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Women and skin conditions - Women's Health Update

Townsend Letter for Doctors and Patients, May, 2003 by Tori Hudson

If you observe a middle-aged woman with great skin, here are the possible beneficial influences: She's lived in a rainy climate her whole life; she grew up in the fog; she protects herself from the sun; she's had good nutrition her whole life; she's never smoked; she has regular sleeping, eating, and exercise habits with good stress reduction skills; she has great skin genes; she has great skin care products; she has a great dermatologist and plastic surgeon; she's taking estrogen; or she's known the particular value of selected nutrients and essential fatty acids for skin health for many years now.

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As women age, our skin changes in obvious ways. This is inevitable. Dryness, wrinkling, bruising, thinning, slow wound healing, aging spots, blotchiness, postmenopausal acne, and even pre-cancerous and cancerous growths are common changes. Other women have ongoing problems related to eczema and psoriasis that is not associated with aging but other factors.

Aging skin is most apparent in smokers and, in fact, smoking increases the number of facial wrinkles by 2-3 times in Caucasian men and women. Stress also sets off a cascade of responses that affect the skin. When under stress, our body sends blood to vital organs rather than to the skin, which can affect our tone and color and reduce the nutrients that the skin receives. Stress and anxiety can also cause chemical changes that trigger or worsen problems we already have with our skin such as acne, hives, eczema and psoriasis. And yes, frowning and worrying as manifested in a tense face will cause permanent wrinkling.

The decrease in collagen that occurs after women reach age 40 affects the elasticity and resiliency of our skin. The primary cause of this decrease in collagen is the drop in circulating estrogen. Women who take estrogen replacement therapy (ERT) can have a significant impact on increasing the concentration of Type III collagen in their skin. The drop in endogenous estrogens associated with menopause lead to an atrophying effect and is a major factor in the aging of skin. As women age, there is a decrease in the epidermis turnover rate which accounts for the doubling of time it might take to heal a wound. With age, the cell cycle slows down and cells cannot slough off quickly enough to make way for the new cells. This is what can cause the skin to become leathery and dull and more prone to the etching of wrinkles.

However, we can protect our skin, improve the health of our skin, slow the aging of our skin, revitalize it, and even cure some common skin diseases. Protective sun clothing and hats plus sunscreen can dramatically reduce the incidence of skin cancer. However, most of us get 50%-80% of our lifetime sun exposure before age 18 and by midlife, much of the damage has already occurred. The lesson here is to start protecting our skin at a much younger age. A product with at least an SPF of 15, providing protection from UVA and UVB rays is adequate. Make-up and lipstick and foundation are not reliable skin protections.

Alpha-hydroxy acids (AHAs) are naturally occurring fruit acids that exfoliate dead cells on the surface and leave behind the smoother, softer skin underneath. AHAs may also slough off age spots and reduce tiny wrinkles. Most dermatologists believe that a 5% acid content is adequate but products range from 0.5% to 15%.

Topical retinoids (vitamin A derivatives, i.e. Retin-A) can improve the texture of the skin and reduce fine lines. Retin-A causes the epidermal cells to slough off so that a smoother texture results.

Estrogen creams can significantly improve the skin's thickness, fine wrinkling, roughness and elasticity. A topical 0.3% estriol cream is a very weak (and safe) estrogen available by prescription. Stronger estrogen creams such as estradiol creams (Estrace) or equine estrogens (Premarin) cream is also available by prescription. As mentioned earlier, Oral ERT can slow skin aging by increasing the concentration of collagen and improving elasticity, thereby slowing aging of the skin and decreasing the onset and severity of wrinkles.

Chemical peels, Botox and collagen injections are more drastic measures mostly for cosmetic reasons and have potential side effects, some of them significant.

There are several key nutritional issues and natural substances that provide protection and treatment for skin problems not the least of which is a fundamentally healthy whole foods diet. Fruits, vegetables, whole grains, nuts, seeds, legumes, a small amount of low fat dairy and fish would be for most individuals, a well rounded optimal diet.

Treatment considerations for eczema and psoriasis include avoiding food allergens and concentrating on good oils. The manipulation of dietary fats is extremely important in the management of both these chronic skin diseases. Our bodies need a healthy ratio of saturated, monounsaturated and polyunsaturated fats. Some polyunsaturated fats are as essential as vitamins and minerals for the maintenance of good health -- these are the essential fatty acids (EFAs), or "good" fats. Skin problems in general, are common in people who do not get enough essential fatty acids or who have an imbalance of EFAs in their diet.

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Women and skin conditions - Women's Health Update

Townsend Letter for Doctors and Patients, May, 2003 by Tori Hudson

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