10 top tips for summer skin survival.

1. Slop on some sunscreen.

This is the best defense against sunburn, photoageing and skin cancers. Make sure you use a broad spectrum, SPF 50+ sunscreen and apply 30 minutes prior to heading outside, and reapply every 2-4 hours. Make sure it’s water resistant if swimming or exercising.

2. Slap on a hat.

Don’t forget to put on a hat, to stop the sun’s harmful UV rays reaching your scalp, face and ears. This will also help protect your hair from UV damage. But make sure it’s a broad-brimmed hat (at least 7.5cm), not a baseball cap.

3. Slip on protective clothing.

Look for clothing that covers as much skin as possible. Materials that have a close weave give higher UV protection. Cotton, polyester/cotton and linen materials are lightweight, cool to wear and when tightly woven can protect against 95% of UV radiation. Some clothes are given an Ultraviolet Protection Factor (UPF) rating, indicating how much of the sun’s rays are absorbed by the fabric. For example one with UPF30 will allow only 1/30 of UV light to penetrate.

4. Slide on some sunglasses.

Prolonged UV exposure can cause redness of they eyes, just as our skin can burn. Over time, UV damage can result in eye problems such as cataracts and macular degeneration. Make sure your sunglasses meet the Australian/New Zealand standard for sunglasses (Category 2, 3 or 4). Oversized sunglasses are ‘in’: so you can look great and protect your eyes at the same time!

5. Seek shade.

Staying in the shade is one way to reduce sun exposure, but you still need other sun protection measures (clothing, hat, sunglasses and sunscreen) to avoid reflected UV radiation.

6. Protect your pout.

Sun damage can lead to dry, cracked, scaly lips, as well as skin cancers. So love your lips and put on a lip balm. Look for lip-specific products that have an SPF 30 or higher. If you wear lipstick, darker shades provide more UV defense than sheer, glossy ones.

7. Fake it, don’t bake it.

Forget sunbathing and tanning booths. Fake tans are now better than ever, and come in lotion, cream, gel and spray form. Most have the active ingredient dihydroxyacetone (DHA), which coats dead skin cells with colours. The “tan” then disappears when the cells are washed off or sloughed off. Exfoliating for a few days prior to application will help ensure a longer lasting, more even colour. And remember, a fake tan will not provide you with any protection against the sun’s UV rays, so you will still need to apply a sunscreen.

8. Get up and glow.

For radiant summer skin, look for moisturisers that contain anti-oxidants (such as Vitamin C, E, B3) to help mop up free radicals produced by sun exposure. Use weather appropriate products: pack away the thicker winter creams and go for lighter lotions and serums. If you are prone to acne, make sure you choose oil-free products.

9. Powder your nose.

“Functional coloured cosmetics”, such as foundation, powder, blush, eye shadow, eyeliner, mascara and lipstick are the second most important anti-ageing products after sunscreen and also reduce the incidence of skin cancer particular around the eye. Due to their unique blend of SPF ingredients, pigments and reflectors of solar radiation they should be a vital part of every woman’s anti-ageing and skin cancer prevention regime. So layer it up: apply sunscreen first, and then make-up on top.

10. Drink up! Water that is…..

Make sure you drink plenty of water to keep your body and your skin hydrated. And don’t forget to rinse off after swimming and apply a moisturiser to avoid dry, irritated skin.

Can sunscreens actually turn back the clock?

Investigators studied 32 women that applied a broad-spectrum photostable sunscreen (SPF 30) for 52 weeks to the entire face. Evaluation by dermatologists and self-assessments by the subjects were conducted at baseline and then at weeks 12, 24, 36 and 52.

Data analysis from the dermatologist’s assessment showed that all photoageing parameters significantly improved from baseline, as early as week 12, and continued until the end of the study. Skin surface and pigment attributes (texture, clarity, mottled and discrete pigmentation) improved the most, showing 40-52% improvement from baseline at week 52, with 100% of subjects showing improvement in skin clarity and texture. All other photoageing signs (crow’s feet fine lines, skin tone evenness, overall skin tone and overall photodamage) improved 18-34% by week 52. Subject self-assessment reports showed similar trends.

The results suggest that daily use of a broad-spectrum, photostable sunscreen not only prevents additional photoaging but may actually visibly reverse some of the signs of existing photodamage. Yet another reason to slather on that sunscreen!

Reference: Dermatol Surgery 2016;42:1354-1361. Daily use of a Facial Broad Spectrum Sunscreen Over One-Year Significantly Improves Clinical Evaluation of Photoaging. Randhawa M, Wang S et al.

Sunbathers beware! Skin damage continues hours after sun exposure.

The unusual chemical properties of melanin mean that although it is a good UV absorber, it is also susceptible to other chemical reactions that have the same impact as the UV. Melanin may thus be carcinogenic as well as protective against skin cancer.

Researchers exposed human and mouse pigment cells (melanocytes) to radiation from a UV lamp. Although the cells experienced immediate DNA damage, this continued for hours. In fact, half of the damage occurred in the hours following exposure.

Free radicals generated by UV light caused delayed damage to DNA with the aid of compounds derived from melanin. This melanin-assisted process creates compounds known as cyclobutane pyrimidine dimers in DNA, which can lead to mutations that cause melanoma, a potentially deadly skin cancer. These changes are identical to the well-known genetic alterations caused directly by UV light, but at least half of the dimers appear well after your trip to the beach.

However, there is some good news. Researchers say it may be possible to develop sunscreens that protect against this type of damage. But we’re not there yet………

Reference: Science 2015;34:842-847. Chemiexcitation of melanin derivatives induces DNA photoproducts long after UV exposure. Premi S, Wallisch S et al.

How can we blitz those zits?

General measures that will help acne include:

• Avoid applying greasy cosmetics, moisturisers or sunscreens to acne prone areas
• Wash the face with warm water and a gentle cleaner to remove oil. If this leaves the face still feeling oily, an over-the-counter acne wash or cleanser that contains salicylic acid, glycolic acid or benzoyl peroxide may be helpful
• Avoid abrasive scrubs, toners and cleansers
• Avoid squeezing and picking pimples as this irritates inflamed lesions and is more likely to lead to scarring
• Avoid hot humid areas and tight clothing in acne prone areas
• Follow a well-balanced, low GI diet combined with regular exercise
• Avoid smoking

Non-prescription topical products

These can be used to treat mild acne and include:

• Benzoyl peroxide lotions and creams
• Azelaic acid preparations
• Glycolic acid preparations

Prescription topical products

Prescription products are usually prescribed by your doctor or dermatologist when non-prescription products have not been effective.  These include:

• Topical antibiotics (either alone or combined with benzoyl peroxide) to reduce inflammation in pimples or pustules
• Topical retinoids or Vitamin A creams (either alone or combined with benzoyl peroxide) to help remove the skin plugs and prevent the formation of whiteheads and blackheads

All of the above topical treatments may cause irritation and dryness in some people. Reduce the frequency of application if this happens and stop using the product and see your doctor if severe irritation occurs.

Prescription oral preparations

These may be prescribed by your doctor or dermatologist to suppress acne which is either more widespread or more inflammatory. Oral prescription-only medications include antibiotics (such as doxycycline or minocycline), the oral contraceptive pill and anti-androgens (such as aldactone, cyproterone acetate).  The latter two are often most effective in women with adult acne. Oral preparations are usually used in combination with topical therapies.

Treatment of severe acne

People who have large, deep acne spots or those who are not responding to standard oral therapies may need a referral to a dermatologist to consider:

• High dose, long term oral antibiotics
• Oral isotretinoin (Roaccutane®, Orotane®)
• Kleresca®: a new alternative to oral therapy (see below)

Other treatments

Light chemical peels or laser and LED light systems may help mild acne. However, these treatments may not be effective long term and may need to be repeated regularly.

New Breakthroughs

Kleresca® Acne Treatment is a breakthrough BioPhotonic treatment that improves moderate to severe acne. BioPhotonic means that the light produces biological reactions in the skin, including killing bacteria, normalising cellular activity and stimulating the skin’s own repair systems to build-up collagen and reduce the signs of scarring. In clinical trials, Kleresca® Acne Treatment showed high efficacy in people with moderate to severe acne, with 9 out of 10 patients showing an improvement in their skin. This treatment is now available at Inner Sydney Dermatology.

So what really causes pimples?

Acne usually starts at puberty when increased levels of sex hormones (androgens) cause an increase in the size and oil production of glands. The face, neck and chest, shoulders and upper back are most likely to be affected by pimples as they have the highest number of oil glands. If the blockage of dead skin cells and sebum stays below the skin you get a whitehead. If the blockage reaches the air, it turns dark and becomes a blackhead. When bacteria gets into the surrounding tissue, it can become inflamed, with small red bumps (papules), white or yellow pus-filled pimples (pustules) or large red bumps (inflamed nodules).

Some people are genetically predisposed to acne. Stress has also been linked to acne, as have hormonal conditions such as polycystic ovary syndrome. Acne can be caused or aggravated by a high glycaemic index diet, oil-based cosmetics, sunscreens or creams, hot and humid environments, working with oil and grease, and some medications, including steroids, certain contraceptive pills and some epilepsy treatments.

The good news is there are effective treatments out there to help most acne sufferers.

Popping the acne myths.

Acne myth #1: Only teenagers get acne

While there are many who only experience acne during their teenage years, plenty of adults get acne too. A survey of more than 1000 adults published in the Journal of the American Academy of Dermatology found that 50% of women 20-29 years old, 35% of women 30-39 years old, 26% of women 40-49 years old and 15% of women aged 50 and over reported having acne. Adult acne is more common in adult women than in men, due to ongoing hormonal fluctuations.

Acne myth #2: Acne is not related to diet

We used to think that diet had nothing to do with acne, but recent studies have shown a possible link between high glycaemic index (GI) foods and acne. A high GI diet can aggravate acne because it stimulates insulin production, which affects our endocrine system and hormones.

Acne myth #3: Blackheads are dirt in your pores

Skin cell turnover is a natural process that pushes oil and debris out of our pores, keeping them clean. When this process occurs too slowly, sebum and skin cells build up in our follicles, resulting in a blackhead or whitehead. Blackheads are open, which lead to oxidation of the plugged materials and a black colour. It has nothing to do with dirt. Vitamin A creams (retinoids) help reduce blackheads by increasing skin cell turnover.

Acne myth #4: If you have acne, you need to wash your face more often

Although it’s important to maintain good skin hygiene to remove bacteria, dead skin cells, excess oil and dirt from the surface, over-washing and over-scrubbing can actually irritate the skin and make acne worse. When you wash too much, you strip your skin of it’s natural oils. This dehydrates the skin, so it overcompensates by producing more oil, which can then clog pores and increase acne.

Acne myth #5: Moisturisers cause acne

Dehydrated skin actually produces more pore-clogging oil than hydrated skin. If your skin is dry, apply a lightweight, non-comedogenic moisturizer twice daily. Moisturisers don’t prevent wrinkles (another myth!) so skip this step if your skin is producing enough natural oils itself.

Acne myth #6: Make-up makes acne worse

It’s true that some products can clog pores and make acne worse, but the right makeup can actually improve acne. Powder foundations can absorb oils that would otherwise clog pores. It you prefer a liquid foundation, look for one labeled oil-free or non-comedogenic, meaning it won’t clog pores.

Acne myth #7: Sun exposure helps acne

Although it may feel like the sun is drying up your pimples, at best a tan or mild sunburn only camouflages the breakout. The sun’s ultraviolet rays can damage the skin, releasing free radicals and destroying cellular DNA, which can increase inflammation and lead to premature ageing and skin cancer. Look for a broad spectrum, SPF 50+ sunscreen that is oil-free and non-comedogenic. Some physical sunscreens containing Zinc may actually help kill acne-causing bacteria. A higher SPF sunscreen is not more occlusive and does NOT increase the risk of acne.

Acne myth #8: Toothpaste can heal a pimple

Toothpaste contains a number of ingredients including baking soda, hydrogen peroxide, alcohol, menthol, essential oils and triclosan, which can dry pimples out. However, it can also cause irritation and rashes, so use a product specifically designed for your skin.

Acne myth #9: It’s OK to squeeze pimples

Tempting as this may be, it’s never a good idea. Popping pimples causes trauma to the skin and may actually drive bacteria deeper into the pore, increasing inflammation. More importantly, the trauma to the skin may increase your chance of leaving redness, pigmentation or permanent scarring.

Acne myth #10: Acne is not affected by stress

Although the exact mechanisms by which stress increases acne outbreaks are unclear, it is thought to be linked to chemical reactions, which create hormonal imbalances in the body. For example, during times of stress the stress hormone cortisol is increased, resulting in increased oil production, which can lead to pimples. Stress-induced inflammation may also play a role.

External ageing factors.

Pollution

Air pollution is an environmental factor related to premature skin and hair ageing, via the generation of free radicals and cell damage. A recent study comparing women living in urban and rural areas showed a direct link between pollution exposure and skin ageing signs including pigmentation and wrinkles. Research has also linked pollution as a contributing factor to bone loss.

Smoking

Smoking is another independent skin ageing-inducing environmental factor, and the effect with sun exposure is additive. Many studies have confirmed an association between smoking and premature wrinkling. In vitro studies have also shown that smoking leads to a reduction in collagen and an increase in enzymes involved in the degradation of collagen and elastin. There is also a relationship between smoking and baldness in men, and premature greying of hair. Smoking has also been linked with increased bone loss in post-menopausal women and increased risk of fracture.

Diet

The role of diet in skin ageing is highly controversial with limited scientific studies. We do however know that the ingestion of sugar promotes cross-linking of collagen fibres through a process known as glycation, leading to the production of tissue-destroying advanced glycation end products (AGEs). Grilling, frying or roasting produce high levels of AGEs compared with cooking processes such as steaming.

Exercise

Like diet, there is limited scientific data on the effect of exercise on skin ageing. However, a recent study by Tarnopolsky and his colleagues looked at the effects of exercise on the skin of volunteers aged between 20 and 86. The study had 2 groups: one exercising for less than an hour per week, and one doing at least 4 hours of high-intensity aerobic exercise each week. A skin sample taken from each volunteer’s sun-protected buttock skin demonstrated that those who exercised frequently (even those over 65) had skin closer in composition to those of 20-30 year olds. Furthermore, exercise has also been shown to improve bone mass in the spine of post-menopausal women over 50.

Sleep

Unfortunately short sleep duration has become increasingly common in modern society. Poor quality sleepers have higher intrinsic ageing scores than good quality sleepers. Poor sleepers also have reduced skin barrier function and lower satisfaction with their appearance. Bad sleep quality in older people is also associated with reduction in muscle mass and function, and reduced bone mineral density.

Dental hygiene and care

The teeth support the lower third of the face, and over time that support begins to collapse if there is loss of teeth, which is frequently associated with periodontal disease. Tooth loss has a significant effect on the underlying skeletal proportions of the face, and along with fat loss leads to the formation of wrinkles and hollow cheeks, and affects the muscles of the lower face which must compensate for the absence of teeth by contracting.

Stress

Chronic stress results in activation of pathways which results in immune dysfunction, increased production of free radicals and DNA damage. Chronic psychological stress is also associated with bone loss.

Hormones

For women, decrease in oestrogen during menopause is associated with increased skin dryness, and decreased skin elasticity, dermal thickness and collagen content. Although several studies have shown that hormone replacement therapy can improve skin quality, much of the evidence is controversial. The reduction in oestrogen levels with age also increases bone resorption. Furthermore, a low dietary intake of Vitamin D and calcium hastens bone loss and osteoporosis.

Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature.  Dermatologic Surgery 2017;43:475-484.

A holistic approach to anti-ageing.

Sun exposure of the skin and hair

Apply a broad-spectrum,  SPF 50+ sunscreen and re-apply approximately every 2 hours, or after swimming or sweating. In addition to wearing sunscreen, seek shade, wear sun protective clothing (including hat and sunglasses) and use extra caution near water, snow and sand, as they reflect the damaging sun’s rays. Ideally combine this with a blend of topical antioxidants that provides infrared and heat protection while minimising inflammation and promoting skin repair.

Pollution

Sunscreens do not protect against pollution so the best defence is routine cleansing to remove particulate matter that can attach to the skin, a combination of topical (Vit C, E, B3, Ferulic acid) and systemic antioxidants (diet high in fruits such as blueberries, vegetables, nuts, olive oil, fish, whole grains, and legumes) to counteract oxidative stress, and barrier repair with moisturisers. Cosmetics such as foundation may also have a protective effect.

Smoking

Don’t smoke. The benefits of not smoking include healthier skin, as well as protection from hair loss and low bone mineral density.

Diet

The combination of a Mediterranean diet and a low glycaemic diet, along with food sources containing Vit C and linoleic acid (ie. a diet with high intake of fruits, vegetables, nuts, olive oil, fish, whole grains, lean protein, legumes and monounsaturated fat but a lower intake of refined carbohydrates, sugar, processed foods, butter, saturated fat, fried food, red and processed meat) can promote healthier skin and may have a protective effect on bone mineral density.

Exercise

Do at least 4 hours of moderate or high-intensity physical exercise each week to promote healthier skin. Some exercises (especially weight training) have a protective effect on bone mineral density as well as muscle structure and function.

Sleep

Try and get a good-quality sleep of 8 hours a night to improve skin barrier function, satisfaction with appearance, bone mineral density and muscle mass and function.

Dental hygiene and care

Good oral hygiene and regular dental examination are key to preventing periodontal disease that can result in tooth loss and subsequent bone resorption.

Stress

Reduce stress using mind and body approaches such as mindfulness meditation, yoga, tai chi, qi gong, progressive relaxation, and deep-breathing.

Hormones

Given the possible increased risk of breast cancer, stroke and blood clots in hormone replacement therapy users, and increased risk of endometrial cancer with unopposed oestrogen use, the risks and benefits of this therapy need to be carefully evaluated by your doctor. Make sure you consume the recommended amounts of calcium and Vitamin D from diet and supplements.

Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature.  Dermatologic Surgery 2017;43:475-484.

The internal ageing process: what actually happens? 

Skin and Hair

Skin’s intrinsic deterioration is related to an accumulation of damage from free radicals created during normal cell metabolism, and a reduction in the body’s ability to defend against it.  This triggers chemical pathways that results in suppression of skin growth factors, up-regulation of tissue destruction enzymes, and increased inflammation. This causes breakdown of the collagen and elastin network, resulting in dry skin, loss of elasticity, thinning of the skin, and wrinkles. Our hair follicles also accumulate damage over time resulting in thinning of our hair.

Fat changes

Oxidative stress in fat cells is linked to accelerated fat ageing and DNA damage. Studies have shown that the fat compartments of our face are discretely partitioned into multiple, independent units by facial barriers. Fat loss and descent of these compartments compound the ageing appearance, giving us a deflated, sagging look.

Muscle changes

Free radicals also play an important role in the muscle ageing process. Also, as we age our facial muscles no longer have the bony support that they once had. As they try to maintain their resting tone, repetitive facial movements results in wrinkles that once were only noticeable with facial expression and soon become noticeable at rest.

Bone changes

Bone is a living tissue that is constantly remodelling. Studies have show that oxidative stress which increases with age, adversely affecting our bone homeostasis. In subjects older than 35 there seems to be a tipping of the balance in facial bones toward bone breakdown and resorption rather than bone formation. This results in changes to our facial structure and reduction in support for overlying soft tissues. Our cheeks flatten, our orbits widen, and our soft tissues head south!

Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature.  Dermatologic Surgery 2017;43:475-484.

The stats on tatts in Australia: growth, changes and regrets.

• 1 in 5 (19%) Australians has one or more tattoos, and with females it is almost 1 in 4 (24%).
• While a number of individuals report getting tattoos when they were younger, over a third (36%) of people got their first tattoo aged 26 or older
• 20% of Australians got their first tattoo aged mid-30s or older
• Most tattooed Australians have more than one. Of the Australians that have tattoos, almost half (48%) only have one, 30% have two to three, and 15% have between four and nine, with 7% having ten or more!
• While for the majority (72%) of tattooed Australians their most recent tattoo was a picture or symbol, for 1 in 5 (19%) it was a phrase or work. The biggest growth in tattoo design is in the phrase and word category.
• More than 1 in 4 (27%) of Australians with tattoos say that they regret getting a tattoo and 15% have commenced or looked into tattoo removal.
• Of tattooed Australians, 17% would discourage or strongly discourage their adult children from getting a tattoo.