Are Your Hands Showing Your Age?

How to Rejuvenate Their Youthful Appearance

By Kevin C. Smith MD FACP FRCPC

Because of sun and weather exposure, years of minor scrapes and cuts, and for some, constant exposure to water and detergents, our hands sometimes age faster than other parts of our bodies, and detract from our appearance. Fortunately is it now possible to rejuvenate the hands, restoring their appearance and sometimes also improving the thickness and health of the skin on the backs of the hands.

Fun loving, hard working hands don't get the sun protection they need. The backs of the hands are sometimes overlooked when sunscreen is applied - or the sunscreen is washed off or accidentally wiped away. Gardening gloves, golf gloves, bike gloves work gloves can help to protect our hands from sun and from trauma. Read more on sun damaged skin.

Daily moisturizing your hands is critical to keep your skin supple and prevent dryness and cracking. Wearing gloves and moisturizing in the cold weather helps protect your hands from chapping and cracking.

For some people, dry cracked hands are a chronic condition called contact dermatitis, or hand eczema. Often caused by your daily routine, one which involves constantly having wet hands (i.e. hairdresser, surgeon, homemaker), this condition results in red, scaly, and very itchy hands. If you suspect your have this, read more at http://www.eczemaguide.ca/basics/eczema_like/hand_eczema_hand_dermatitis.html

There are some solutions to rejuvenating the look and feel of your hands:

• There are numerous special hand creams available, more being introduced almost every week! Creams with vitamins A, C, E and alpha hydroxyl acids are key ingredients which can help prevent and restore your youthful looking hands.
• Restisol-A® 0.01% cream contains tretinoin (which prevents and corrects some aspects of sun damage) and also has an SPF 15 sunscreen. When Retisol-A cream is applied to exposed areas like the face and the backs of the hands EVERY morning - year after year - the aging process is slowed down, and sometimes after a year or two the skin will actually start to look and feel younger and healthier.
• Sunscreens which have the ability to stick to the skin (for example, Anthelios-45® Waterproof Sunscreen) can be very helpful on active parts of the body like the hands, and can also act as a moisturizer. The sunscreen should be applied before sun exposure, even if you are using Retisol-A as a base coat for your skin every morning.

When the skin on the back of the hands has become old looking and freckled - and sometimes also thinned out - it is possible to correct these problems and give your hands a fresh, more youthful look:

• Brown spots (sometimes called freckles, "age spots" or "liver spots") can be faded using fading creams and also by using the Medlite C6 laser. Treatments take only a few minutes, are well tolerated, and great improvement is usually obvious within a couple of weeks.
  
  
• Thin skin on the backs of the hands can be quickly improved by treatment with Restylane™. This not only improves the appearance of the hands by making veins and bones less obvious, but also restores the fullness found in youthful skin and gives some protection against bumps and bruises. The benefits of a single treatment can be seen immediately and often last 6-12 months, sometimes longer.
  
  
• In some cases Artecoll™ can also be used to improve the thickness of the skin on the backs of the hands. Artecoll™ costs more to use, and several treatment sessions 2-4 months apart may be required, but Artecoll™ has the advantage of producing an improvement which can last for many years.

Like most things, prevention is your best solution. Keep your hands beautiful by remembering to moisturize, use a sunblock and protect your hands from exposure - the same way you look after your face. For more information on cleansers, moisturizers, sunscreens, and general skincare, go to SkinCareGuide.ca.

A Resolution That Helps Your Skin

How stopping smoking improves your skin

By Richard Thomas, MD, FRCPC

We all know that aging is a natural biological process that affects all of us. The aging of your skin is also greatly affected by external factors that accelerate this process; particularly smoking. Exposing our skin over many years to sunshine will give the skin an old wrinkled, blotchy look. Drinking too much alcohol over many years may also give you an older appearance. A study showed that the appearance of precancerous sunspots may be even influenced by your diet. A low fat diet (also certain vegetables, legumes and olive oil) has been shown effective in reducing the number of sunspots (Actinic Keratosis), while a diet high in meat and dairy, might increase their number. (For more information on A.K, visit Skin Cancer Guide)

Cigarette smoking, known to cause lung cancer and encourages heart disease, also has significant aging effects on your skin and hair.

Effects of cigarette smoking on your skin and hair:

• Increases wrinkles, especially if you are a woman
• Can make your complexion red or orange
• Can produce pale or yellowish skin in places
• Causes puffiness
• Don’t forget the stains that create those “yellow fingers”
• Brings about premature aging of your skin
• Causes gray hair
• Results in thinning hair, more pronounced in men but also seen in women
• Slows wound healing
• Increases your risk of squamous cell cancer

Whose skin is most affected?

• Affects women more than men
• Especially increases wrinkles around the mouth
• Has a greater affect on white versus dark skin
• Increases if you have smoked for more than 15 years
• Increases if you smoke more than ½ a pack a day

What does smoking actually do to the skin?

• Smoking causes drying of the surface of the skin as nicotine is a diuretic
• It reduces the vitamin A levels in the skin
• Smoking affects matrix metalloprotienases (MMPs) causing collagen to degrade and elastin to fragment
• While aging from the sun happens in the higher levels of the skin (dermis), smoking predominantly affects the lower, deeper part
• Smoking lowers the blood supply to the skin and reduces collagen production. Both of which slow healing in the skin
• This slow healing has an influence after surgery including after cosmetic surgery or laser resurfacing. It prolongs the healing process and increases the risk of complications
• Nicotine, carbon monoxide and hydrogencyanide have toxic effects on healing tissue
• Some suggest that nicotine may suppress the immune system to increase susceptibility of viral infections of the skin such as warts

Health wise, smoking is not a good idea, but if you add in the effects it has on your skin, hair and aging, better make quitting your New Year’s resolution.

Hormones and Your Skin

Covering the basics

By Richard Thomas, MD

“How to achieve beautiful, supple and young-looking skin”. You almost can’t avoid it - splashed on magazine covers, reported in newspapers and marketed on television and radio, the message to improve our skin would appear paramount to how we and others view our looks.

How does our skin age?

Skin aging is influenced by:

• Genetic differences
• Hormonal changes, e.g. estrogen and thyroxin
• Chronic sun exposure
• Wind, pollution

Blame it on hormones

Hormones are mostly to blame for skin changes as we age. Hormones are chemical messengers produced in organs such as the ovaries, adrenal glands, and thyroid glands, and all have an effect on other tissues.

Much of the reason why our skin begins to suffer is primarily due to hormones -- and there is a massive industry manufacturing products to try to alleviate the results of these hormonal changes, notably as women reach menopause in their 40s and 50s.

As menopause occurs, estrogen is reduced and while it has a direct effect on thinning bones, it also creates significant changes in the skin. Women find:

• their skin becomes drier with increased wrinkles
• skin becomes more fragile, loses some of its elasticity, and is looser because the production of collagen is reduced
• older skin appears paler as the lack of estrogen reduces the number of blood vessels in the skin
• menopause also causes a reduction in the level of testosterone but not as significant a drop as in estrogen

Hormones and dry skin

Another hormone we have is thyroxin, produced by the thyroid gland, which influences skin appearance. Too much thyroxin shows a warm, smooth, sweaty, flushed skin. Under-activity of thyroxin produces a dry, coarse thickening of skin with reduced ability to sweat.

Hormones affect acne

The oil glands of the skin are in part controlled by the level and activity of the hormone testosterone in the skin. Testosterone is required to produce acne. This outcome can be seen in conditions such as polycystic ovary syndrome, which produce some elevation in testosterone, which in turn causes increased facial hair, irregular periods and acne. It has also been found that some birth control pills can block testosterone skin reactors to improve some of the consequences of increasing hormone levels. (See Acne Guide for more acne information)

Thinning hair

Hair will thin after menopause. In some women, genetic factors produce significant thinning. Abnormalities in the level of a thyroid hormone, in addition to the amount of iron stored in the body, can influence the volume of hair.

Estrogen encourages hair to stay in its growing phase (Anagen hair). This is seen in the significant thickening of hair towards the end of pregnancy. After menopause, however, the lower estrogen amount allows the scalp hair to grow towards the falling out stage (Telogen hair).

HRT and skin

Post menopausal women will notice that unlike their scalp, facial hairs increase. This is thought to be because estrogen -- which opposes the effect of testosterone -- drops relatively more after menopause than testosterone.

Hormone replacement therapy (HRT) has been used over the last 20 years to combat the signs of aging. HRT can promote a fuller-looking skin because the skin then becomes thicker with less loss of subcutaneous fat. Thinning and drying of vaginal surfaces is also minimized. This can also be achieved by using topical estrogen. The use of estrogen creams has been shown to maintain the elasticity and fullness of skin after menopause, although at this time it is not used extensively because of concerns about side effects and the variability of absorption into the body.

See your doctor or dermatologist to determine which solutions best suits your experience with aging skin.

Antioxidants Clean Up: Combat Those Free Radicals

By Dr. Richard Thomas

If you want to protect your skin, think antioxidants.

These have gained a great deal of attention in recent years, and for good reason.
They work to combat the ‘free radical cells’ that damage your skin.

What are free radicals?

Created when oxygen produces by-products during normal cellular metabolism. More accurately, this reactive oxygen ‘steals’ electrons from proteins, DNA and cell membranes, damaging tissue. If left unchecked, free radicals may cause heart damage, cancer, cataracts, and a weak immune system. Free radicals may be involved with aging of tissue; and coupled with sun damage, could promote skin cancers.

While free radicals are produced by normal human metabolism, they can be increased by smoking, alcohol, exposure to heavy metals, and radiation. Antioxidants counteract this process by binding to the free radicals, transforming them into non-damaging compounds, or repairing cellular damage. It would seem logical, then, to include antioxidants in your daily regime.

To the rescue

Antioxidants are the antidote to free radicals. They can be taken orally or applied directly to the skin.

What are antioxidants?

In order for antioxidants to have any benefit they have to be in sufficient quantities in the tissue. Common antioxidants that are taken orally, or eaten, are Vitamin C, Vitamin E, Selenium and the carotenoids, (fruits and vegetables having the most deeply or brightly-colored fruits and vegetables, i.e.: spinach, carrots, red bell peppers, tomatoes).

What are topical antioxidants?

Topical antioxidants may reduce UVA damage. UVA is the wavelength that mostly produces visible signs of sun damage and has some carcinogenic effect.

Topical antioxidants that have been studied in creams or ointments are Vitamin C, Vitamin E, Glutathione, Lipoic Acid, Coenzyme Q10, Soy- isoflavanone. It has been shown that combining some of these have additional benefit.

Others such as selenium, zinc and silymarin have not been studied for their effects.

Which are the antioxidants?

Antioxidants can be divided into those that are fat soluble and those that are water soluble.

Fat soluble is:

• Vitamin E, coenzyme Q10 and lipoic acid

Water soluble is:

• Glutathione and Vitamin C

Vitamin E:

• The antioxidant effect can be more effective if combined with other antioxidants i.e.: coenzyme Q10 and Vitamin C
• Is found in fresh vegetables, oils, seeds, nuts, cumin, and soy. Animal studies have shown that Vitamin E protects against UVB damage, although this effect has not been proved in humans. (UVB is much more carcinogenic than UVA, and causes sunburns).
• Commonly used to help wound healing. However, studies in human burns did not show Vitamin E helping and about a 1/5 of patients reacted to vitamin E with a contact dermatitis).
• Topical Vitamin E is commonly used by pregnant women in the belief that it prevents stretch marks. There is no evidence for this, and sometimes an acute allergic dermatitis is produced causing an inflamed uncomfortable rash.

Coenzyme Q10 (also known as Ubiquinone)

• Found in fish and shell fish
• It penetrates well into skin, and is claimed to reduce the breakdown of collagen after exposure to UVA light
• It may reduce the depth of wrinkles but this has not been confirmed in studies

Lipoic Acid

• This is well absorbed into the skin, and converted quickly into dihydrolipoic acid in the cells. It has an anti-inflammatory effect. A three per cent application of Lipoid Acid has been shown to reduce redness in the skin after UVB exposure.

Glutathione

• This antioxidant is produced by amino acids, eysteine, glycine and glutamic acid

Vitamin C

• Also known as Ascorbic Acid
• Oral Vitamin C improves wound healing and may enhance the immune system
• The lack of vitamin C produces scurvy, which produces fragile skin and bleeding gums

Topical Vitamin C

• reduces sun damage, fine wrinkles, and may lighten dark skin pigmentation

Green Tea (Tea polyphenols)

When used topically as a cream

• Has shown to reduce the carcinogenic effect of certain chemicals and ultraviolet rays on the skin of animals. We are still awaiting good evidence for benefit in humans
• Produces anti-inflammatory effects
• Reduces the redness caused by UV light

DHEA (Dehydroepiandrosterone)

• Occurs naturally in our bodies
• When taken orally, DHEA is a powerful antioxidant that may have an anti-aging effect and help thicken skin and reduce pigmentation
• It is not know if there are any long-term negative effects from oral injection

Soy-isoflavones

• When used topically it may increase collagen and decrease redness and damage from ultraviolet rays
• For more information about caring for your skin, visit the rest of this site.

Age Spots? Sun Spots? Skin Cancer?

By Kevin C. Smith MD FACP FRCPC

What is that Spot?

As time goes on, we start to notice brown spots and freckles -- “souvenirs of Florida” -- on the backs of our hands and on other sun exposed areas like the upper chest and face. At first these brown spots are small and light colored, but eventually they become a cosmetic problem -- an obvious sign of premature aging of the skin because of ultraviolet damage from sun exposure or from tanning beds. (Learn more about Sun Damage)

By using modern high-SPF sunscreens like Ombrelle-60™ or Anthelios-60™ we can safely enjoy outdoor activities like gardening, golf and boating, and greatly reduce the rate at which our skin deteriorates. Patients who get into the habit of applying Retisol-A 0.01% cream (a prescription product which combines a retinoid and an SPF-15 sunscreen) to their faces every morning will usually see a considerable improvement in the appearance of their skin after 1-2 years, and if treatment is continued long-term patients will notice that their skin ages more slowly.

Hats and sun protective clothing can also slow down the rate at which “age spots” appear – and also reduce the chance that we will develop skin cancer. You can learn more about how to prevent sun damage, learn about the early warning signs of skin cancer and see photos of typical skin cancers at Skin Cancer Guide.ca.

The early warning signs of skin cancer include:

• new and unusual growths on the skin
• moles and freckles which have unusual colors or mixtures of colors
• moles and freckles with irregular borders
• growths on the skin which bleed, or which form an open sore which does not heal within a few weeks.

It is not too late for those of us who already have sun spots and age spots. I have seen many patients who had sun damage improve gradually over a period of 3-5 years simply in response to daily sun protection. For those who want more rapid and complete improvement in their sun damaged skin, one or two treatments with the Medlite™ laser can fade or eliminate brown “age spots” on the face, chest and hands within a few weeks.

Intense Pulsed Light (IPL) treatments, for example with the Cutera Xeo-600, can be used in cases where there is a background of tiny freckles and brown discoloration – sometimes erasing 20 years of irregular pigment with a series of 20 minute treatments! Where there is severe sun damage or when a person wishes the most rapid improvement (for example, if a daughter is getting married in two months) a medicine called Levulan™ is applied to the skin for one hour before treatment with the Cutera Xeo-600. Levulan™ is absorbed by cells in the skin which are misbehaving, and then is activated by light from the Xeo-600. The abnormal cells are shed from the skin over a period of 1-2 weeks, revealing fresher, healthier skin – and giving the patient a “fresh start”.

What ever the type of spot – if you have concerns, or if you see changes in its appearance, it is important that you have it inspected by your family physician or dermatologist.