Healthy skin starts at a young age

February 20, 2018 by Shari Twigg, MD
Healthy skin starts at a young age
The skin is the largest organ of the body and makes up about 18% of a person’s body weight, yet many really don’t take care of their skin.  The skin can help to reveal health and disease in a person.  The skin functions in many different facets for example:  temperature regulation, Vitamin D production, protection agents from the environment, energy storage, sensation, and immune responses.  As we age, the skin does undergo numerous changes that are naturally occurring, but others can change due to illness, environmental exposures, trauma, and premature aging.

Several factors can lead to deterioration of the skin that can be controlled, while other factors are not controllable, at least looking at our present knowledge.  Skin health can be restored and maintained by targeting the different layers and cells of the skin.

There are several layers and components of the skin and it is broken into three horizontal layers:  the epidermis, dermis, and subcutaneous layer.   Appendages that insert into these layers include hair follicles, sweat glands, and sebaceous (oil) glands.  Starting with the epidermis, the thinnest most outer layer, it functions as a barrier between the rest of the body and environment.  It keeps water balance correct, keeps out bacteria, toxins, helps protect against UV light, and protects against allergens. The dermis lies just beneath the epidermis and is rich in collagen fibers, elastic fibers, ground substance, as well as a rich supply of blood vessels and nerves. The deepest layer of skin is the subcutaneous tissue composed of primarily fatty tissue.

In the epidermis, there are 4 types of cells.   Keratinocytes make up the majority of these cells and originate in the lowest layer and gradually move up forming a dry surface layer.  These cells continue to loosen from each other and then detach taking about 30-40 days to complete this cycle.  Restoration of a healthy epidermis through skin conditioning takes 6 weeks of skin conditioning just to complete one cycle and often more than one cycle is required to treat some patients.

In addition to keratinocytes, another important cell in the epidermis is the melanocyte, aka pigment producing cell.  Every person’s skin has approximately the same number of melanocytes no matter the skin color, it’s the amount of pigment each of these cells produce, size of the pigment granules and proximity to one another that account for skin coloration.    The main function of melanin (the pigment) is to protect DNA from UV light damage.  In darker skin, more UV light exposure leads to tanning, while in more fair skin it often leads to freckles and uneven skin tone.   The type of melanin differs in darker skin and lighter skin.  Darker skin melanin protects better than the lighter skin melanin which is unstable and provides little protection to natural UV light, causing more DNA damage.  Other factors that cause skin darkening besides UV light are hormonal stimulants.

Moving to the dermis, the layer directly below the epidermis, we see that it is a layer of connective tissues made of a matrix held together by primarily collagen fibers and a small amount of elastin.  It gives the epidermis support and provides nutrition and removal of wastes.  It is constantly repairing damaged collagen and elastin.  It has a very rich blood supply.  As the skin ages, the collagen fibers become less alike and the dermis becomes thinner.  This also happens in skin exposed to sunlight, but typically has more severe changes than normally aged skin.  Elastin fibers are also very important to maintain the integrity of the skin, as with gaining and skin damage creates damage to these with a slow turnover rate.  The loss of these healthy elastin fibers creates wrinkling, looseness, and sagging in the skin.

One additional very important proportion of the dermis is the extracellular matrix.  This is what the collagen and elastin fibers are embedded in.  You may have heard of hyaluronic acid, as it is in many skin products.  What makes this so great is that the dermal matrix is composed of two major glycosaminoglycans (I know, who needs to really know that big word).  One of them is hyaluronic acid and it can bind to 1000 times their own weight in water, providing important hydration to the skin.  As we age, the hyaluronic acid diminishes which may explain the reduction of skin turgor that is seen.  There are many additional cells in the dermis as well as blood vessels, nerves, and appendages like hair follicles.

The subcutaneous layer is composed of fatty tissue and helps provide a cushion against trauma as well as giving skin its full appearance.  Skin with abundant subcutaneous tissue heals better with less scarring.

Another major component notes in the skin are sebaceous glands.  These are present on all of the body except the palms and soles.  Sebum, the oily substance these glands secrete help to keep the skin at a slightly acidic pH, provides lubrication and thus protects the hair and skin.  The amount of sebum produced does not affect how the skin ages, which involves changes in collagen and elastin.   There are problems that can occur in the sebaceous gland such as acne, but I won’t get into that in this discussion.

What does healthy skin look like?  Check out a 1 year old’s skin.  It is smooth, has even coloration, and is firm and tight.  It is well hydrated with fullness and free of underlying disease.  Yes, I know most of us aren’t going to have skin this great forever, but this is skin health at its best and easy to visualize.  When you look in the mirror what do you see?  Look at the areas on your skin that never get exposed to the sun verses the face, chest, back and arms.  How much of a difference is there?  It’s probably quite striking the difference in the skin from these places to the skin that has had little to no sun exposure.

Now, how do we start to make the skin healthy and younger appearing again?  First is preparing the skin to normalize it.  This involves proper cleansing, exfoliation, oil and sebum control, moisturizing, and, of utmost importance, UV light protection daily.  Not all products are created equal, so beware.  In addition, I know all the rage is “natural”, but if these don’t do their job (not saying it necessarily won’t), then there’s no sense in using them.

To prepare the skin for accepting changes and good penetration of products, it is essential to cleanse skin properly with a great cleanser.  This should be done twice each time to remove surface oils, makeup, residual dust and debris, then to fully cleanse the surface of the skin.

Exfoliation can be done both mechanically such as with a good scrub that doesn’t scratch the skin as well as with products such as alpha hydroxy and beta hydroxy acids or other products.   Exfoliating regularly help remove the dry flaking cells at the surface of the skin, it stimulates cell renewal, stimulates circulation, eliminates microcomedones (the early black or whiteheads or plugs in the skin), and helps prepare skin to accept topical products better.

Once this is done, serums or other medications that are geared to act directly on the cells are easier to get to their target to correct and stabilize the skin, and hopefully start the process of a healthier, younger-appearing skin.  These treatments may be targeted to treat irregular pigment, stimulate collagen and elastin production and repair to reduce the signs of aging, correct acne, reduce scarring, as well as many other functions.

Once treatment products or medications are placed on the skin, hydration and “sealing” the skin off from outside influences is accomplished through various moisturizing agents. These are to reestablish the barrier and provide essential moisture to the surface of the skin.

Last, but certainly not least is ultraviolet light protection.   This is incredibly important to maintain a healthy and young appearing skin.  This is done through the use of broad-spectrum sunscreens (at least SPF 30 or greater and I prefer mineral-based sunscreen/sunblock), applying an adequate amount, as well as reapplication.  In addition, physical barriers to UV light are essential, as no sunscreen will protect fully.  This includes the use of a wide-brimmed hat and other protective clothing.  Sorry girls, but the ball cap doesn’t cut it.  Get a pretty hat with a string to tightly secure it to your head, or you will be chasing it across your yard.  The most intense UV light penetrates from 10 am – 2 pm, so try to do activities outside of these times, but still use sunscreen and protective clothing.  Don’t forget to protect the eyes with UV protected sunglasses.

I know this is a long topic, but it is important to know why the skin changes over time due to various reasons as well as what general skincare can do to help re-establish healthy skin.  None of us want to look like shoe leather when we are 60.