Premature skin aging is the syndrome of age spots, wrinkles, sagging skin and exaggerated folds around the mouth and neck that we start to develop around middle age.
Recognized causes of this syndrome are excessive ultraviolet exposure, cigarette smoking, excessive consumption of alcohol and drugs or medications. Hereditary factors certainly also play a role as some people are more susceptible to this condition than others. Patients with darker skin types are more protected than those with fair skin.
As a general rule, application of topical products on such skin, other than for moisturization, is not effective in reducing wrinkles or age spots or plumping the skin. A laser procedure, surgical procedure or cosmetic fillers can significantly improve the appearance in this condition. However, there are several topical cosmeceuticals that have shown effect in improving either fine wrinkles or age spots in prematurely aged skin.
- Retinoids, such as prescription-strength tretinoin, are derived from vitamin A and can be applied directly to the skin. Topical retinoids are one of the most well-established and effective treatments to reduce the appearance of fine lines and wrinkles due to aging skin. Retinoids cause the skin cells to turnover more rapidly. Less potent cosmeceutical forms of vitamin A include retinol, retinaldehyde, retinyl palmitate, and retinyl propionate. Retinoids may cause skin irritation, dryness, and peeling. Most patients have to use retinoids for months or years to see visible results.
- Hydroxy acids, such as glycolic acid and salicylic acid. These remove older skin cells (exfoliation) and make the skin appear younger and softer. Hydroxy acids can be added to daily-use moisturizers or can be incorporated into solutions used in dermatologists' offices, such as chemical peels. The downside of using hydroxy acids is that repeated exfoliation removes the skin's protective stratum corneum layer, leaving the skin vulnerable to additional UV damage, bacterial infection or skin allergies. In view of these issues, hydroxy acids and exfoliation are not recommended in my practice, as safer alternatives exist to rejuvenate the skin.
- Botanicals. These are active ingredients from roots, fruits, seeds, leaves, and other parts of a plant. These are sometimes referred to as "phytochemicals" and these include green tea, coffeeberry, pomegranate juice, chamomile flowers, and licorice root. This area is in its infancy and many claims are made by manufacturers that have not been substantiated by science. In addition, many plant-derived chemicals cause allergic reactions so be cautious when trying new wonder cures for aging skin.
- Antioxidants help to protect cells from damage caused by free radicals.Topical Vitamin C and Vitamin E have been studied for over 40 years and have been shown to protect against both UV-A and UV-B radiation. This means they prevent not only sunburn but also sun tanning and the damage to collagen and elastin in the dermis. No topically applied product can protect the skin for hours without reapplication and as always, a hat and protective clothing is the best protection from UV radiation, but for incidental exposure such as reflected radiation from water or sand, these topical vitamins work better than commercially available sunscreens. In addition, topical Vitamin C is very effective at healing burns, skin infections, and early actinic keratoses.