The Ageing process

Ageing not only affects our physical bodies, but also our psychological state of mind and our quality of life.  For this article we will look at the ageing of our skin. Did you know that there are in fact 2 ageing processes involved in our overall ageing? One which we have no control over, while the other we do have some control over.

1. Intrinsic (internal) ageing: This ageing process is due to the genes we inherit from our parents.
2. Extrinsic (external) ageing: Considering that you have normal healthy genes, Extrinsic ageing is responsible for premature ageing of the skin. This is the ageing that occurs due to environmental factors such as sun exposure, and smoking. Exposure to the sun's Ultraviolet (UV) light accounts for 90% of symptoms of premature ageing.

  

INTRINSIC AGEING:

It is the natural ageing process that all of us go through in our lifetime. Till our early 20's we are in our growth period. Intrinsic ageing begins from our mid 20's at the cellular level though the actual results may only be visible to us years later. The ageing process affects all 3 layers (epidermis, dermis, subcutaneous layer) of the skin. Let's look at what happens to each of them.

Epidermis: This is the top most layer of the skin and it is in this layer that our skins pigment, melanin is produced. With intrinsic ageing these epidermal cells become thinner and less sticky. Thinning of this layer makes the skin look thinner. By becoming less sticky, the effective barrier function of this layer is decreased and is thus not able to effectively retain the water in the skin. This leads to increased TWEL (trans epidermal water loss), which causes dry skin.  Also the surface dead cells do not shed as quickly and the cell turnover may decrease.

Dermis: This is the middle layer of the skin. It is the structural layers of the skin. It is here that structural components such as collagen and elastin are produced. With intrinsic ageing the skin gradually loses its ability to effectively repair itself. Collagen and elastin production decreases, causing skin to lose its structural integrity and elasticity. This leads to wrinkles, loss of elasticity of skin and sagging. Also the number of sweat glands decreases, and the amount of sebum produced is reduced. Both of these factors further contribute to skin dryness.

Subcutaneous layer: The fat cells provide cushioning and insulation. With intrinsic ageing the fat cells shrink, making wrinkles more visible and also causing ‘sinking' of the skin causing hollowed cheeks.

Signs of Intrinsic Ageing:

1. Fine wrinkles
2. Thinning of skin
3. Dry skin and associated itching
4. Loss of underlying fat: hollow cheeks & eye sockets
5. Hair loss and greying
6. Growth of unwanted facial hair

EXTRINSIC AGEING:

Extrinsic ageing is caused by environmental factors and lifestyle habits, and is responsible for premature ageing of the skin. Sun exposure is the main cause of premature ageing. Other factors that contribute to premature ageing of the skin are, smoking, repetitive facial expressions, sleeping positions and gravity. Let's look at what each one does.

A) Sun Exposure:  Aging due to sun exposure is also known as photoageing. As this is the main cause of extrinsic ageing, we will look at this in some depth.

How does the sun damage our skin?  The damage is done by the sun's radiation. The ones we are concerned with are Ultraviolet (UV) radiation. There are 3 types of UV radiation:

1. UVA radiation: Ageing: - It is the main contributing factor towards skin damage and photoageing. It penetrates deeper into the skin than UVB radiation. It damages skin cells predominantly through the formation of free radicals. Its intensity is not very much determined by time of day or season. It does penetrate glass. So it is able to enter our homes and offices through glass windows. So even by being indoors, we will continue to photo-age. So it is essential to use a moisturiser that protects against UVA while indoors.
2. UVB radiation: Burning;-  It affects the epidermis, the outer layers of the skin. It is responsible mainly for sunburns, but also contributes towards skin damage. It is most intense when the sun is brightest, between 11:00am and 3:00pm. It is more intense in the summer months. It however does not penetrate glass.
3. UVC radiation: most dangerous and can increase the incidence of cancer. Fortunately it is blocked by the ozone layer of the skin.

Effect on the different layers of the skin:

1. Epidermis:  UV radiation causes thinning of the epidermal cells. It also leads to skin lesions such as actinic keratoses, and even skin cancers. 
2. Dermis: UV radiation increases the rate of destruction of the structural protein, collagen. It also It is also responsible for the formation and accumulation of abnormal elastin. The accumulation of this abnormal elastin stimulates the increased production of an enzyme called metalloproteinases.  Normally this enzyme is responsible for the repair of sun damaged cells by manufacturing and remodelling collagen. However when excessive amount of this enzyme is formed, it also breaks down collagen and also forms unhealthy collagen. The repetition of the abnormal process contributes to wrinkle formation. UV radiation also causes free radicals which are high energy molecules, which can damage the cells and even the DNA within the cells, leading to mutations. 

 

(Above is a photo of a lady in her 50's with signs of extrinsic ageing: wrinkles, age spot, leathery skin, drooping of upper eyelids, sunken cheeks, smokers lines around mouth)

Signs of Photoageing:

1. Fine wrinkles
2. Thinning of skin
3. Age spots or also know as liver spots (nothing to do with the liver)
4. Actinic keratoses
5. Rough leathery skin
6. Solar elastosis. Thickened skin with deep wrinkles usually seen at back of neck
7. Skin cancers: Basal cell carcinoma, Squamous cell carcinoma, Malignant melanoma (most serious type of skin cancer)

The degree of photodamage in an individual is dependent on the colour of his/her skin and the amount of sun exposure they have had.  Darker skin individuals have better protection than lighter skin individuals in the sun. Photoageing occurs over a period of years. With repeated exposure the skin loses its ability to repair itself and the damage accumulates.

B) Smoking: Studies have shown smoking to accelerate the process of ageing. It can lead to deep wrinkles and leathery skin. Some long term smokers may even develop a yellow hue to their complexion. Interestingly studies have shown that smokers who quit, notice an improvement in their skin tone.

 

(Photo showing smoker's lines around the mouth)

C) Facial Expressions:  Repeated movement of facial muscles, usually by habit of expression can lead to wrinkles. Such as lines on the forehead and around the sides of the eyes.

D) Sleeping Position:  An individual may develop ‘sleep lines' over a period of years, if person rests his/her  face in the same position each time he/she goes to sleep. Sleep line are seen on the chin and cheeks of individuals who sleep on their sides.

E) Gravity:  As our skin loses its youthful elasticity as we age, gravity's effect becomes more visible....parts of our body begin to sag, such as drooping eyelids, elongation of earlobes, etc.

WHAT CAN WE DO?

For those of you who still have young and healthy skin, you are now better prepared to protect your skin from ageing prematurely. And for those of you, who already have some degree of accelerated ageing due to extrinsic factors, do not lose heart. There are still things you can do to prevent further damage:

1. Balanced Diet: Skin cells like any other cells in the body needs nutrients to produce energy and function effectively. A healthy balanced diet will provide a constant supply of essential nutrients for that the cells require. Fruits and vegetables are also an excellent source of anti-oxidants.
2. Sun Protection: The importance of proper sun protection cannot be stressed enough. Knowing what we know about the dangers of sun exposure, we need to use proper sun-protection to prevent photodamage to our skin. We can do this by using a broad-spectrum sunscreen with a high SPF (SPF 15 or more), wide brim hats and sunglasses. Most important is try not to get sunburn. Of the skin cancers, Malignant melanoma is the most dangerous as it often spreads to other parts of the body. If you notice any changes in your moles or any unusual lesions/ bumps appearing on your skin always visit your doctor especially if you have had long periods of sun exposure. It is equally important to educate our children of the dangers of Ultraviolet radiation, as the visible signs of sun-damage takes years to show up. By then it may be too late. Skin cancers take a long time to develop
3. Lifestyle Factors: i) If you have not started smoking, please don't. If you are already a smoker, there are many options out there to help you stop smoking. You can even speak to your doctor if you have found it difficult to give up the habit in the past. ii) Try to alter your sleeping position. Try sleeping on your back. Of course once you are asleep you have no control of your sleeping position. iii) Exercising regularly increases the oxygen uptake by our body.

Sun damage is cumulative. Knowing what we know about the harmful effects of the sun's UV rays, I feel it is really important for us not only to protect ourselves, but also to educate our children about the dangers of sun exposure without proper sun-protection. Remember children in all their innocence love the outdoors. And with the right knowledge, they will still be able to enjoy the outdoors but will be better equipped to protect themselves against the dangers of sun-exposure such as premature ageing of their skin, and more seriously against skin cancer.  Let's take care of the skin we are in, for it's the only one we have got in this lifetime :)