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Demystifying the effects of aging
Dermatologist explains how skin ages and what can be done about it

by Veronica Sudekum

There is no miracle in a bottle to defeat wrinkling and other signs of aging, Dr. Recia Blumenkranz informed an audience at the Stanford Alumni Center last week.

But if there were, the best candidate would be sunscreen. Two sunscreens, in fact — Neutrogena Helioplex and L'Oreal Anthelios SX with Mexoryl. These products exemplify the type of water-resistant, "broad-spectrum" sunscreen of at least SPF 15 that the dermatologist recommends for skin of all ages to protect against harmful UVA and UVB (ultraviolet) rays.

In a conference room packed with women ranging from their early 20s to their 70s, members of the alumni group Stanford Professional Women, Blumenkranz offered this and other skin-care advice while also debunking myths and misunderstandings associated with skin health and aging.

Sunscreen applied liberally and daily helps prevent skin cancer and facial furrowing, according to Blumenkranz, a youthful-looking adjunct clinical professor at the Stanford School of Medicine. It also can reverse existing damage to the skin caused by prior sun exposure. The only trick to putting on sunscreen is putting on enough — a one-ounce "shot-glass" full of sunscreen every time it is applied, she said.

In addition to several scientific studies suggesting the restorative potential of sunscreen, Blumenkranz cited her own clinical experience, particularly in treating whitish, sun-damaged skin on patients' lower lips.

"I've seen that [skin irregularity] in six months reversed with scrupulous use of lip balm with sunscreen in it," she said.

Sunscreen helps protect against the most common types of skin cancers: basal and squamous-cell carcinomas. Both are linked to exposure to UV radiation. Regular sunscreen use also diminishes an individual's risk for melanoma, a rarer type of cancer responsible for the majority of skin-cancer deaths.

In addition to protecting against skin cancer, sunscreen diminishes the likelihood of aging phenomena caused by sun exposure — blotchiness, pre-skin cancers, thin and cracked skin and some types of hyperpigmentation, such as liver spots, Blumenkranz said.

She also addressed the issue of vitamin D, a compound produced by sunlight-exposed skin. Some medical and health-science commentators including the New York Times' Jane Brody have speculated that the vitamin is "poised to become the nutrient of the decade, if a host of recent findings are to be believed."

Yet Blumenkranz insists individuals should not expose unprotected skin to sunlight to acquire more vitamin D.

"Many of us are getting enough even with sunscreen. ... If we need more, we can get the vitamin D other ways" including supplementary and dietary sources, she said.

Topical creams containing compounds related to vitamin A, called retinoids, and skin-whitening agents called hydroquinones can help diminish the appearance of sun-related brown spots on the face and hands, she said.

Blumenkranz distinguished between skin problems caused by UVA and UVB exposure and more "intrinsic" consequences due to aging — the skin's fine wrinkling, thinning and increased transparency, and loss of fat.

Most people can expect certain "birthday presents" as they grow older, Blumenkranz said. These gifts from Mother Nature can include graying hair, thinning nails, skin tags, and growths called seborrheic keratoses and stucco keratoses. Even acne can persist through middle age, which Blumenkranz noted typically responds positively to hormone treatment, antibiotics or topical creams.

Blumenkranz also addressed popular treatments that she says may not have the proven results people assume they do.

She advised those interested in anti-aging procedures to ask their skin-care providers about their professional experience and degrees, the number of times they have completed the procedure of interest and how many patients see improvement.

"Many of these procedures result in minimal improvement," she said, mentioning that for the FDA to approve a new device, the manufacturer does not have to prove its efficacy. Instead, they prove "safety and equivalency to the other products out there, so it is very difficult to know what is worth using."

The use of laser machines is "ahead of where the science is, where our knowledge is," she said, though she acknowledged that pulsed lasers sometimes help reduce the appearance of birth marks, spots or broken blood vessels.

As for "fillers" and other injectibles, Blumenkranz prefers "hyaluronic acid" products like Juvederm and Restylane — these formulations smooth wrinkles for a period of months.

"But there are many other products; that is just my preference," she said.

When buying over-the-counter products and spa therapies, consumers should be wary of well-packaged products and procedures that pack more hype than bite, the doctor warned.

Discussing common beauty recommendations made by spa aestheticians and department-store sales clerks, Blumenkranz called for some "common sense."

"No one needs separate creams for eyes, chest, lips and hands," she said.

Another myth: that monthly facials promote skin health.

"Frankly, I think the worst thing we can do is over-cleanse. We can do more damage by over-washing," Blumenkranz said. "There is nothing wrong with using Dove soap and water" or Cetaphil, an affordable drugstore staple, if one finds these products are not overly drying to the skin.

Toners and exfoliants can be tossed by the wayside; though they can even out skin tone, they are medically unnecessary for skin health, she said.

As moisturizers go, "a plain moisturizer — anything — will do," Blumenkranz said, noting that noncomedogenic products cause fewer black- and whiteheads relative to greasier alternatives and are often sufficiently moisturizing.

"If you wanted to do very little, all you have to do is use sunscreen."

On the whole, Blumenkranz characterized the anti-aging product market as overwhelming, with a vast array of potions and lotions falling far short of being flawless fountains of youth.

Thus, the doctor administered a last dose of common sense: "If a treatment seems too good to be true, it probably is."

Editorial Intern Veronica Sudekum can be contacted at vsudekum@paweekly.com.