Over the past several months we have reviewed the mechanism of action and the medically proven benefits of the major therapeutic ingredients common to most modern skin care regimens. In this final article in the series, we will review some of the high points and try to tie them all together so that you can develop a game plan not only to enhance the appearance of your skin, but to preserve a youthful look well into the future.

Prevention. The single best thing you can do to preserve a youthful complexion is to avoid excessive sun exposure. Sun exposure accelerates aging changes in the skin. "Photoaging" is the medical term for sun damage over time.

Excessive sun exposure does several bad things to skin.

Microscopically, this is manifested by damaged elastic fibers in the dermis and an overall decrease in collagen. Externally, photoaging is characterized by age spots, coarseness, wrinkling and laxity of the skin. Sun damaged skin bruises easily and often has small visible spider veins. In the public's eye, sun damaged skin is synonymous with old looking skin. So if you want to look old before your time, bake in the sun, and in the off season visit tanning salons frequently.

Tanning is our skin's natural protective response to sun exposure. Sunlight increases the amount of melanin in the skin, and this pigment absorbs light energy and helps prevent sun damage over the short term. Years of sun exposure can overcome this protective barrier, however, leading to the skin changes outlined above.

Sunscreens help reinforce our natural defenses by reducing the deleterious effects of sunlight through absorption or reflection of ultraviolet rays. Sunscreens are either physical reflectors, such as zinc oxide, or chemical absorbers like PABA or other clear compounds. There is no firm scientific evidence to support the use of any sunscreen with an SPF greater than 30. But in my opinion, if a little sun protection is good, more is better. A variety of well tolerated sun screens, including an SPF 20 clear zinc oxide, are available at Dermatique.

Many of the aging changes in our skin may be due to "oxidative stress", a term used to describe damage to our tissues caused by the over production of free radicals - toxic byproducts of oxygen metabolism. In the skin, unchecked free radical production can degrade collagen, destroy elastic tissue and reprogram DNA. Over time, this damage may result in aging, wrinkles and skin cancer.

Fortunately, our cells also produce antioxidants - the body's defense mechanism against free radical damage and oxidative stress. Antioxidants scavenge and neutralize injurious free radicals, and as such are natural candidates in the search for substances that will help prevent cancer and retard the aging process. Many well known antioxidants such as vitamins C and E and beta-carotene are supplied by diet, others are produced by the body.

Maintaining a high level of antioxidants in your skin may help to retard or even prevent some of the typical outward signs of aging. Topical use of specially formulated antioxidants such as Skinceuticals Serum - C and Vitamin C and E Osmogen Patches by Glyderm can deliver the free radical fighting effects of these compounds directly into the skin. One of the newest topical antioxidants to arrive on the scene is pyncnogenol, one of a family of compounds known as proanthocyanidins. These substances are found in many plants and are felt to be significantly more powerful than both Vitamin C and Vitamin E. Theraderm RS-OPC Reparative Gel by Therapon, is a moisturizer that utilizes proanthocyanidins, vitamin E and other natural ingredients in a elegant product that is a useful addition to any skin care regimen. This select group of excellent antioxidant products is available at Dermatique.

In summary, a good diet, judicious sun avoidance, and the regular use of appropriately formulated topical antioxidants and sunscreens are the most effective preventive measures you can use to maintain smooth, healthy skin. Of course, good genes don't hurt.

Correction . Among the major topical ingredients with proven corrective effects on the skin are the retinoids, bleaching agents, alpha hydroxy acids and antioxidants.

Retin-A (tretinoin) belongs to a group of compounds called retinoids. These are Vitamin A derivatives that have been used to treat a variety of skin conditions since the early 1960's. In recent years, researchers have shown that Retin-A is beneficial in reversing some of the skin changes associated with the aging process.

As we age, our skin becomes thinner, less elastic and contains less collagen than it did in our youth. Aged skin also contains less water, making moisturizers more important. The end result of these microscopic changes is skin laxity and wrinkling.

Fortunately, Retin-A helps to reverse some of the skin changes associated with the aging process. Studies on Retin-A from around the world have shown that it not only exfoliates, but it also increases blood flow to the dermis, increases the amount of collagen in the dermis and eventually leads to improved skin elasticity (i.e., tighter skin). Abnormal cells and pre-malignant skin lesions are also improved.

The most common side effect of Retin-A is the so called "retinoid skin reaction", characterized by redness, peeling, itching and a sensation similar to sunburn. Sun sensitivity is increased, so sunscreen is mandatory. After several weeks the reaction subsides and you begin to enjoy the benefits of younger looking skin.

Retin-A comes in three strengths: 0.025% (weakest), 0.05%, and 0.1%. Renova is 0.05% Retin-A in a heavy oil base. Treatment approaches range from conservative to aggressive depending on the concentration of Retin-A and the frequency of application. The higher the concentration and the more frequent the application, the more intense the reaction phase but the sooner the irtritation will subside. Rarely, patients find the reaction phase intolerable and have to decrease the dose of Retin-A, temporarily add a steroid cream, or stop treatment altogether.

Most authorities now believe that the benefits of Retin-A are dose dependent and recommend using the highest concentration the patient will tolerate. Night application is recommended to avoid degradation of tretinoin by light and possible inactivation by concomitant use of sunscreens and cosmetics.

At Dermatique, rather than worry about compatibility problems between products from different sources, we use the Obagi Nu-Derm program. This is a comprehensive skin health and maintenance program with Retin-A as its cornerstone. All of the products are built around the same neutral base so they can be used together in any combination without one cream decreasing the effectiveness of another.

The Nu-Derm program allows for individual variability with regard to the dose of Retin-A and the number and concentration of adjunctive products utilized, depending upon patient needs, skin tolerance, etc. Patients must be willing to learn about the products and take an active role in the day to day "fine tuning" of their skin care routine. Of course, the entire staff at Dermatique uses the Obagi Nu-Derm program, and they are always available for questions, one-on-one consultation or hand holding during the initial reaction phase.

Patients who are unwilling to go through the reaction phase of Retin-A, and who demand more immediate results, may be better off starting with a regimen based on fruit acids. Fruit acids, also known as alpha hydroxy acids (AHAs), have been around for centuries but have only recently been rediscovered. AHAs produce significant smoothing of the skin by loosening the bonds between dead cells on the skin surface. Depending on the concentration of the acid, its pH and several other factors, this loosening results in either accelerated exfoliation or a superficial "peel". Decreased cohesion between skin cells not only results in accelerated exfoliation, but in a more uniform exfoliation than occurs naturally, which results in the smoothing effect mentioned above. Moreover, accelerated exfoliation stimulates new cell growth, and this increased "cell turnover" gives skin a fresher, younger look.

AHAs have been shown to increase the skin's water content, to increase the production of collagen and to increase the number and quality of the elastic fibers in the dermis. The numerous beneficial effects of the AHAs work in concert to help restore a youthful glow.

There are numerous products on the market that employ a variety of different fruit acids. At Dermatique, we have used the Glyderm line of glycolic acid products as our preferred AHA program because it is simple, it is well tolerated by patients and it works. We offer pH adjusted home products with lower acid concentrations for sensitive skin and higher concentrations for more tolerant skin. The products come in either an emollient lotion for dry/intermediate skin, or an alcohol based solution for oily skin. The Glyderm program also includes six superficial office peels, with the strength increasing weekly in step wise fashion to insure safety and patient comfort. Over the past three years, we have performed hundreds of Glyderm peels with no significant complications and only occasional patchy redness that has resolved in 24 - 72 hrs.in every case. Patients report smoother skin, a subtle diminution of fine wrinkles and a pleasing "glow". They wear less make-up and what they do wear goes on more smoothly.

Retin-A, alpha-hydroxy acids and the topical antioxidants mentioned in the previous section, all have proven corrective effects on aging or sun-damaged skin. At Dermatique, we will be happy to explain each of these programs in detail and help you decide which combination of products is right for you.

Maintenance. Maintaining the improvement obtained through your skin care regimen involves all of the products and concepts mentioned above. A good diet, exercise and adequate rest are the foundation. Sun protection is essential. If you smoke, quit. Topical antioxidants play an important role. Retin-A, in a lower concentration and with less frequent application than during correction, is probably the key ingredient. Skin maintenance is an ongoing process. Flexibility and patience are required to fine tune your individual routine.

It is important for women to understand the difference between medically proven, corrective skin care treatments like Glyderm and Nu-Derm, which improve skin quality in measurable ways, and treatments which are largely fluff, relying on textures, fragrances and atmosphere that produce no significant result. Dim lights, soft music and aromas may make you feel good, but they won't do anything at all for long term skin health and maintenance. If you are serious about skin care, see a plastic surgeon or a dermatologist.

For a free consultation, or to receive a reprint of any of the articles in this skin care series, drop by Dermatique.

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