Skin in the Game

Skin in the Game

Keeping your hide happy and healthy.

In ancient times, the Egyptians used sea salt scrubs to keep their skin smooth and supple, while the Romans coveted aloe vera to treat war wounds. Mayan women swore by avocados for hydration and acacia with honey for cleansing. During the Renaissance, women applied a poultice of bread crumbs and egg whites to soften their skin, while ladies of the Victorian age liked to make masks of green clay and herbs.

The skin is our largest organ, ot only serving as a guard against external threats like infection, chemicals, and temperature extremes but also to keep the brain in touch with the outside world. Unfortunately, as we age, our skin loses its ability to retain moisture—which decreases its elasticity—and starts to thin as fat, collagen, and elastin stores decrease. (Collagen is a protein that acts as a glue between connective fibers; elastin is another protein that helps tissues contract back to their original shape after stretching.)

Although there may not be much to do about the inherent factors that affect our skin as the years pass, there are plenty of external options for keeping it healthy and vital. And since our skin is part of the first impression we make on others—after all, our faces are what new friends see first—it’s important to give it some TLC.

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What’s good for your overall health is good for your skin, according to Oakland dermatologist Tomi Wall—so get enough sleep, take that multivitamin, exercise, and drink your water. And stop smoking.

“Even if people have been smoking their whole lives, I still encourage them to stop,” Wall says. “Not only is smoking bad for your lungs, it ages your skin.”

In addition to clean living, protecting your skin by avoiding the sun during peak hours and religiously applying sunscreen is one of the best ways to take care of it, Wall says.

“My baby boomer clients often come in and tell me they’ve never really worn sunscreen,” Wall says. “And they wonder whether there’s any point in using it now. I tell them, the American Academy of Dermatology says that 80 percent of sun exposure damage happens before a person is 18, but that still leaves 20 percent we can try to mitigate.”

Sunscreen has been around for a while—scientists were making lotions and creams as early as the 1930s, and Austrian scientist Franz Greiter introduced the idea of sun protection factor (SPF) in 1962—but that doesn’t mean it’s not a challenge to figure out what to look for in a good one.

It helps to know the science. There are two kinds of sun rays: ultraviolet B (UVB) and A (UVA). UVB rays are the ones we associate with sun exposure, since they penetrate the skin surface and cause suntans and sunburns. These rays cause the most damage midday and during the summer. UVA rays were once thought to be safe, but now researchers know that they penetrate deeper layers of skin and contribute to fine lines and wrinkles. UVA rays are potent all year-round, in any weather—and are not filtered by window glass, so even if you’re working in an office with a window, you’re still being exposed.

Wall tells her patients to look for three things in a sunscreen: an SPF rating of 30 or higher (the higher the SPF, the more protection sunscreen offers against UVB rays); the words, “broad spectrum” on the label, because that means it has UVA protection; and water resistance for at least 80 minutes.

“There are only a few active ingredients in sunscreens that provide broad spectrum UVA coverage,” Wall says. “So when you’re choosing a sunscreen, look for one with one of these ingredients: Parsol 1789, Helioplex, Mexoryl, zinc oxide, or titanium dioxide.”

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The years have rolled on and all that hatless frolicking in the sun has taken its toll. What to do now? Of course, the least expensive way to take care of your skin is to cleanse it daily and use a good moisturizer and sunscreen, all of which can be found at your local drugstore. But if you’d like to improve the look and feel of your skin beyond your daily regimen, there are many other options across a range of intensities and cost.

One of the consequences of overexposure to the sun is hyperpigmentation, or sun spots—which aren’t necessarily a health concern, but rather an aesthetic one. These can be lightened, either at home or at a salon, using natural ingredients, says Jeska Manuel, owner of Neptune Skin Care in Oakland.

“I like to use natural skin care products, with ingredients like cojic acid, which is a mushroom-based lightener, as well as licorice and daisy extracts,” she says. “The main advice for making skin tone more even is to exfoliate the skin regularly, which you can do at home with products that have lactic acid, a milk-derived alpha hydroxyl acid, or for less sensitive skin, products with retinols. And anything with antioxidants packed into it will help.”

Ani Tajirian, a dermatologist who practices in Oakland and Lafayette, suggests hydroquinone, a prescription bleaching agent, to deal with sun spots.

“It may take longer than more intense treatments to see results, but hydroquinone is not invasive,” she says. “There’s less redness and peeling.”

Beyond creams and unguents, chemical peels go a long way toward rejuvenating the skin, Manuel says, and can be done at various depths. She offers light, mid-depth, and deep peels; as the intensity increases so does the recovery period (that is, the peeling your skin does to slough off the dead cells)—although peels don’t necessarily keep a person from their daily activities. Prices for chemical peels range from about $85 to $200.

“Peels can treat a number of issues at once,” Manuel says. “They encourage cell regeneration, which improves skin tone and texture.”

What about other cosmetic solutions to skin problems? Treatments have evolved from the face-lifts of old—although surgery is certainly still an option—to less invasive solutions that produce a natural look, such as laser treatments or microdermabrasion.

“Lasers do a lot to rejuvenate the skin,” Wall says. “They get your body’s own repair mechanisms going, tricking it into responding as if there’s low-level damage to the skin and therefore making new cells, new collagen.”

Laser treatments (also known as laser resurfacing, lasabrasion, or laser peels) use light to eliminate flaws but leave normal skin structures alone. Practitioners can target the entire skin surface, particular areas, or blood vessels. There are two types of lasers: carbon dioxide and erbium; the former has been used for years, but recovery from the procedure can take longer, while erbium laser resurfacing causes fewer side effects such as swelling, bruising, or redness, and may work better for those with darker skin. A laser treatment takes from 30 to 60 minutes, costs between $400 and $2,000, and depending on what is being treated, can require downtime of up to a week.

Of course, it’s important to protect your investment after the procedure by minimizing sun exposure.

“The longevity of your laser treatment depends on what you do afterwards,” Wall says. “If you’re a golfer or a gardener and you don’t want to cut back your time in the sun, you’ll probably be back in a year or two. But then there are those folks who don’t need another treatment for 10 years, because they stay out of the sun.”

Microdermabrasion uses microparticles to slough off the top layer of the skin and stimulate new skin growth, particularly collagen; it’s used to treat light scarring, uneven skin tone, and sun damage. Treatments last about 30 minutes, but there is o recovery period.

What about fillers? Consider treatments like Botox, a toxin that temporarily paralyzes facial muscles so that they lose their “wrinkle memory,” or products such as Juvéderm, which is hyaluronic acid, a substance found in the skin, muscles, and tendons.

“Botox fills lines that are in motion, like the frown lines between your eyebrows,” Tajirian says. “Other fillers like Juvéderm or Restylane fill lines at rest, like the smile lines around your mouth.”

A Botox treatment lasts about three to four months and costs from $200 to $500 (charged by the unit, usually about $10 to $20; a frown line treatment might take 20 units), while a Juvéderm treatment costs between $300 and $600 (charged by the syringe). In addition to laser therapy and fillers, Tajirian offers a radio frequency treatment called Thermage that helps improve the appearance of sagging or loose skin. Thermage is considered a nonsurgical face-lift and on average costs about $2,000.

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Cosmetic treatments aside, it’s crucial to see a dermatologist regularly as you grow older, Tajirian says. A doctor can find pre-cancerous lesions called actinic keratosis, which, if left untreated, may become skin cancer. A doctor can also identify basal cell carcinomas (small, pearly bumps that are more common among people with lighter skin) or squamous cell carcinomas (characterized by red, scaly patches) before they become malignant.

“Patients come in concerned about one particular spot, but while I’m doing a full body check I’ll find other areas of concern they haven’t noticed,” Tajirian says. “It’s good to have a full dermatological checkup at least once a year after the age of 30.”

Treatments for these skin cancers include freezing lesions off with liquid nitrogen, topical chemotherapeutic creams, photodynamic therapy—which combines a drug called a photosensitizing agent with light—or Mohs surgery (also known as chemosurgery). During a Mohs surgical procedure, the physician removes suspicious tissue, examines it for cancer cells and checks the lesion margins while the patient waits, and then, if necessary, removes more tissue so that the margins of the lesion are clear. “Unfortunately, people with a history of sunburns are at increased risk of skin cancer,” Tajirian says. “But the good news is that there are lots of treatments available, especially if we catch it early.”

Legend has it that Cleopatra’s skin care regimen included bathing in donkey milk and honey. Nowadays, we get the best of both worlds with skin care: the ancient secrets plus modern medicine. Natural treatments are available—no donkey required—but if your skin needs more than milk, there are plenty of options. Just don’t neglect it. Because as it turns out, beautiful skin is more than skin deep.

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Kate Madden Yee is an Oakland-based freelance writer.

Faces of the East Bay