Step into any drugstore in America and the options for skincare are overwhelming, where wild promises come slickly packaged in sleek tubes and frosty jars. It's big business, and some of it may deliver—but it can be difficult to navigate.
"Your skin kind of takes care of itself," says Dean Care dermatologist Dr. Robert McDonald, who cautions his patients to be wary of the marketing machine driving many products—the first ingredient in most is water. (Not to mention the laundry list of ingredients that follow, irritating to those with sensitive skin.)
"It's like licking your lips," says McDonald. "It feels good, but doesn't accomplish much."
McDonald says most need little more than a mild, non-soap cleanser and petroleum jelly. Medical-grade products are appropriate for certain uses, but perhaps the most effective anti-aging "potion" available is good quality sunscreen.
"When I go golfing I have a hat with a brim all the way around, a protective shirt and a thick coat of sunscreen," says McDonald. "I put it on until it's white, let it soak in and after ten minutes wipe off the excess."
But when it comes to preventing skin cancer, McDonald says there's no substitute for good judgment. If you're going to lunch outside, sit in the shade. Spending the day at Noah's Ark? Wear a swim shirt. Beware the false sense of security that sunscreen can bring, and don't fool yourself into believing a tan is healthy.
"You peel after a sunburn because you have damaged DNA," says McDonald. "Your body says ‘if we don't get rid of these bad cells we're going to get cancer.'"
He says many people believe tanning beds are better because they tan rather than burn with them, but those long rays actually penetrate deeper into the skin.
"Short ultraviolet burns you, long ultraviolet tans you," says McDonald, "but both of them cause skin cancer."
When caught early, skin cancer has a high cure rate—that's why GHC-SCW's Dr. Christine Tock offers free skin cancer screenings to GHC members eight times each year. These screenings are non-invasive; Tock simply eyeballs the skin for moles that are asymmetrical, have irregular borders, are multi-colored or are larger than 6mm. She also checks overall sun damage, and assesses each patient's unique circumstances.
"It can happen in places on the body where there isn't sun, and in children that have not had sun damage," says Tock. "It could be related to your family, and certain people just have higher risk."
Tock moved to Madison from New York City three years ago, and was surprised to find "a lot more skin cancer in the patient population here" than she'd seen in her previous practice. Tock says it's common for people here to use tanning beds, but that even minimal use is damaging. She says data over the past two years name tanning bed use a carcinogen.
"If you were in a tanning bed for over 50 sessions across your lifetime, your risk for melanoma goes up extraordinarily," says Tock. "Even with casual use over many years."
Tock says there have been significant advances in sunscreen technology in the last five years, changing a lot of the labeling. She encourages her patients to seek out "broad spectrum" protection, which blocks both UVA and UVB rays.
Anne Hill from Radiance Skin Therapy and Laser Center agrees that as long as your SPF is at least 15, the most important component of sunscreen is the full spectrum UVA and UVB coverage—which must be reapplied every couple of hours if in direct sunlight.
"SPF only speaks to UVB ray coverage, which is what keeps you from burning," says Hill. "Since the SPF number doesn't account for UVA rays, which also cause premature aging, wrinkles and cancer, only the right ingredients in sunscreen can give you full protection."
Hill sells only full spectrum suncreen at Radiance Skin Therapy, including medical- grade brands OBagi, La Roche Posay, iS Clinical, Dermaquest Skin Therapy and Jane Iredale, but she also recommends the new Neutrogena Spectrum+ sunscreen line, available at most drugstores.
Hill says many people have more wrinkles and discoloration on the left side of their face and neck due to sun exposure while driving, and you can even get UVA exposure sitting at a desk near a window. Many believe they don't need sunscreen, and are surprised by their sudden skin damage.
"When people say to me, ‘It seems like I just aged overnight!' that kind of statement usually means there is UVA damage," says Hill. "It usually happens pretty quickly."
Hill recommends starting with a cleanser, then toning if needed. Next apply the active ingredient that's best for you (perhaps an exfoliant, anti-oxidant, moisturizer) and then a broad-spectrum sunscreen. Make-up, if desired, is the final step.
"What we apply daily is as important or even more important than going in for a treatment," says Hill. "If you don't brush your teeth every day, you cannot expect good news at your dental checks—it is the same with skin. The best of both worlds is combining professional treatments with a professional daily skin regimen. That combination can change the look and health of your skin."
In addition to skin cancer, too much sun exposure may cause excess wrinkles, leathery skin, blotchy patches, small brown spots and more.
"Sunscreen is just that—a screen—and not a complete block to the sun's rays," says Kim Schuchardt of Lasting SkinSolutions. "Wear sunscreen daily and reapply it every two to four hours, but no matter how well you use it there's still some risk of sun reaching the cellular level of your skin and causing damage. The question is, what can you do about it?"
Schuchardt says the damage you're seeing today is the result of sun exposure a decade or two ago. She says many don't notice the effects of sun damage at first, noting only that their skin isn't as radiant as it once was. They may have dry, flaky spots, subtle light brown circles or eventually dark, flat, round spots—if they become dry, flaky and reddish underneath, those spots are often pre-cancerous and should be evaluated by your dermatologist.
At Lasting SkinSolutions, Schuchardt utilizes peels (chemical, microdermabrasion and laser), Intense Pulsed Light (IPL) treatment and Fraxel treatment (laser resurfacing using tiny pinholes that break up pigment, much like aerating a lawn). The appropriate treatment depends on how deep into the skin layers the damage goes and each patient's capacity for recovery time.
She also cautions people to pay attention not only to their face, but to the rest of their body, too: chest, hands, arms, shoulders and back are all commonly affected areas.
"The high majority of skin damage occurs before our 20s," says Dr. Kevin Robertson of Robertson Plastic Surgery.
Extrinsic aging occurs when sun exposure over time breaks down the collagen component of the skin, resulting in the loss of the elastic tissue. Coupled with the natural aging process, skin begins to take on a thin, crepe-like quality through which discoloration is more visible.
"We used to think tightening up the skin was the main way to make patients look younger," says Robertson. "Now studies show that the component that makes people look aged is as much color as it was wrinkles."
Robertson says implementing a good skincare line and sunscreen regimen are the first steps. He also encourages patients to look for products containing anti-oxidants such as Vitamin C, green tea extract and coffee berry. These elements are useful when it comes to prevention, but reversal is another story.
To roll back the effects of aging, start with products that contain bioactive elements Glycolic Acid and Retin A (not to be confused with Retinol, 10 times weaker than Retin A). Robertson says the gold standard is Hydroquinone (HQ), the active ingredient in bleaching agents. A combination of HQ and Retin A or Glycolic Acid is effective in slowly and progressively breaking up abnormal pigment depositions.
For more dramatic solutions, there are chemical peels, IPL and fractionated laser technology—the key factor is determining how much recovery time a patient is willing to tolerate. There are many, many options out there, but generally the more effective the treatment, the more downtime involved.
Dr. Richard Parfitt of AestheticA Skin Health Center seconds the efficacy of combining HQ and Retin A, particularly when supplemented with a chemical peel.
"The most effective way to deal with sun damage, especially hyperpigmentation such as age spots, mottled pigmentation, melasma or just an overabundance of freckles that get worse in the sun, is to use a combination of a good exfoliant like Retin A and a lightening cream with HQ. And if you really want the best improvement in your skin, do periodic chemical peels."
Parfitt believes peels are more effective and much less expensive than laser treatments, but says not all peels are created equal. Some are too aggressive and others aren't effective enough. He prefers Trichloroacetic (TCA) peels, which yield "the most improvement the fastest, in terms of wrinkles, skin textures, skin tone and pigmentation problems."
Parfitt says it's a balancing act between treatment and recovery time, and stresses that after treatment protecting your skin becomes as important as ever.
"Any skin treatment that you get at a medical skin clinic, if it's doing anything good for your skin, is going to produce some degree of redness," says Dr. Parfitt.
As long as this redness persists, you need to take extra precautions. Avoid sun exposure during downtime as much as possible and ramp up sunscreen and protective clothing when you can't help exposure. Look for sunscreen that contains at least 7.5 percent octinoxate, 5 percent zinc oxide and an SPF of 30 or greater.
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