Want Healthy Skin? A Top Dermatologist Shares Her Secrets

Ultraviolet rays, which can penetrate and damage skin, are abundant year round. Get a dermatologist’s skinny on sun safety, skin cancer and ways to help skin stay healthy and youthful... “When it comes to our skin, women want a glowing complexion free of acne, rashes and blemishes, “ says Diane Berson, M.D., a New York City-based dermatologist and assistant clinical professor of dermatology at Cornell University’s Weill Medical College. “We also want to erase laugh lines, crow’s feet and unsightly wrinkles – and, of course, avoid skin cancer.” Berson, president-elect of the Women’s Dermatologic Society, shares tips on looking younger, the best sunscreens and more. Everyone knows about the dangers of skin cancer and tanning. Why is it such a major health problem among women? People still think they look better with a little glow and tan. A lot of melanoma in young women is related to the use of tanning parlors. Studies now show that [it] has become an addiction. More people are using [them] because they think they’re getting a safe tan. Is there such a thing as a “safe tan”? No! The rays that cause a tan – ultraviolet A (UVA) rays – also cause damage that can lead to aging and cancer. How do UVA rays harm the skin? UVA tanning damages the dermis, the thick layer of living tissue below the epidermis, the skin’s outer layer. The dermis contains blood capillaries, nerve endings, sweat glands, hair follicles and other structures. UVA rays penetrate more deeply into the dermis than UVB rays, and they damage the collagen and elastin [a protein found in the skin which helps keep skin flexible]. That destroys the skin’s support structure and leads to premature aging and wrinkles. UVA rays also contribute to [suppressing the immune system], so the skin is less able to fight infection, which may also lead to skin cancer. That’s why it’s critical to look for broad-spectrum protection [that] blocks UVA and UVB rays. How safe and effective are broad-spectrum products? The safety of sunscreen has improved significantly in recent years, thanks in part to stabilizers that have made [them better] at blocking UVA and UVB rays. [But] the problem has been that the Food and Drug Administration (FDA) doesn’t regulate UVA testing and labeling of sunscreen products. The agency relies on sunscreen makers to test their products for UVA protection if they make broad-spectrum claims on their labels. As a result, companies can claim their product provides UVA protection when, in fact, it may not. That should change once the FDA releases data that will define what a sun block is and rate both UVA and UVB protection. Four stars will indicate the highest amount of protection, while one star will mean the product is low on protection. Until then, how do you know which are best? Know the ingredients that provide UVA protection. These include [chemicals like] oxybenzone, avobenzone (Parsol 1789), titanium dioxide and zinc oxide. You also need to look for photostabilizers in sunscreens with avobenzone. The trouble with avobenzone is that it degrades in light. So when you go in the sun, you can lose some protectiveness, depending on how [long] you’re [outside]. That’s why many products need photostabilizers, such as Helioplex or Mexoryl (ecamsule) – chemicals that help avobenzone maintain its effectiveness in sunlight. Ecamsule also absorbs UVA rays. Is there any truth to rumors that chemical sunscreens cause cancer? Some believe some [ingredients] cause cancer. But, as far we know, there hasn’t been a lot of scientific study of those claims. Some sunscreens have titanium dioxide and zinc oxide. What’s the difference between these and oxybenzone and avobenzone? Titanium dioxide and zinc oxide [physically] block the sun’s rays. Avobenzone and oxybenzone are chemicals that absorb the rays and prevent them from damaging the skin. Titanium dioxide and zinc oxide are the white, opaque products you used to see on lifeguards’ noses. But the newer [physical sunscreens] aren’t as thick and pasty as they used to be. What about these new oral sunscreen supplements? Do they work? There’s evidence that taking an oral product provides some sun protection. But at this point, we don’t recommend replacing topical sunscreens with them. What are the best anti-aging techniques and ingredients? The only topical FDA-approved anti-aging medication is tretinoin, the active ingredient in Retina A and Renova, and tazarotene, which is sold as Tazorac. These are the only FDA-approved wrinkle creams. Other treatments include light chemical peels, laser and light treatments, injectible fillers, neurotoxins such as Botox and Dysport, and surgical treatments. All these can improve the appearance of aging skin. The key is, don’t do anything harsh or abrupt. We have creams and protection agents that will gradually and subtly improve appearance. It’s like a good diet: Lose it slowly and gradually, and you’ll look better. Do drugstore beauty products really work? Patients who use these products look better and [see] slight improvements in the skin’s appearance. But very often it’s the emollient effect; two weeks later they look better because they’ve used a [product that soothes and moisturizes]. We can’t say the [improvement] is due to the active ingredients. Dermatologists want more evidence-based trials showing us what these products do. We’re hoping the FDA will impose stricter oversight of these products. The FDA doesn’t regulate beauty products? Cosmeceuticals – products you see in drugstores labeled as “anti-aging” – aren’t makeup or a pharmaceutical, so the FDA doesn’t regulate them. They typically claim you’ll look better and get rid of lines and wrinkles. Trouble is there aren’t many clinical trials with a randomized placebo control. Right now, they’re simply not required to go through that process. Which cosmeceutical ingredients make anti-aging claims? There are several kinds, including antioxidants, polyphenols, peptides and growth factors. Antioxidants claim to counteract free-radical damage caused by the sun, and include vitamins A, B (niacin), C, D and E. Only vitamin A (retinol) has been approved as an anti-aging agent. Polyphenols include green tea, soy and grapeseed extract, and they’re supposed to counter the effects of oxidative damage too. They’re also classified as anti-carcinogenic and anti-inflammatory. There are also peptides, which are supposed to stimulate collagen production to repair sun damage, and a new category called growth factors, which take human growth factor or placental growth factor and use them to stimulate [new cell production]. Very popular in recent years are anti-inflammatory products, which are botanicals such as licorice, oatmeal and mushrooms; and polyphenols such as green tea, soy, grape seed extract, pine bark, aloe, and chamomile. These are for people with redness, sensitive skin, rosacea or sun damage. But we really don’t have great products for redness. Besides treatments, how can women prevent wrinkles? The most important things are: Avoid the sun, wear daily sun protection and avoid cigarette smoking. And if you get sunlight and smoke, that's a double whammy. You get even more damage.