Lifestyle Changes
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.
One study indicated that reducing intake of saturated (animal fats) might significantly reduce the risk of actinic keratosis, a common aging skin disorder that can also be a precursor to skin cancer. Certain fatty acids, however, such as those found in monounsaturated fats (e.g., olive and canola oils) or fish oils, may help protect the skin against sun-related diseases.
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.
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| The many methods of quitting smoking include counseling and support groups, nicotine patches, gums and sprays, and incremental reduction. |
Antioxidant Products: General Information
Antioxidants are substances that act as scavengers of oxygen-free radicals, the unstable particles that can damage cells and 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 alone 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. UV radiation produces Vitamin A 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 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. 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.
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