proper sun protection when using them.

Experts are further concerned because part of the wrinkle-reducing effects of alpha hydroxy involves calcium loss, which in turn may promote cell growth and impair differentiation. Theoretically, this might increase the risk for skin cancer. There is no evidence of this at all, but more research is warranted on long-term effects of AHA.

Other Skin Treatments

Copper Peptides. Certain copper containing compounds may both protect skin and help repair it. Of note, copper itself is a toxic metal and it should only be used in products that contain peptides (small protein fragments) that bind to copper. Most studies have been conducted on a copper peptide glycyl-l-histidyl-l-lysine:copper (II) or GHK-Cu. It is currently used in a number of products (e.g., CP Serum, Neutrogena's Visibly Firm, ProCyte's Neova).

Furfuryladenine. Furfuryladenine (Kinetin, Kinerase) is a naturally occurring growth hormone found in plant and animal DNA; it has antioxidant and anti-aging properties. Some small laboratory studies suggest that it may both delay the onset and decrease the effects of aging on skin. However, no well-conducted human trials have been performed.

Vitamin K. Microsponge-based vitamin K is being promoted to clear bruises spider veins, and other small blood vessel damage. Vitamin K is important for blood clotting.

TNS Recovery System. California physicians have developed a product, TNS Recovery System (NouriCel), which was discovered as a byproduct of a process that grows human skin for burn victims. Research conducted by the manufacturer has suggested that it may produce new collagen and significantly eliminate wrinkles compared to Retin-A. The product is a combination of growth factors, collagen, antioxidants, and other ingredients.

Moisturizers

Moisturizers help prevent dryness, bruising, and tearing but have no effect on wrinkles by themselves. They should be applied while the skin is still damp. These products retain skin moisture in various ways:

  • Occlusives, such as petroleum jelly, prevent water from evaporating.
  • Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin generally should use the humectant type.
  • More powerful compounds, such as one called monolaurin (Glylorin), contain mixtures of fatty molecules called lipids, which may help restore the skin's natural barriers against moisture loss and damage.

Most moisturizers contain combinations of these and usually have other ingredients, such as AHA, sunscreens, collagen, and keratin. (Collagen and keratin leave a protein film and temporarily stretch the skin.) They range widely in price, and a major consumer organization found little difference in general between the more and less expensive products.

Under-Eye Creams

The skin under the eyes is very thin and does not produce as much of the protective oils that keep skin soft and supple. Under-eye gels are aimed at reducing puffiness and dark circles. They typically work in one of two ways:

  • Temporarily constricting blood vessels to prevent the build-up of fluids.
  • Firming the skin with an invisible film.
  • Never rub under the eyes, as this may cause more wrinkles to form. Instead, apply these products with a light tapping motion to stimulate the skin.

Cosmetics

Cosmetics, if properly applied, can be surprisingly effective in camouflaging the signs of aging skin, including wrinkles and age spots. Moreover, they offer additional benefits by retarding water loss and providing a physical barrier to UV radiation. However, as women age, less is more. Here are some suggestions for older women:

Moisturizers. Moisturizers should be applied before foundation. If reddish discoloration is extensive or the skin is sallow, tinted moisturizers may be helpful and can be worn alone or under foundation.

Foundations. Caking on make-up will cause cracks at the wrinkle lines and only increase the appearance of aging. Large areas of the face are best covered with a moderate-coverage foundation with a matte or semi-matte finish. Facial powder reflects light and thus minimizes wrinkles but should be avoided by people with dry skin.

Correcting Color. When blemishes are especially prominent, applying color correctors under the foundation can be very effective:

  • Green neutralizers mask red lesions.
  • Yellow will camouflage dark circles and bruises.
  • Mauve (a purplish-pink color) helps neutralize sallow skin or yellowish blemishes.
  • A white, pearled base helps to minimize wrinkles.

Blushes. Blushes and color washes can help conceal the spidery network of dilated capillaries on the nose and cheeks. Powder blushes are preferred because they blend easily on top of foundation.

Eyes. Powder eye shadows applied on top of a moisturizer are preferred to cream-based shadows. The appearance of deep-set eyes is best offset with light-colored shadow, which should be applied along the upper eyelid crease and above the iris. A slightly deeper shade of the same color should then be applied to the lower part of the eyelid and drawn out to the corner.

Lips. A lip-setting cream or facial foundation should be applied before lipstick to help prevent it from bleeding into surrounding wrinkles. Try using a stiff bristle brush instead of a lip pencil. The brush will help keep the lipstick on and prevent bleeding. (Some women use the pencil itself for the full lip, which gives color but appears natural.) Some make-up artists recommend cream lipsticks instead of matte.

Warnings on Alternative and So-Called Natural Remedies

Alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the body's chemistry can, like any drug, produce side effects that may be harmful. Even if studies report positive benefits from herbal remedies, the compounds used in such studies are, in most cases, not what are being marketed to the public.

A wide range of herbal products, both oral and topical, may contribute to dermatological problems. Some Chinese herbal creams have been found to contain corticosteroids, and some may contain mercury or arsenic contaminants have been reported in some Ayurvedic therapies. In addition, a number of oral herbal remedies used for medical or emotional conditions may produce irritation in reaction to sunlight (photosensitivity). They include, but are not limited to, St. Johns Wort, kava, and yohimbine. St. John's Wort, in fact, has been associated with severe toxicity in a patient who had laser treatments.

The following website is building a database of natural remedy brands that it tests and rates. Not all are available yet (www.consumerlab.com).

The Food and Drug Administration has a program called MEDWATCH for people to report adverse reactions to untested substances, such as herbal remedies and vitamins (800-332-1088).

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