Healthy Skin Women and Dermatology

Healthy Skin Women and Dermatology
By:Suguru Imaeda, M.D.
Chief of Dermatology, Yale University Health Service

Overview
* Normal structures of the skin
* Changes in the skin over time
* Sun and skin
* Skin cancer
* Maintaining healthy skin
Epidermis
the largest organ
* key role in normal healthy functioning of the body
* Disorders range from those limited to the skin to manifestations in the skin of internal disorders
* plays important role in social and psychosocial functioning of the individual
* undergoes changes with aging and in response to external environmental factors and internal hormonal influences
Gender differences
* Fundamental differences in structure and function of the skin
* Differences impact on presentation of skin disease and its management
* Hormonal influences affect common disorders such as acne, rosacea, lupus erythematosus, psoriasis, lichen planus, anogenital pruritus, hidradenitis suppurativa, and atopic dermatitis
Infancy
Toddler to adolescence
Adolescence
Body piercing
* presents risks for multiple possible complications
* nickel allergy
* secondary infection with staphylococcus or streptococcus
* ear cartilage destruction from pseudomonal infection
* candidal infection of the navel or genitalia
* Keloids
* traumatic tears
Tattoos
* Infection
* Granulomatous reaction
* Photodermatitis
* Difficult to remove
Melasma
* Brown patches on forehead and cheeks
* Very sensitive to sun exposure
* More common in Hispanics, Middle Easterners, and Asians
* Most common cause is oral contraceptive use or pregnancy
Melasma management
* Discontinuation of oral contraceptive
* Avoidance of sun/tanning bed
* Daily application of broad spectrum sunscreen
* 4% hydroquinone or 20% azelaic acid
* ? laser
Intrinsic aging
* Changes of chronologic aging gradually become apparent
* Influenced by genetics, gravity, and hormones
* Clinically, the normal aging process leads to fine wrinkles, dryness, sallow color, thinner skin, laxity and purpura
Aging skin
* Decreased function as environmental barrier, sensory organ and immune organ
* Epidermal and dermal atrophy with loss of appendages
* Decreased sweat production leads to dryness
* Decreased body and scalp hair
* Decreased ovarian estrogen production leads to decreased collagen and increased wrinkling
* Overall thinner, paler, drier, with fine wrinkling and decreased elasticity
Histologically
* dermal thinning
* decreased vascularity
* decreased subcutaneous fat
* reduced cellularity of the dermis
* elastic fiber loss
* dermal thinning
* decreased vascularity
* decreased subcutaneous fat
* reduced cellularity of the dermis
* elastic fiber loss

Environmental factors on skin
* create extrinsic damage
* major effect is from photoaging with wrinkling, laxity (sagging), lentigenes, dyschromia, coarseness, sebaceous hyperplasia, and telangiectasia
* 90% of visible skin changes of aging
* Visible as early as age 20
Smoking
* shown to decrease both hyaluronic acid and glycosaminoglycan synthesis
* causes decreased capillary blood flow in the skin
* changes accelerate wrinkling
The twenties
* Skin is smooth and coloring is even
* Little need for emollients
* Skin care is simple - variety of products are tolerated
* May be persistent acne associated with hormonal activity manifest by flaring during the week prior to the menstrual period.

The thirties
* thinning of the skin beneath the eyes
* skin is less elastic
* Fine wrinkles begin to appear around the mouth and lateral periorbital region
* Increased fat and sluggish blood flow contribute to puffiness and darkening of the skin beneath the eyes
The forties
* More sallow and less supple
* Skin surface not as smooth
* Liver spots, solar lentigenes, appear on areas of chronic low grade sun exposure - face, dorsal hands, back or dorsal feet
* Thin red spider angiomas appear on the legs
* Weight gain leads to sagging skin
* Cellulite appears on thighs and buttocks
* Deep furrows develop on forehead and lateral periorbital areas (crow’s feet)
* Skin becomes drier - sweat glands grow smaller and become less effective
The fifties and sixties
* Wrinkles are deeper - skin begins to sag and droop
* Skin tone is lighter from decreased circulation
* More solar lentigines form
* Collagen and elastin are thinner
* Collagen is estrogen dependent therefore skin is both thinner and drier
* Dryness occurs from thickening of the stratum corneum
* Moisturizers help keep the skin moist and supple
* Alpha hydroxy acid-containing products help by reducing the thickness of the stratum corneum, promoting thickening of the epidermis and dermis, and promoting synthesis of collagen, elastin, protein and glycosaminoglycan
Pregnancy
* rosy complexion - increase in vascular circulation
* hyperpigmentation on the nipples, vulva, anus and inner thighs from hormonal stimulation
* Freckles (ephelids) and birthmarks may also darken
* Melasma, the mask of pregnancy, from hormonal changes, sun exposure and genetic factors
* Skin tags develop on the neck, chest, inframammary area, inner thighs, and face
* Spider angiomas, purpura and capillary hemangiomas
* Stretch marks, striae distensae
* Varicosities and hemorrhoids
Sun protection
* Signs of extrinsic photoaging not intrinsic genetic aging usually prompts the visit to the dermatologist
* Therefore, it is most important to incorporate into the daily routine a sun protection regimen
Tan
* Coco Chanel declares tanning “in” in 1920’s
* Suntan seen as symbol of health, youth, status
* Skin’s reaction to damage from UV radiation
* Melanocytes produce melanin
Indoor tanning
* Increasingly popular, esp among young women in 20’s
* Advertised as safe, “healthy glow”, little risk of skin cancer
* Controlled tanning protects against sunburn by building up melanin
* Vitamin D helps prevent breast, prostate, colon cancer
Dripping faucet
* Your skin = empty glass
* Dripping water = ultraviolet radiation
* Rate of drip = amount of sun exposure
* Rate of evaporation of water = skin’s ability to repair DNA damage caused by UV radiation
* Your glass is full = you’ve reached your limit of sun exposure
* Water starts spilling over the top = getting skin cancers
Ultraviolet radiation
Sun myths
Basal cell carcinoma and Squamous cell carcinoma
Melanoma
IARC (International Agency for Research on Cancer)
Sunless tanning
Tanning pills
Sun Protection Factor
In vitro CT FL
New proposed labeling guidelines for sunscreens
Sunscreen
UV Index
Anti-aging treatments
* Prevention
* Retinoids
* Lasers
* Chemical peels
* Dermabrasion
* Botox
* Fillers
* $35 billion/year industry
Prevention
* Daily use of sunscreen or moisturizer with sunscreen SPF 15+
* Clothing
* Avoiding unnecessary UV exposure
* Avoiding sun exposure between 10a-4p
Retinoids
* Tretinoin and tazarotene
* Vitamin A derivatives
* Even out skin tone
* Rebuild collagen
* Repair minor sun damage
* Inhibit tumor growth
* Decrease inflammation
Lasers
Chemical peels
Dermabrasion
Botox
Fillers
General skin care
Skin Care Tips
* Sun protection
* Hydration
* Healthy diet – fruits, vegetables, fish
* Gentle skin care products – soaps
* Moisturize
* Don’t smoke

Healthy Skin Women and Dermatology.ppt