LiveLongAgeWell

Here in LLAW we’ve recently covered sunscreens, and that the sun is responsible for a majority of the changes in our skin that we normally blame on aging. It’s not our age, but the amount of sun exposure we’ve accumulated over the years that gives us most of our wrinkles.

If you listen to dermatologists, they will say something like: “there’s no such thing as a safe tan”. Meaning, all tans, while they might make you look good, are manifestations of damage to your skin’s DNA. From a wrinkle- and cancer-prevention standpoint, a pale complexion, while not considered the most attractive, is certainly the most “healthy”.  I have several dermatologist friends who are really serious about the sun issue. They practice what they preach, and I have never seen them with a tan.  But, for me, I’ll take a bit of sun, a bit of that risk. Still, it’s nice to know there’s a decent alternative—self-tanning—something people are moving to as a way of avoiding the risk and damage altogether. Are self-tanners safe?…

In the last few years the cosmetic industry has developed products that won’t turn you a sickly shade of orange.  By blending the tanning chemical DHA (dihydroxyacetone) into a blend of moisturizers, and stabilizing the chemical release, most people can now get acceptably good results. And the active component DHA does truly appear to be safe. It’s derived from glycerin, is not absorbed into the bloodstream, and only works on the outmost layer of the epidermis of the skin. The brownish color is result of a chemical reaction between DHA and the proteins in your skin cells, and, since your dead outer skin cells are constantly shed off, the “tan” also sheds off within a few days to a week.

DHA has been around for 30 years in various cosmetics, and as far as I can find has never been found to be toxic or carcinogenic. While you might hear about other products, such as tyrosine, DHA is the only component that appears to be safe and effective. Certainly avoid any pill that promises to make you tan; these are all dangerous. (And don’t believe that some tanning beds are OK; none of them are safe sun alternatives.)

Sunless-tanning hints:

1. check out products from Jergens (the Natural Glow line, various products for different skin tones) and L’Oreal Sublime Glow Daily Moisturizer. If you like the more “chic” brands, try one made by Clarins.

2. consult the list of products approved by the Skin Cancer Foundation.

3. you might have to experiment with several to see which one works best for you. When you first use one, don’t use it on your face; find an out-of-the-way spot to check the result and to make sure you aren’t allergic.

4. first wash and gently exfoliate your skin before applying, so that your skin is a smooth surface to uniformly pick up the product.

5. use fairly generously, as you would sunscreen, but avoid too much around your elbows, hands, and tops of the feet. Here your skin is thicker and you might get more pigment change. If certain areas turn out too dark, you can partially reverse the process with a bit of hydrogen peroxide or even whitening toothpaste rubbed-in as needed.

6. wash your palms right away, and if you use on your face, don’t forget to apply to your ears.

7. remember you still need to use sunscreen if you get out into the sun! Neither the “sunless tan” or the product themselves will protect your skin from sun damage. However, there are new products that combine 15-30 SPF sunscreen into the self-tanners.

I suggest you try one of these products, particularly if you are worried about the damage you get from even a mild tan, or about possible toxic effects from sunscreens themselves. None of these DHA products out now are perfect, but most people can find one that works quite well.  And on the horizon, being developed in Australia, are self-tanners that work by stimulating our skin’s melanin. If they are shown to be safe (I wouldn’t be the first to use them), they will be a remarkable leap forward in sunless tanning.

Several weeks ago I detailed some problems with the common over-the-counter pain reliever acetaminophen (otherwise known as paracetamol, and the biggest U.S. brand name is Tylenol). The issue is that this medication, even in what many consumers feel is a safe dose, can lead to permanent liver damage.

Just today there was a big FDA meeting in Maryland, and a number of  recommendations were made (likely to be accepted by the full FDA) which will soon limit your choices for OTC and prescription pain relievers. The committees voted to limit the maximum pill size from 500 to 325 milligrams for acetaminophen, and lower the accepted maximum daily dose to well under the current 4000 milligrams. Further—and significant for many people in chronic pain—it looks like Percocet and Vicodin, two exceedingly popular drugs that mix acetaminophen with a stronger narcotic, will be banned. Read more details here

Normally I publish a post on Monday or Tuesday, and again later in the week. This week has been particularly busy for me, so…sunless tanning, part III of the sunscreen series, will be posted later in the week rather than today. In the meantime, if you are lucky enough to have sun where you are, I suggest you put on a good sunscreen and get outside!

Last week I presented some of the issues surrounding sunscreens and today I’ll give some practical hints. Unfortunately, there is still no sunscreen available that is even close to perfect; they all have potential issues regarding how well they block both UVA and UVB, how long they are effective, and how safe they are (particularly regarding absorption into the bloodstream). Still, protecting yourself from excessive sunlight is critical, not only to help protect from the number one cancer of all—skin cancer—but to avoid early aging. Consider this quote from the U.S. Environmental Protection Agency’s excellent pdf fact-sheet “The Burning Facts”:

Up to 90 percent of the visible skin changes commonly attributed
to aging are caused by sun exposure.

11 Hints…What You Can Do

1. If you are very concerned about the potential toxicity of sunscreens, consult this summary from the Environmental Working Group, a non-profit consumer “watchdog” organization that has issued a list of what they consider recommended and relatively safe products. One problem is that you probably won’t find many of their recommended ones at your local drugstore, but you can probably find most online.

2.If you are not so concerned about theoretical chemical risks, you can consult this short list of American Academy of Dermatology (AAD) “recognized” products (while not as cautious as the EWG list, the AAD is still quite a careful group). One brand from their list I particularly like is Aveeno, which you will be able to find locally. Aveeno makes high-quality products that are not terribly expensive.

3. The last several years has seen release of several products that have longer-lasting, stablilized UVA protection (as well as the more standard UVB protection), and Mexoxyl and Helioplex are two components to look for. Helioplex seems to be the superior product, and of those brands with Helioplex, I like the Neutrogena brand, particularly Neutrogena Ulta-Sheer SPF 70 with Helioplex. It’s what I use. Some researchers have claimed that since these chemicals are partially absorbed into the bloodstream, that they might have an estrogen, hormonal-type effect internally. Talk to your physician if you are concerned about possible hormonal effects,  and you may not want to use one that is absorbed, on children.

4. If you want a sunscreen that is not absorbed, find a zinc oxide or titanium dioxide product (and see EWG report above), though these often leave the skin with an unattractive white cast.

5. It is probably best to avoid spray and powder sunscreens that have (ultra-small) nano-particles which might be inhaled.

6. Besides using a broad-spectrum UVA/UVB product, buy at least a SPF 30, and use enough of it! Shockingly, you need to use a “shot-glass” amount, about 1 oz. (1/3 of a typical 3 oz. tube) for your entire body, if you want to get the advertised SPF factor. Bottom line: use more than you think you should.

7. Apply 30 minutes before going in the sun to allow it to absorb.

8. Sunscreens lose potency over time. Look at the expiration date when you buy or use, and throw away any product at 3 years.

9. Reapply after going in the water, after significant sweating, and about every 2 or 3 hours. Even “waterproof” sunscreens come off after 40 minutes in the water, so if you are a water person, look for “very waterproof” which should give double water protection.

10. Don’t forget to apply to areas commonly forgotten such as: the entire surface of the ear (I can’t count how many ear skin cancers I excised and re-constructed when I was in California), any bald spots, the tops of your feet….and use a lip-sunscreen too (lip cancer is common)!

11. Avoid the sun during peak times, 10 am to 3 pm, wear a hat and don’t forget quality sunglasses to protect your eyes from cataracts! (a subject for a future post…)

Next: self-tanning products.

First, the big picture: the most important measure you can take to keep a “youthful” appearance—as much as your particular genes will allow—is to minimize exposure to UVA and UVB irradiation from the sun. Of course staying out of the sun as much as possible is the most sure way, but also it’s inconvenient, impractical, and not healthy from many aspects, including the psychological ones, so most people use sunscreens. The problem is finding a good one.

Sunscreen use is critical both to minimize wrinkles and cut the risk of skin cancer, which ranks as the most common cancer of all. But the subject has become complex in the past few years, so today let’s go over some of the current science of sunscreens, and the next post I’ll give some specific ideas on what you can use.

A few years ago it was easy to know what to do. Most people, even dermatologists, felt that if you used a SPF 15 or, then…wow…a 30, you would be highly protected and would not have to worry much, because a 30 was thought to allow you to be in the sun 30 times as long as if you didn’t use any sunscreen. But in the last few years as more products have been released, with higher and higher SPFs, the sunscreen field has become much more murky and confusing.

Some doctors have even gone so far as to state that using sunscreens will increase the risk for the deadliest form of skin cancer, melanoma, because many products will stop the burn (mostly from UVB), but will not stop UVA. This UVA irradiation doesn’t cause as much redness, but penetrates more deeply into the skin causing worse aging damage and a higher melanoma risk. So since you don’t get red, you think you are fine, while the sneaky UVA rays are causing their deep damage.

One simple way to remember the basic difference between A and B is: UVA,  a longer wavelength, is the aging radiation, and UVB causes more burning…however, both, in excess, lead to wrinkles, skin cancer, and even a diminished immune system. And if you sit by a sunny window, know that UVA radiation penetrates glass.

Here is a summary of some recent issues. But don’t get discouraged as you read this, because there are some solutions, which we’ll discuss in the next post…

1. The “SPF” rating only concerns the level of UVB protection. There are no good FDA standards or labeling or SPF ratings for UVA, and many products don’t offer, or even claim, good protection from UVA.

2. Many of the chemicals that do provide UVA protection, perhaps ironically, break down quickly in the sun, which is one reason sunscreens should be re-applied every 2 to 3 hours.

3. Toxicity: some of the chemicals used in sunscreens are absorbed into our bloodstream and may be toxic. Particular concern has been raised about two popular components, oxybenzone and avobenzone, which theoretically could alter our internal hormonal balance, and some doctors advise: don’t use these on pregnant women or children. Then there are the super-small, nano-particles used in some expensive new products. Again, while some have claimed these tiny particles might be absorbed, the super-cautious Environmental Working Group has concluded they are not. But the EWG recommends staying away from spray or powder products that might cause lung damage from the inhaled nano-particles. Finally, some sunscreen chemicals have been shown to produce free radicals when mixed with sunlight, and free radicals (which we try to neutralize with antioxidants) lead to skin aging.

4. While many of those issues are controversial, most doctors agree: very few people use enough sunscreen to provide adequate protection. A large Australian study showed that even “diligent” sunscreen users were only applying about half of what they should to get the advertised SPF protection, and most people only get about a quarter of the protection they think they are.

5. “Waterproof” sunscreens only last for about 40 minutes in the water, and for typical beach use, even these should be re-applied regularly.

6. If you read this blog often, you know I am a big fan of vitamin D, which we naturally get from sun exposure on our skin, and many people are vitamin D deficient. For some, this D vitamin shortage is rooted in excessive paranoia about sun exposure and many of these people use too much sunscreen. Like most things in life, moderation is the best route.

Next: SPFs and good sunscreens.

On Monday I addressed the importance of moisturizers and sunscreen for your hands, fingers, and arms. Many people remember sunscreen for their face, but forget about it elsewhere, so, over time, your face might look pretty good but your hands—because they were not well protected—look like hands of an old person. (Remember too that sunscreen decreases the risk of skin cancer, which occur commonly on the back of the hands.)

Today we consider other creams you can use for your hands. First you might ask: should I see a dermatologist? Yes, if you have spots you are concerned might be cancerous, or you already have extensive aging changes. A dermatologist has many stronger treatments than you can find over-the-counter; her arsenal includes (from easiest to most complicated): prescription-strength bleaching agents and Retin-A, chemical peel, intense pulsed light, laser resurfacing, and injection of filling agents. Your doctor can combine several of these, and they tend to be very effective.

If you are younger and your hands currently look quite good and you want to keep them that way, or you have only mild changes at this point, there are effective products you can buy “OTC” (over-the-counter).  First are the alpha-hydroxy acids, and with these you can give your hands a mild chemical peel. They may give some mild benefit, but by far the most effective creams are the retinoids, derived from vitamin A (Retin-A is the prescription-strength form).

Retinoids are, well, fantastic, and I will devote a future post just to them and how they work, but in short, they are the very best agents we have to restore the collagen framework—the firmness and elasticity that your skin loses from aging and sun. The best OTC form is retinol, and I recommend the Neutrogena line because they are high quality and not overpriced (in skin creams, you can spend a fortune for a chic package and a psueudo-European name complete with accent marks, but often these are far inferior to the less flashy brands such as Neutrogena). One good choice is Neutrogena Healthy Skin Original Formula or the stronger Neutrogena Anti-Wrinkle Intensive.

Spread about a pea-sized amount on your hands, at first every several days, and if you don’t get any irritation, slowly increase to every night use. The main side effect is redness and irritation, and if that occurs, use it less often, then after a few weeks again try to use it more frequently. You need at least a month to see any improvement, and if you aren’t happy with the results after three months, see a dermatologist. You might benefit from a stronger retinoid or other types of treatment.

Finally, retinoids have the catch-22 that they make your skin more sensitive to sun damage, so it’s best to use them at night, and you need to be really serious about using a sunscreen. Monday I mentioned Lubriderm with SPF 15, but if you are using retinoids regularly, you might move up a notch in sun-protection to something like Neutrogena Norwegian Formula Age Shield SPF 30 Hand Cream. Carry a tube in your bag to use whenever you wash your hands, so even on-the-go keep up your younger hands program!

I hope you now have a good idea how to get younger-looking hands, and Friday, we leave the most superficial part of the body and dig towards a much deeper subject.

You may know that a current hot procedure in cosmetic dermatology involves “facial fillers”—artificial and in some cases natural substances, such as one’s own fat cells, injected to expand facial areas that have shrunk as a natural result of aging. But you might not be aware that these same plumping-out techniques are becoming all the rage for a different area—the hands. More individuals, who may have young-looking faces, are directing attention now to their hands, which, they feel, “give away” their age. It’s a valid concern, and they want something done.

As detailed in this New York Times article, more than a few people are spending a small fortune trying to reverse the natural tissue shrinkage (which gives a “bony” or “veiny” look) that occurs in some people’s hands over time. The cost of filling procedures for the hands can range from $3,000 for results that last about a year, to $12,000 for results (using fat) that might last a decade. Certainly not a trivial amount, so you will be happy to know there are several simpler, cheaper, and less painful routes to help prevent, and then treat, some of the age-related changes that might occur.

Besides the atrophy, or shrinkage, problem, other age-giveaways are hand wrinkles and brown spots. Prevention is best of course, and if you are in your 20s or 30s still with perfect hands, notice your grandparents’ hands and consider: sun damage may have caused much of the changes you see, and in large part, it’s preventable.

Point one: faithfully use at least an SPF 15 sunscreen (with both UVA and UVB protection), on the backs of your hands and fingers…wrists and arms too if they are sun-exposed. Do this no matter if you are young and unwrinkled, or already have a problem…even if you already have wrinkles, this will help slow down their progression.

Two: moisturize and hydrate your hands, and your body in general. For a daytime hand moisturizer, best is to use a moisturizer-sunscreen combination. One quality, economical, and convenient choice is Lubriderm Daily Moisture with SPF 15. Leave a 16 oz press-top dispenser handy, and make a habit of using a couple squirts before you go out into the sun and weather.

Then hydrate your skin from inside by drinking enough water. Especially with winter approaching, the indoor heated environment can be very drying, wrecking havoc on your skin, so consider purchasing a portable humidifier or two for your home. It’s slightly inconvenient to deal with filling up the device, cleaning it, changing the filters, etc., but the results are well worth the effort. Your wrinkled skin might noticeably “flesh-out” as the humidity rises in your environment. And the increased humidity has other health benefits that will be detailed in a future post.

On Wednesday… several specific creams that work well for age spots and wrinkles!