Skin care for the elderly: myths and facts
I recently had the opportunity to visit a very relaxing and beautiful day spa during the midday break from sessions at a Keystone meeting. I was having a very relaxing and relaxing day when I went for my ultimate treatment: the facial. The cheerful and cheerful beautician began examining my skin and applying several creams, when I heard her say something that almost spoiled my experience: She claimed that the topical treatment she was about to apply, as she put it, "will clean the liver. "
As a scientist, I know better. Most of the over-the-counter doses used at everyday spas are harmless and are intended to cleanse the skin and increase transient moisture retention, and cleaning anything other than my skin seems like a strong claim. So I decided to embark on a challenging task for JCI readers: determining whether facials or other topical treatments are worthwhile investments in keeping skin healthy and wrinkle-free. And see whether a topical treatment to cleanse the liver is possible or not. In pursuit of this goal, I spoke with four doctors dermatologist (Figure 1 ) and two specialists beauty. Here are his views on how to keep your skin (and liver) in the best possible condition.
The point of view of cosmetologists
Since skin is our largest and most visible organ, most of us agree the importance of proper care. In fact, the skincare industry has estimated that Americans alone spend more than $ 43 billion annually ( 1 ) on topical creams and cosmetic enhancements like botox and spa treatments (spending in this industry is only over $ 12) billion; Reference 2 ).
To learn more about facials, I spoke with two beauticians (neither of whom wanted to be named in this article) at spas in New York City. I also spent some time reading beauty blogs and other articles about skin care on the internet. According to the cosmetic experts consulted, a professional face usually has some differences in these steps: deep cleansing of the skin; Skin analysis by a facial therapist; peeling; Remove blackheads, clogged pores and pimples if necessary; Facial massage treatment mask, application of serums, moisturizers and sunscreens. Facial treatment sometimes includes massaging hands and arms, all in the pursuit of healthier and more relaxed skin. To maintain youthful skin (in women), they recommend quarterly facials, starting at around age 25.
One of the facial plasticists I spoke with said that by getting a suitable analysis of your skin, you will get to know your skin type to properly meet your skin's needs. It was mentioned that most people are using the wrong products for their skin type and this causes skin sensitivity. On the internet, I found a beauty blogger who was quite certain about how a facial esthetician is in a better position than most people to recommend products and topical treatments, stating that "Beauticians have a variety of skin care products They are products and beauticians just for professionals to figure out how." Using these products correctly.Without the training and knowledge of a licensed esthetician, finding the right products for your complexion can be a completely wasted effort ( 3 ). Here's a message I definitely agree with: The cosmetic departments of most supermarkets or even most drugstores have an amazing array of options, and the marketing and packaging can entice even the most logical scientists. Flaunting fancy packaging and boutique skincare can be wonderfully indulgent, which in and of itself can have psychological benefits.
This is a point that cosmetologists have returned to time and time again: the psychological effect that the face can have. They stated that the relaxing facial effect does nothing more than benefit your skin and your overall mental and physical health. Someone said, “The stress of everyday life is on your skin, so taking an hour to relax and focus on yourself will help you both physically and emotionally. Sure, facials are a luxury because of the money and time invested, but consider the fact that you have more than an hour of protected time without your phone ringing. "Your cell phone or your email is ringing. There is no way to diminish the power of rest, relaxation, and rejuvenation."
So how much can relaxation do from a scientific standpoint? In my experience, much of the relaxation comes from the facial massage component. Again from the blog, “Massage is an important part of professional facial beautification. Massage will help you relax and also reduce the hormone cortisol in your body. If cortisol is a liquid in the body, it will only hurt you over time, and furthermore, massage releases oxytocin, which is one of the Body-well-being hormones "( 3 ). Unfortunately, the point about cortisol is not entirely correct: a recent study showed that the effect of massage therapy on cortisol "is generally very small and statistically indistinguishable from zero" ( 4 ). The point about oxytocin isn't completely accurate either: Two studies report almost minor changes to oxytocin as a result of tactile stimulation ( 5 , 6 ).
The beauty experts I spoke to and the blogs I read continued to discuss the other medicinal benefits of the face: regulate the immune system, detoxify, reduce fluid buildup, exfoliation, and lymph drainage. Antioxidant facials are said to contain nutrients that fight free radicals that would help remove pollutants from the body (maybe a liver cleanse?). High-frequency electrical currents have also been described as effective as a part of the face, with claims that they will improve circulation, increase collagen and elastin production, remove toxins and bacteria, stimulate lymph drainage, and exfoliate dead skin cells. Skin and skin care improvement. Absorption of the product. I have treated most of these allegations with skepticism.
The view of dermatologists
Due to my doubts about the medicinal benefits of topical treatments for skin, I contacted four dermatologists: three academic dermatologists (George Cutsarlis, John R Stanley, and Michael Dietmar) and one from Fifth Avenue (Adarshe Modgill) in my neighborhood to answer some questions related to face and skin care.
We start with a quick primer on the skin: how well can a topical product available from the spa penetrate the skin (figure 2 )? Apparently, a typical ingredient in an effective skin care product can break down dead cells in the stratum corneum and cause reactive proliferation of basal keratinocytes, but most creams do not penetrate the epidermis. Something like protein won't go anywhere outside the surface. All dermatologists talk extensively about retinoids, which are a class of chemical compounds related to vitamin A that can actually transport into the dermis, even into blood vessels, which can then have systemic effects. In fact, tretinoin (also known as retinoic acid or Retin-A) is often used to treat skin conditions, from photoaging to acne and psoriasis ( 7 ).

Human skin consists of two basic layers, the epidermis, which contains the outermost layers, and the dermis, with connective tissue, hair follicles, blood vessels and lymph.
Given the original motivation for writing this article, I couldn't help but ask the team of dermatologists if a topically applied product by a spa technician could clean my liver. They all responded with a resounding rejection. In particular, Dietmar commented, “At the concentrations available to spas, it is not really possible for a compound to get to the liver to 'cleanse it.' I think this statement belongs more to voodoo than reality.” Two exceptions were mentioned: topically applied steroids could enter the circulation and could inhibit the pituitary axis, and carbon tetrachloride could also penetrate, but this compound is toxic to the liver when applied to the skin and would be an unlikely component of a spa. Treatment or treatment. Basically, you can end the article here: Unfortunately it is impossible to cleanse the liver in the spa,
The conversation pushed us away from the liver and back to the face. I asked them if there was a case where getting a face would be medically beneficial. The group's lead physician, Mudgil said: “I never recommend this to my patients. When you have darker pigmentation and the facial specialist presses on whatever is there, pimples and the like, they can do more harm than good, meaning you could end up with hyperpigmentation it might It takes months. ” Cotsarlis added that there is no benefit for people with normal skin, who are the majority of the population, and the only one who disagreed with him was Stanley, who said that a face can achieve exfoliation of dead cells. “The stratum corneum is exfoliated and the very superficial layer can be removed; if there is little desquamation, the face can remove it.
These experts quote claims from beauty experts online about the major health benefits of regular facials: regulate the immune system, detoxify, reduce fluid buildup, stimulate lymph drainage, exfoliate, and relieve stress. They get it well in part, Stanley said: "I can definitely see how a face can help relieve stress, and I suppose you can say relaxation modifies the immune system, but the face won't have a direct effect on cells. Immunity." . Keep in mind that what we said earlier is in direct conflict with what they say: Facial treatments can cause swelling and then swelling, and they say facials cause less fluid on the skin. If you have less fluid on your skin, it looks dry. "
Regarding the point of fluid accumulation and lymph drainage, two academics saw different aspects. "What really is the meaning of the words I do not understand" the low accumulation of fluid "when it comes to the skin, unless it refers to the edema of heart failure, but the kidneys do it for you, not the skin. He said Couttsarles. And when you suffer from lymphatic drainage problems? If you do You definitely won't get a facelift to solve it. A normal person doesn't have problems with the lymphatic system in the face. ” On the contrary, Dietmar says there is a constant flow of lymph fluid in our skin. When fluid leaks out of the blood vessels, it is absorbed by the lymph network - this is our body's natural washing system. As you age, especially if you have sun-damaged skin, the function of the lymphatic system deteriorates and you have fewer lymph vessels ( 8 , 9 ). He commented, "You might be able to argue that you can reduce fluid buildup in the face to stimulate drainage when your skin has fewer lymphocytes. So, boosting lymph flow could have benefits. Whether or not this is achieved using the face, that's a different story."
Scientific study
I decided (Fig. 3 ) to conduct my own scientific study in which I asked Dr. Mudgil to evaluate my skin before and after the facelift (although I didn't tell him what he would do for my face) to determine if there was some noticeable difference. Mudgil noted: "You have the advantage of having very little pigment in your skin, so your skin is very young - you have 20-year-old skin, although I bet you are more likely to be in your mid to late 30s. It can be very difficult for Asians. Or dark-skinned Africans know their age based on their complexion . Your skin is completely normal, so I'm not sure I can tell the difference on subsequent visits if I did something. "
The author described having sun damaged and slightly dry skin, as well as completely normal skin in her 20s.
On the advice of many beauty-conscious friends, I chose a dermatologist-run medical spa in midtown Manhattan for a basic facial treatment. A facial plasticist (one of the beauticians who did not want to be named) claimed that you have “slight congestion in your T-zone, and it actually looks like you are a bit dry. I would say you have combination skin where it's oily in your T-zone. Your nose and cheeks are also damaged by the sun. ” I recommend that I start using a pearl or enzyme scrub to help“ lighten skin and reveal new cells ”. He also advised me to apply an eye cream, since you are "a little dry in that area. You don't have big wrinkles, but you really want to keep this area moist to keep it from showing."
I went back to see Dr. Mudgil the next day for a facial to see if he could figure out what he did for my face, if anything, but he noticed everything he did was subtle. Since I had a subtle erythema between my edges, I assumed I did something exfoliating, maybe like a chemical peel. When I told him that I had just had a basic facial plastic surgery, and told him my esthetician's rating for my skin (combination skin), he agreed, but he said, "Basically, everyone has combination skin, and I would say you are at the very low end of this spectrum - Your skin is very natural everywhere. Your face area with the highest density of sebaceous glands is in the T-zone, and your nose probably contains more. ” When I asked her if she noticed any sun damage to my nose and cheeks, Disagreed with the assessment of an expert beauty, saying: "Her skin from less skin affected by the sun 's rays in the age class. Inclined people who have more pigment in their skin not to carry the same amount of damage caused by the sun 's rays." However, this skin pigmentosum It has limits to its benefits . Mudgil stated, "As much as your sweat may be sunscreen, it will be full of genetics.. Indians tend to have a more sunken view and tint under the eyes." So unfortunately, a beautician's advice to keep the under-eye area better moist may be in vain. "As much as your race may be sunscreen, your genes will chase you. Indians tend to have sunken eyes and change color more." So, unfortunately, a beautician's advice for keeping the under-eye area moist may prove to be in vain. "What might your ethnic background be. Since you are sunscreen, your genes will chase you. Indians tend to have eyes more sunken and discolored." So unfortunately, a beautician's advice to keep the under-eye area better moist may be in vain.
My visit to the doctor ended Mudgil some advice: Don't get facials because it can do more harm than good. It is recommended to use a daily face moisturizer with SPF 15, even if it's raining or snowing outside. She also added that I have to wash my face twice daily with a gentle all-purpose acne cleanser, even if I don't have acne. Then after reaching a certain "wisdom" threshold, I have to use the retinoid at night.
Beauty is only superficial (but can it be deepened by applying the product?)
I decided to consult more with the dermatologist team about skincare products and the best ways to maintain youthful skin, this time focusing on over-the-counter topical products. Each of our experts mentioned that the most important thing to remember when it comes to maintaining youthful skin is the daily use of sunscreens, especially those that contain titanium dioxide or zinc oxide, which are in fact a physical blocker of sunlight. Specifically commented Stanley: "Sun protection is the most important thing to make sure your skin looks good for a long time. All the other things you can do for your skin are slight compared to sunlight, and it's not just sunscreen - clothes and hats and not just baking in the sun. " .
What about other products, such as detergents? On this point, Cotsarlis noted that people used to use soap that was advertised with 99.44% purity. He pointed out that "surprising numberpeople who see them in clinical and who practice have dry or itchy skin inskin peeling, especially in winter, and thisbecausesoap only. Americans tend to shower excessively, and those who bathe twice a daydry. goal of Soap removes oils, but the skin needs a little oil and moisture. If everyone uses a moisturizing soap, we will really reduce the amount of skin diseases. " He also told me what he learned during his medical training from Albert Kligman, a renowned dermatologist at the University of Pennsylvania who discovered tretinoin (Retin-A), and what he told all of his patients: "You should use Vaseline at night take off your makeup. Use a tissue to get rid of the excess, as it creates a barrier and keeps the skin hydrated."
When I asked dermatologists whether there should be a difference between products that are applied directly under the eyes and on the rest of the face, Stanley said that the skin under the eyes is so thin that it has a more pronounced reaction to an irritant in this part of the face. It made sense to use a moisturizing product without other ingredients, while Cutsarlis noted that "Vaseline works there, too."
But does Vaseline prevent aging? I went to ask the committee whether there should be a difference between skincare products used before and after 50 years, given the massive efforts in cosmetic marketing aimed at older women. "I think that is not very logical," Dietmar said. "Some people seem to be 50 years old when they are 30 years old. Others do not appear to be 50 to 60 years old. It is the most suitable skin type of age. If your skin is dry, there are specific products for you." , whether you are 35 Or 55 inches. Medjell agreed, saying: “The skin is different for an older person, but the recommendations are exactly the same.” Cotsarlis added that the main difference between small and large skin is the degree of exposure to sunlight: “This can cause loss of collagen and elastin, which keep the skin tight. Then there are the effects of gravity. So definitely, if you have loose, wrinkled skin or brown spots, you will see a much greater benefit from lasers, peels and topical compounds. "
Is there a difference between men's and women's skin care products? Dietmar replied: You have more money. Other than that, of course, there are hormonal differences that can dictate the use of certain ingredients. “ But that brings a good point: Should we spend $ 150 on one bottle of Creme de la Mer instead of $ 9 a bottle? An ounce of Olay oil? Does the brand or cost really matter? ”Stanley said,“ There is a psychological effect of spending more. One of my relatives buys according to the ads, and says the products work better, sometimes if they cost more, she likes it more even if I tell her that the items on the label don't get to her hair or skin, she doesn 't care. Much skin and hair care is based on psychology. " However, it was the Costarelis addition to this argument . He said that if the product comes from a large company, the chance of a negative reaction is much less and it is more likely that the product will work as advertised, as companies tend to perform more thorough testing before bringing a product to market. He said, "It is the marketing arm of these companies that is conducting studies on what will attract more and more effective buyers: Marketing can be really smooth and it can skew things in ways that are not completely dishonest, but very far from what scientists have already shown. " Regardless, he still recommends buying products from a brand you know and have previous experience with. He went on to say, "When you see some new herbal tinctures and brands appear, you have no idea what the products actually contain. It is also possible that each batch will be completely different." If the product comes from a large company, the chance of a negative reaction is much less and the product is more likely to operate as advertised. Firms also tend to do more thorough testing before the product is put on the market. He said, "It is the marketing branch of these companies that conducts studies on what will attract buyers the most effectively: Marketing can be very clever and can twist things in ways that are not completely dishonest, but far from the right. That scientists have already shown. " Regardless, he still recommends buying products from a brand you know and have previous experience with. It's also possible that each batch will be completely different. “ The likelihood of an adverse reaction is much lower and the product is more likely to operate as advertised, as large firms tend to test more thoroughly before launching a product to market. He said, "It is the marketing branch of these companies that conducts studies on what will attract buyers the most effectively: Marketing can be very clever and can twist things in ways that are not completely dishonest, but far from the right. That scientists have already shown." Regardless, he still recommends buying products from a brand you know and have previous experience with. "When you see some new herbal tinctures and brands appear, you have no idea what the products really contain. Each batch might be completely different as well," he said. He said that if the product comes from a large company, the likelihood of a negative reaction is much less and the product is more likely to operate as advertised, as companies tend to test more thoroughly before launching a product on the market. . He went on to say when you see some new herbal tinctures and brands appear, you have no idea what the products actually contain. It's also possible that each batch will be completely different. “ The likelihood of a negative reaction is much lower and the product is more likely to operate as advertised, as large firms tend to test more thoroughly before releasing a product to the market, ” the market said : “Branch marketing to these companies is to conduct studies on what attracts buyers most effectively. A: Marketing can be very clever and can skew things in ways that are not completely dishonest, but very distant. What the scientists have really shown. ” Regardless, he still recommends buying products from a brand you know and have prior experience with. He goes on to say,“ When you see some herbal tinctures and new brands appear, you have no idea what the products actually contain. He said, "It is the marketing branch of these companies that conducts studies on what will attract buyers the most effectively: Marketing can be very clever and can twist things in ways that are not completely dishonest, but far from the right. That scientists have already shown. " Regardless, he still recommends buying products from a brand you know and have previous experience with. He went on to say, “When you see some herbal tinctures and new brands appear, you have no idea what the products really contain. Each batch is likely to be completely different as well. ” Large companies tend to do more thorough testing before a product is put on the market. He said, "It is the marketing branch of these companies that conducts studies on what will attract buyers the most effectively: Marketing can be very clever and can twist things in ways that are not completely dishonest, but far from the right. That scientists have already shown. " Regardless, he still recommends buying products from a brand you know and have previous experience with. He went on to say, “When you see some herbal tinctures and new brands appear, you have no idea what the products really contain. Each batch is likely to be completely different as well. ” Large companies tend to do more thorough testing before a product is put on the market. He went on to say, "When you see some new herbal tinctures and brands appear, you have no idea what the products really contain. Each batch will likely be completely different as well." He said, "It is the branch of marketing in these companies that studies what will attract buyers the most effectively - marketing can be really nimble and can skew things in ways that are not completely dishonest, but very far from what scientists have already shown." Regardless, he still recommends buying products from a brand you know and have previous experience with. "When you see some new herbal tinctures and brands appear, you have no idea what the products really contain. Each batch might be completely different as well," he said. "Marketing Branch in these companies is being studies on what will attract buyers more effectively: it can be marketing very brilliant and can distort things in ways that are not dishonest completely, but they are far from right. Shown by really scientists." Regardless, do not He still recommends buying products from a brand he knows and has prior experience with. He went on to say, “When you see some herbal tinctures and new brands appear, you have no idea what the products actually contain. Each batch might be completely different as well.” “The marketing arm of these companies is doing studies on what will most effectively attract buyers: It can. Marketing to be really clever and can twist things in ways that aren't completely dishonest, but it's far from what scientists have really shown. '' "When you see some new herbal tinctures and brands appear, you have no idea what the products contain. And each batch might be completely different as well," he said. He still recommends buying products from a brand you know and have prior experience with. He still recommends buying products from a brand he knows and has prior experience with. He continued, "When you see some new herbal tinctures and brands appear, you have no idea what the products actually contain. Each batch might be completely different as well."
What about products that are natural or organic? Are they more effective or safer to apply to the skin? “I think you are fooling yourself a little bit into thinking that just because it's natural, it will be more effective. ” Cotsarellis pointed out that there are caustic acids in lemons. Stanley went on, noting that lemon juice can cause severe photodermatitis in people with the gene and tonics: “You see. All the time in people drinking in the pool. It can be a serious pigmentation problem and cause a bad reaction. This is a natural product. Natural doesn't mean that it won't hurt if you put it on your skin. Poison ivy is a natural product and do not rub it on your skin. "
Last but not least, the bottom line for older women like me: I asked the panel if there were any topical treatments to reduce or prevent the appearance of fine lines and wrinkles, and it's not surprising that it all comes down to the retinoid. . Mudgil said: "It's very important to use a retinoid, and there are formulas that are not as dry as the ones I use for acne sufferers or even botox patients who want to maintain youthful skin." Dietmar points to the oldest trick in the cosmetics industry: "You can easily reduce the appearance of wrinkles with a moisturizer. Most cosmetic treatments are different types of moisturizers. Instantly reduce the appearance of fine lines between 15% and 20%. Avoiding their appearance is different. It can prevent them." Daily use of retinoids. Wrinkles appear; they penetrate the skin
Final lessons: Use sunscreen, Vaseline, and retinoids. Never mind the face. Do not rub poison ivy and citrus juices on your skin; Don't be tempted by elegant packaging and high prices. Easy enough!
Footnotes
Conflict of interest: The author has declared no conflict of interest.
Quote from this article: J Clin Invest. 2012; 122 (2): 473--477. Doi: 10.1172 / JCI61978.
Article information
J Clin Invest. 2012 Feb 1; 122 (2): 473--477.
Published online February 1, 2012 doi: 10.1172 / JCI1978
PMCID: PMC3266803
PMID: 22293186
The Journal of Clinical Research, Ann Arbor, Michigan, USA. UU.
Send correspondence to: Ushma Neill, Journal of Clinical Investigation, 15 Research Drive, Ann Arbor, Michigan 48103, USA. UU. Phone: 734.222.6050; Fax: 7342226058; Email: gro.icj-eht@srotide .
Copyright © 2012, American Society for Clinical Research
This article has been cited in other articles in PMC.
Articles from the Journal of Clinical Investigation are presented here with permission from the American Association for Clinical Investigation
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