Clinical Skin Care
 Is there true magic in the bottle? Dr. Sommerville believes that of all the antiaging topicals currently on the market, the two most studied and proven topical rejuvenation therapies are retinoids and hydroxy acids.
Retinoids are synthetic derivatives of Vitamin A shown to improve wrinkles, decrease skin roughness and hyperpigmentation. They include tretinoin, tazarotene and retinaldehyde. Tretinoin was approved by the US Food and Drug Administration (FDA) in 1971 for the treatment of acne. Soon thereafter it started being used off-label for photoaging (aging of the skin related to sun exposure). In 2003, an emollient-based retinoic acid cream was specifically approved for the treatment of sun damaged skin. Other formulations approved for this indication currently include tazarotene 0.1% cream, and tretinoin 0.02% emollient cream. The efficacy of these products is supported by the results of multiple, high quality studies. Therefore retinoids are the foundation of an aggressive antiaging topical skin care routine and the irritation that accompanies their use early in the treatment may be minimized or nearly eliminated with proper medical advice and the use of supporting products.
Hydroxy acids which naturally occur in fruit and dairy products appear to help normalize disordered, hyperkeratinized, rough skin, producing exfoliation and reducing mottled hyperpigmentation. By promoting collagen synthesis they may also reduce sallowness and fine wrinkles. Their examples include glycolic acid, salicylic acid and lactic acid.
Antioxidants such as vitamin C, vitamin E, green tea, and ferulic acid compounded into the skin care products offer skin protection form ultraviolet rays. Vitamin C is also a promoter of collagen synthesis. Vitamin C levels in the skin decrease with advancing age and with ultraviolet exposure. Achieving adequate levels with oral supplements is limited by active transport capacity to the skin. Vitamin C levels in the skin can be enhanced with well formulated topical preparations.
Another antioxidant, ferulic acid, common in the plant world, has also shown anticarcinogenic properties. Lipoic acid and coenzyme Q10 or idebenone have shown efficacy in reducing photodamage.
Niacinamide (vitamin B3) has demonstrated ability to improve fine lines, hyperpigmented areas, red blotchiness, and skin sallowness. Its sun protective effect is mediated by enhancing DNA repair.
Skin lightening agents include hydroquinone, arbutin, kojic acid, azelaic acid and glabridin.
The newest additions to the ever growing anti-aging skin care repertoire are growth factors and peptides. Growth factors regulate wound healing. We now know that repair of sun damaged skin requires tissue remodeling similar to that occurring in a chronic wound. Peptides are involved in production of new collagen and elastin.
Sun protection is at the core of any well thought out skin care regimen. Historically, the focus has been on the ultraviolet B (UVB) portion of the solar spectrum (the sunburn spectrum) and sunscreens were originally developed to provide protection against the redness and inflammation which arise from UVB exposure. Growing body of evidence indicates that it is ultraviolet A (UVA) portion of the solar spectrum that is a primary factor in photoaging and major contributor to immunosuppression and sun related carcinogenesis. The difficulty is that UVA absorbers in sunscreens tend to be unstable. Fortunately, the newer compounds Mexoryl and Helioplex have overcome this obstacle.
Which Sunscreen to choose and which to avoid
Which sunscreens to choose
According to the American Academy of Dermatology, an optimal sunscreen must have an SPF rating of at least 30. It also must have the words “broad spectrum” (UVA + UVB protection) on the label. If used while swimming, it is preferred that the sunscreen is labeled as “water-resistant for 80 minutes.” Since one in five Americans is destined to develop a skin cancer within his or her lifetime, the need to determine the optimal, non-toxic, and the most cosmetically-elegant sunscreen has never been more pressing.
Which sunscreens to potentially avoid
A recent study indicated that spray sunscreen is the most common type of sunscreen delivery used in children. Although no proof exists, the Environmental Working Group (EWG) recently warned against spray or powder-based sunscreens since these formulations can fill the air and be inhaled potentially causing lung inflammation and contributing to carcinogenesis. EWG also warns about certain sunscreen ingredients such as oxybenzone which is linked to hormone disruption and allergic reactions. Instead, EWG recommends choosing sunscreens containing zinc oxide, titanium dioxide, avobenzone, or Mexoryl.
How to correctly apply sunscreen
For adequate protection, sunscreens are best applied 15 minutes before going outside, and re-applied every two hours when outdoors. The recommended amount of sunscreen is one ounce for the entire body, or enough to fill a shot glass, however research demonstrates that most people only apply 25 to 50 percent of the recommended amount and do not re-apply often enough. Since most sunscreen containers have 4 to 6 ounces of product, if applied and re-applied correctly, an adult spending a day on the beach could easily go through a 4 ounce container of sunscreen in just one day!
Which sunscreens can claim to be most “cosmetically-elegant” and have most anti-aging benefits
Sunscreen formulations have moved beyond simple sun protection into the realm of skin repair. The most comprehensive sunscreen formulas such as Revision Skincare Intellishade SPF 45 contain antioxidants guarding against free radicals; botanical anti-inflammatory ingredients like green tea extract, or aloe leaf juice; and collagen-stimulating peptides. These innovative products incorporate mineral, physical sunscreen ingredients like micronized zinc oxide and titanium dioxide. In clinical studies, these mineral sunscreen ingredients show a dose-dependent degree of protection against DNA damage which is the initiating factor of skin cancer formation. Despite delivering SPF of 30 or above, these formulas are “cosmetically-elegant” and do not have the sticky, greasy feel, or white residue. Other examples of high quality, paraben-free anti-aging sunscreens include Obagi Nu-derm Sun Shield SPF 50, Innovative Skincare Extreme Protect SPF 30, and Avene Tinted Compact SPF 50. We are pleased to offer these sunscreens along with other carefully selected products at our Chevy Chase office. Please call us at (301) 656-SKIN to discuss which product would be most beneficial for your individual skincare needs.
Dr. Sommerville offers in depth skin care consultations and carries only select group of carefully chosen products from some of the most reputable, innovative manufacturers. Her goal is not only to reverse many of the signs of aging but to keep you looking great! Please call today to schedule your skin care consultation and benefit from her expertise.
Click here to read an interview with Dr. Sommerville on Antiaging Skin Care; What’s Hot, What’s New, What’s Proven…
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INTERVIEW WITH DR. SOMMERVILLE ABOUT ANTIAGING SKIN CARE; WHAT’S HOT, WHAT’S NEW, WHAT’S PROVEN…
Q. Define skin aging and the main factors responsible for this process:
Dr. Sommerville: Aging in the skin is divided into two biologically independent processes, intrinsic aging and extrinsic, externally-determined aging. Intrinsic aging is a natural process that occurs from slow but progressive and irreversible tissue degeneration. It is based on unique genetic and hormonal factors, and it affects everyone at different rates. Intrinsic aging results in decreased collagen synthesis, destruction of elastic fibers, and loss of hydration leading to fine wrinkling of the skin, loss of skin tone, skin laxity, and loss of underlying fat.
Extrinsic aging is caused by exposure to external factors such as the sun, cigarette smoking, and other environmental factors such as cold, heat, dust, smog, and air pollution. Lifestyle choices including diet, exercise, sleep habits, stress, and diseases also impact aging. Extrinsic aging results in coarse wrinkling and furrowing, excessive and uneven pigmentation, dark spots, superficial blood vessels, precancerous conditions, and skin cancers. Of all extrinsic (external) causes, ultraviolet (UV) radiation from sunlight has the most negative effects on the skin.
Q. Since we do not have control over our genes, what percentage of aging-related changes is related to external factors? What has the most harmful effect on the skin?
Dr. Sommerville: This is an excellent question. Up to 40% of aging-related changes in the skin are estimated to be the result of extrinsic aging. It is the sun damage (ultraviolet radiation) that plays the most important role in this process. This is why extrinsic aging is often referred to as photoaging.
Q. How do hormones affect skin aging?
Dr. Sommerville: Collagen is a major component of the human skin, constituting about 90% of total dermal volume. A glaring example of hormonal effect on the skin is the fact that 30% of collagen is lost in the first five years post-menopause, resulting in significant decrease in skin thickness and wrinkle formation. Estrogen supplementation in postmenopausal women leads to the increase of skin thickness and collagen content which results in diminished wrinkling, increased elasticity, and increased hydration.
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