Aging Skin

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Sunlight and Ultraviolet Exposure

We need the sun for its light and warmth, but the sun’s ultraviolet (UV) radiation can cause damage to our skin and eyes - even when it’s cloudy or overcast.

What Damage Does UV Cause?

The short-term results of unprotected exposure to UV rays are tanning and sunburn.

A sunburn causes skin redness, tenderness, pain, and in some cases, swelling and blistering. Symptoms of more serious sunburn include fever, chills, upset stomach, and confusion. If these symptoms develop, see a doctor.

The long-term effect of sunburn is more serious.

UV exposure that is intense enough to cause sunburn clearly increases a person's risk of developing skin cancer. And UV exposure can increase skin cancer risk even without causing sunburn.

Long-term exposure can also cause premature changes in skin including:

Aging

Wrinkles

Loss of elasticity

Dark patches (lentigos, that are sometimes called "age spots" or "liver spots")

Actinic keratoses

Actinic keratoses are small (usually less than 1/4 inch) rough or scaly spots. Usually they develop on the face, ears, back of the hands, and arms of middle-aged or older people with fair skin, although they can develop on other sun-exposed areas of the skin. Although actinic keratoses grow slowly and usually do not cause any symptoms, they sometimes turn into squamous cell cancer.

Besides skin cancer, the sun's UV radiation also increases the risk of cataracts and certain other eye problems, and can suppress the immune system.

Are Any UV Rays Safe?

There are no safe UV rays.

Two main types of UV radiation reach the earth, UVA and UVB. Scientists now believe that both UVA and UVB rays contribute to skin damage, including skin cancer. UVB radiation is known to cause damage to the DNA of skin cells. Skin cancers develop when this damage affects the DNA of genes that control growth and division of skin cells. Recent research has found that UVA also contributes to skin cancer formation.

Artificial sources of UV light, such as sunlamps and tanning booths, may increase risk of developing skin cancer.

What is the UV Index?

To remind people to take precautions against the potential damage of UV exposure, the Environmental Protection Agency (EPA) and the National Weather Service developed the UV Index.

The UV Index number, ranging from 0 to 10+, indicates the amount of UV radiation reaching the earth's surface during an hour around noon. A higher number means greater exposure to UV radiation.

The UV Index is forecast daily for 58 cities, based on locally predicted conditions. It is valid only for about a 30-mile radius from the city, and, as with any forecast, local changes in cloud cover and other factors may alter actual levels experienced.

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Source: American Cancer Society

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Exercising Can Prevent Aging Damage*

What is Aging Skin?

We begin to age the moment we are born, and throughout our lives the effects of aging are evident in our bodies. Up to about age 20 years, the most visually prominent effects of aging are in growth and development. Beginning in our 20s, the effects of aging begin to be visible in the skin.

Genetically programmed chronologic aging causes biochemical changes in collagen and elastin, the connective tissues that give skin its firmness and elasticity. The genetic program for each person is different, so the loss of skin firmness and elasticity occurs at different rates and different times in one individual as compared with another.

As skin becomes less elastic, it also becomes drier. Underlying fat padding begins to disappear. With loss of underlying support by fat padding and connective tissues, the skin begins to sag. It looks less supple, and wrinkles form. The skin may be itchy with increased dryness. A cut may heal more slowly.

Simultaneously with genetically programmed aging, the process of photoaging may be taking place. Photoaging is the effect of chronic and excessive sun exposure on the skin. Cigarette smoking also contributes to aging effects by the biochemical changes it brings about in skin tissues.

Photoaging interacts with chronologic aging and may appear to hasten the process of chronologic aging. In fact, photoaging may be responsible for the majority of age-associated changes in the skin’s appearance: mottled pigmentation, surface roughness, fine wrinkles that disappear when stretched, "age" or "liver" spots (lentigines) on the hands, and dilated blood vessels. Chronic sun exposure is a major risk factor for skin cancers—basal cell carcinoma, squamous cell carcinoma and melanoma.

The effects of photoaging accumulate over years of chronic sun exposure. At first, the effects may be invisible to the casual glance, even while they are on the increase. Photos taken with ultraviolet light will dramatically reveal the accumulative effects of chronic sun exposure. In the following series of photos the accumulative effects of chronic sun exposure are clearly seen. In each set of photos, the two pictures on the left were taken in ordinary light, the picture on the right in ultraviolet light:

At age 18 months, sun damage is not yet apparent.

At age 4 years, early sun damage is evident in freckling across the nose and cheeks.

At age 17 years, a teen-ager has significant sun damage due to deliberate tanning on the beach or in tanning salons

In a woman 37 years old, subsurface sun damage is clearly visible in ultraviolet light

At age 52 years a woman has "old-looking" skin in visible light and significantly sun-damaged skin in ultraviolet light

A 64-year-old beach community resident has skin that chronicles a lifetime of chronic sun exposure. The skin is dry, inelastic, heavily mottled, with wrinkles

(Photos provided courtesy of David H. McDaniel, M.D.)

As skin ages and accumulates sun damage, a number of lesions (sores or spots on the skin) become more common. These include:

"Age" and "liver" spots (lentigines)—flat, brown areas with rounded edges usually found on the face, hands, back and feet. They are age-related and photoaging-related, and have nothing to do with the liver. While they are unsightly, they are not dangerous. However, a large, flat, dark area with irregular borders should be examined by a dermatologist to make sure it is not melanoma.
Actinic keratoses—thick, warty, rough, reddish growths on sun-exposed areas of the skin. They may be a precursor to squamous cell carcinoma.
Seborrheic keratoses—brown or black raised spots, or wart-like growths that appear to be stuck to the skin’s surface. They are not cancerous or precancerous, and are easily removed.
Cherry angiomas—harmless, small, bright red domes created by dilated blood vessels. They occur in more than 85% of middle-aged to elderly people, usually on the body. A dermatologist can remove them.
Telangiectasias ("broken capillaries")—dilated facial blood vessels, usually related to sun damage. A dermatologist can treat them.
Bruising—often a result of skin having lost its fat padding and becoming more susceptible to injury. Some drugs may cause bleeding under the skin. Bruises that persist should be examined by a dermatologist.
Wrinkles—changes in the elastic tissue from exposure to sunlight, effects of gravity, or motion factors in the skin. A dermatologist can treat wrinkles with dermatologic surgery.
Skin diseases more common in older people include shingles, leg ulcers, and seborrheic dermatitis.

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Is That Lesion a Symptom of Something Dangerous?

Symptom May Indicate

A scaly red spot Skin cancer

A change in color, shape or size of a mole
Any new skin growth

Bleeding in a mole or other growth

Excessive dryness and itching that doesn’t respond to moisturizers
Dermatitis, psoriasis, other skin disease

Vague or sharp local pain or headache, followed by formation of blisters on the skin
Shingles

Bulging or tender veins in the legs Varicose veins, associated with spider veins

Any sore on any part of the body that fails to heal Skin cancer, diabetes, circulatory problems

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Prevention of Photoaging

While you can’t slow down or stop the effects of chronologic aging, you can do something to inhibit the skin damage caused by excessive and chronic sun exposure. To avoid skin damage from sun exposure, always use a sunscreen with an SPF rating of 15 or higher, a hat with a brim, and protective covering of arms and legs. Don’t deliberately sunbathe, and limit sun exposure during the 10 AM to 4 PM hours of greatest sun intensity. Avoid deliberate tanning in tanning salons or under sun lamps. If your skin is already sun damaged you can still benefit from these measures.

The skin damage caused by long-term cigarette smoke is avoided by smoking cessation.

Vitamin E, Exercise Prevent Aging Damage

Combination Beats Either Strategy Alone to Prevent Age-Related Ails

You know that exercise is a great way to prevent or delay age-related
diseases such as heart disease, cancer, and Alzheimer's. And perhaps
you've heard that vitamin E supplements -- with their powerful
antioxidant properties -- can also be helpful.

So what happens when both are used in combination?

They provide a better defense than either strategy alone against
several ailments caused or worsened by age, according to a study in
the July issue of Biological Research for Nursing.

Researchers tested both anti-aging methods on 59 men and women
between ages 60 and 75 who were not regular exercisers. Half
continued their sedentary ways while the other half started a 60-
minute, twice-weekly exercise regimen. Those two groups were then
divided, so half of the exercisers and sedentary folks received
either an 800 IU vitamin E supplement or a placebo.

Taming Free Radicals

Whether they exercised or not, those taking vitamin E pills had the
same reduction in harmful substances known as free radicals --
unstable molecules that damage cells and are believed to contribute
to the development of some 200 different diseases, many of them age-
related. The levels of a blood marker that signals free-radical
damage were cut in half.

But don't shelve those athletic shoes just yet. Exercise provides its
own protection -- boosting antioxidant substances that combat these
free radicals. It also reduces risk factors such as obesity,
hypertension, and diabetes that worsen free-radical cell damage.

So while the group that exercised and took vitamin E didn't fare any
better than those who took just the pills as measured by blood levels
of this tell-tale sign of free radical damage, the seniors who became
active lost weight, reduced their blood sugar and blood pressure
levels, and increased their exercise capacity. As expected, the
sedentary folks didn't.

"The conclusion is that a combination of moderate exercise and
vitamin E is the most effective way to go," lead researcher James
Jessup, PhD, RN, of the University of Florida College of Nursing.

"The benefits of vitamin E and exercise are tangible and
intangible."

"Basically, vitamin E prevents free radicals from bumping into cell
walls and destroying them," says Jessup.

"The problem is, after about age 40 or 45, the body produces more
free radicals and fewer natural antioxidants to fight them. You'd
have to eat two heads of spinach a day to get enough vitamin E to be
protective, so you really should take supplements -- especially as
you get older."

Extra E Benefits

Other research indicates that vitamin E offers even more benefit to
those who also exercise. According to one 1999 study in the American
Journal of Epidemiology, it improves lung function in those who work
out when the air quality is poor.

And perhaps more importantly, an October 2001 study in Nutrition
suggests that a daily vitamin E supplement prevents some of the free
radical damage caused by physical activity -- especially if it's
occasional or takes a greater toll on your body.

"Although it's very beneficial, exercise does produce free radicals,"
says Jennifer Sacheck, PhD, cell biologist at Harvard Medical School
and a researcher on the protective properties of antioxidant
nutrients who led the latter study. "And if there's any damage to
muscles, inflammation also produces free radicals."

But taking vitamin E "blunts" this damage. "A little
free radical damage, like that from exercise, isn't bad because it
stimulates a natural antioxidant enzyme. But if it skews over to be
negative, a little extra vitamin E is helpful."

And Sacheck emphasizes "a little extra." Doses in the 800 to 1,000 IU
ranges -- used in Jessup's and her study, as well as others showing
protection from free radicals -- may be no more effective than her
recommendation of 200 to 400 IUs daily.

"Other studies suggest that taking 200 to 400 IUs daily is as good as
taking 800 to 1,000 Ius ... and it's cheaper."

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SOURCES: Biological Research for Nursing, July 2003. Nutrition,
October 2001. American Journal of Epidemiology, Feb. 15, 1999. James
Jessup, PhD, RN, associate professor of nursing, University of
Florida College of Nursing, Gainesville. Jennifer Sacheck, PhD,
research fellow, Division of Cell Biology, Harvard Medical School,
Boston.

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