Taking Care of your Skin

Fall 2008 CSANews Issue 68  |  Posted date : Sep 19, 2008.Back to list

Taking Care of your Skin

We pay a lot of attention to maintaining good health when it comes to nutrition, heart and lung health, but we often neglect our body's largest organ – which can be the source of many abnormal conditions – our skin. It's true that much of the harm to our skin has been brought on over the years by excessive exposure to the sun's harmful rays, including drying, wrinkling and even skin cancers, but it is not too late for many of us to heed the advice of dermatologists about the ongoing ways to maintain skin health.

Sun and Weather-Related Skin Issues

For years, it has been known that excessive exposure to ultraviolet radiation, the sun or tanning studios is harmful to the skin.  Yet many young adults spend hours in the summer sun, often unprotected by sunscreens. Results of research among young adults and their disregard for skin protection is disheartening, especially as the incidence of skin cancers is rising in Canada in the young, as well as the older population. Promising changes appear to be the case with young parents, however, as research has shown that more than 75% of children are now protected from these harmful rays through the abundant use of sunscreen and protective hats and clothing.

Although sun exposure in moderation can have health benefits because of the stimulation to produce natural vitamin D, you should protect yourself from overexposure, especially when the sun's rays are strongest, between 11 a.m. and 4 p.m., or when the UV index is reported as three or higher. Although snowbirds are able to produce more natural vitamin D than their homebound Canadians, most authorities now recommend that supplemental vitamin D be taken daily. Although just a few years ago the recommended supplement was 400IU, last year, the Canadian Cancer Society recommended that seniors take 1000IU daily in the fall and winter months, as research had shown a significant reduction in the incidence of breast, prostate and bowel cancer while on this regimen.

Choosing the right sunscreen is important as well. Sunscreens are rated with SPF numbers (Sun Protection Factor) from 15 to 70. Using a sunscreen with 30-45 SPF is recommended for most, and those having more sensitive skin or a history of skin cancer should use a block with an SPF of 45-70. Be sure that the product protects against both UVA and UVB rays, and that you reapply after several hours or after swimming.

For those of us who do not reach the sunbelt areas early enough in the winter, we are subject to the risk of "winter itch." Drying of the skin due to the drop in humidity and the dry heat in our homes causes itching and scaling. This is often aggravated by excessive bathing or showering.  This removes the natural oils and waxes from our skin, which are necessary to prevent the skin from drying out. Frequent bathing, showering, scrubbing with a washcloth, using strong and perfumed soaps, bubble baths and strong shampoos should all be avoided. Moisturizing creams are helpful in locking in moisture. For those subject to eczema of the hands, avoid strong soaps and be sure to rinse off all traces of soap and use a moisturizing cream on your hands after washing.

Skin Cancers

Most skin cancers are either squamous cell or basal cell carcinomas. These are found most commonly on the sun-exposed area of the body, but may occur anywhere on the skin or mucous membranes. There are simple, but important measures to detect early skin cancers. Any spot on the skin which is enlarging, becoming irritated, changing in colour or shape suggest skin cancer. Any mole in an area of irritation, such as a bra strap, should be removed. For those areas of the body which you cannot readily see, have your spouse check your skin monthly to see if any mole or new spot looks suspicious.

Your physician should be consulted and, if there is suspicion of a cancer, a biopsy or removal of the growth will be necessary.

The more serious form of skin cancer is malignant melanoma. This life-threatening cancer should be identified as early as possible to reduce the risk of spread. Dermatologists recommend that the best method of remembering the signs and symptoms is using the "ABCDE" rule.
  • Asymmetrical skin lesion
  • Border of the lesion is irregular
  • Colour: melanomas usually have multiple colours
  • Diameter: moles larger than 5 mm are more likely to be melanomas than smaller moles
  • Evolution: the evolution (i.e. change) or "elevation" of a mole may be a hint that the lesion is becoming malignant. 
In the case of melanoma, immediate wide resection of the cancer is still the best treatment available.

A pre-cancerous condition which results from sun-damaged skin and that occurs frequently in the older population is actinic keratosis. This condition most commonly affects the face, scalp, ears, hands and especially the forehead. It is characterized by scaly small patches, initially skin-coloured or brown, becoming pink or reddish as they enlarge. It is estimated that 80% of those with fair skin over the age of 70 will have this condition; it occurs most frequently in men.

In addition to careful skin protection, there are several fairly successful treatments which should be considered. Liquid nitrogen application has been the most common treatment, but a newly approved drug, Aldera, in the form of a skin cream has proven to be quite effective as well. Treatment not only is beneficial from a cosmetic standpoint, it also may reduce the risk of development into skin cancer. Conditions such as rosacea and seborrheic dermatitis are less common and require specific dermatological attention.

Skin Infections

Infections of the skin are always a concern. Although more common in diabetics, those with frail skin, peripheral vascular disease, those taking prednisone or on immunotherapy and having other predisposing conditions, all of us can acquire a skin infection. Most are bacterial, but some are fungal. Initiating incidents can be a cut, a bite, surgery, or any break in the skin allowing for the entrance of an infective agent. The most common bacteria are staphylococcus and streptococcus. We are all familiar with impetigo and boils, but less common infections, such as flesh-eating disease (necrotizing fasciitis) and MRSA (methicillin resistant staphylococcus aureus) are much more serious and require immediate medical or surgical treatment. Good skin hygiene, immediate antiseptic care of cuts or bites and urgent medical attention for suspected infection are appropriate measures to reduce the risk of spread.

A more feared infection commonly seen in seniors is shingles. It is caused by the herpes zoster virus and anyone who had chicken pox as a youngster is susceptible. Approximately 20% of North Americans develop shingles at some point in their lives and most are older than 60. The virus which laid dormant in your system becomes reactivated, causing a painful red rash with blisters along one side of your body or face. Immediate medical attention is indicated, as there is a drug which can help abort a full attack if given early in the disease.

A vaccine against shingles, Zostafax, was approved in the U.S. in 2006 but has not yet received Canadian approval. Costing about $275 U.S., some Canadian snowbirds are purchasing their immunization while away. Most Canadian physicians are more cautious and are advising seniors to await more research into its safety and long-term effectiveness, as well as anticipated release in Canada.

Fungal infections of the skin and nailbeds are also common. These fungi are often normally present on our skin, but cause infection most commonly in immune-compromised individuals, as well as in those who are overweight and have numerous body folds and areas in which there has been some skin damage. These fungi include tinea versicolor, tinea corporus (ringworm), tinea pedis (athlete's foot), monilia and nail infections. Maintaining good hygiene, ontrolling weight, avoiding gardening without gloves and persons with active infection are advised to take preventive measures.

Certain medical conditions require very special attention to skin care. Diabetics are very prone to skin infection, and early and aggressive medical therapy is indicated whether at home or away. Legs and feet are particularly vulnerable. Particular attention to blood-sugar control, weight control, proper skin hygiene, avoiding bumps, bruises, scrapes and tears, as well as swelling are extremely important. Keep your legs elevated when necessary – to prevent edema or swelling – and avoid salt and salty foods. Persons with varicose veins or arterial disease in the legs must take similar precautions. Ulcers, abrasions and infections take much longer to heal and require acute medical management.

Most of us can maintain healthy skin if we follow such advice. We are all vulnerable to normal skin aging and the associated wrinkles, drying skin and cosmetic concerns. Some resort to Botox treatments and even plastic surgery to offset these changes, but most of us can accept this normal evolution, remembering that it's not too late to pay attention to protecting and taking good care of our skin.