Ever since I was a teenager in the early Nineties, I’ve been obsessed with skincare.
I was desperate to find a cure for my dreadful acne — my terrible skin was a source of deep embarrassment, and for years held me back.
In the end, it wasn’t apple cider vinegar, home-made sugar scrubs, toothpaste, TCP or peel-off masks that eventually improved it; it was seeing a dermatologist.
These days, I’m no longer a spotty teenager, I’m a qualified dermatologist myself and a spokesperson for the British Skin Foundation, specialising in both beauty and medical skin problems with a particular fascination with anti-ageing.
The process of getting older outwardly can be seen in the skin before any other organ of the body. Growing old cannot be hidden, unlike many other medical issues. We are living longer than ever before and the anti-ageing market grows ever bigger, bombarding us with celebrity endorsed potential ‘cures’, some of which are utter rubbish.
It drives me mad, the amount of bad information out there. Over the past ten years, I’ve seen hundreds of patients, many of whom, faced with a barrage of anti-ageing advice, are crying out for clarity.
So here, based on science rather than hearsay, is what I believe every woman needs to know about combatting the signs of time . . .
CRASH COURSE IN AGEING SKIN
As skin ages, the number and size of skin cells reduces, which means it functions less effectively as a protective barrier, temperature regulation is less efficient and there is a decline in the production of sweat, sebum (oil) and vitamin D.
The skin itself becomes increasingly thin over time owing to a steady reduction in collagen and elastin (the proteins that make skin bouncy and stretchy) and hyaluronic acid (which keeps skin plump and moist). The slow turnover of cells also means your skin heals less effectively.
The result? Dry skin, fine lines, deep furrows and wrinkles. Skin starts to sag as it loses its support and textural changes appear. Broken blood vessels, thread veins and uneven skin pigmentation become more prominent. Frighteningly, some of these changes can set in as early as your late 20s or early 30s.
This sort of ageing happens for a variety of reasons — some of which we cannot really control, such as DNA and cellular damage, and hormonal changes — and external factors, such as exposure to UV, pollutants, smoking and diet, which we can control.
BEWARE MIRACLE CREAMS
Apart from eating a healthy, balanced diet, not smoking and doing everything you can to protect your skin from UV and pollution, what can you do when it comes to skincare?
The elixir of youth has yet to be bottled and sold. Despite impressive marketing and celebrity endorsements, very few creams, gels and serums have robust data behind them for anti-ageing.
I hate to be the bearer of bad news, but creams will not help skin sagging or laxity. These changes occur due to loss of volume of fat and bone under the skin, which happens to all of us as time passes. No topically applied cream can replace that.
That said, certain agents can be used to reduce pigmentation, fine lines and wrinkles, and slow down the signs associated with skin ageing. These include retinoids, antioxidants, botanicals and sunscreen.
Current anti-ageing strategies are focused on limiting long-term damage from sunlight, which is the most significant factor in skin ageing.
... BUT RELY ON RETINOIDS
The retinoid family consists of a group of compounds that are derived from vitamin A. These have been available in skincare since the Seventies and are the only topical agents that repeatedly demonstrate anti-ageing effects in scientific studies.
Retinoids are able to minimise the appearance of wrinkles, slow the breakdown of collagen and fade pigmentation or age spots. They work by improving skin cell renewal and stimulating collagen production.
There are prescription versions available (tretinoin or isotretinoin) but over-the-counter versions (such as retinol and retinaldehyde) are also effective and often don’t come with the same side-effects as tretinoin and isotretinoin (burning, stinging, redness and scaling).
When buying a retinoid, look for a minimum concentration of 0.1 per cent retinol — and remember that it can take three to six months of regular use before any improvement can be seen in the skin.
USE PREVENTION TACTICS
Antioxidants block oxidation, the damage caused by unstable compounds known as free radicals. Free radicals are generated by exposure to the sun (the leading cause of external skin ageing) and by certain biological processes in the body that generate energy.
There are a number of antioxidants available in skincare products, and their role is largely to prevent oxidative damage to the skin, rather than treat the signs of ageing once they have developed.
These are some of the key antioxidants you should be looking for:
Vitamin C — also great for brightening skin, helping with inflammation and helping build collagen which gives skin its support structure.
Vitamin E — shown in studies to help limit the damage associated with UVB radiation from sunlight and can also help reduce fine lines.
Resveratrol — can limit damage caused by UVB radiation, and has also been shown to improve skin firmness and elasticity.
Other antioxidants worth keeping an eye out for include:
Grape seed l Green tea
Silymarin from milk thistle
Coffeeberry
PLASTER ON PEPTIDES
Peptides are types of protein and are hugely important in the human body, often acting as ‘messengers’, conveying information between cells and tissues. Some types can repair the skin’s support structure, thereby improving visible wrinkles.
One of the most widely studied peptides in skincare is Pal-KTTKS, or more commonly Matrixyl — you’ll find it in Olay Regenerist 3 Point Treatment Cream (£14.69, superdrug.com), Sarah Chapman Eye Recovery (£44, sarahchapman.net) and No7 Protect and Perfect Intense Advanced Serum (£34, boots.com).
In some trials, Pal-KTTKS was proven to thicken the skin and reduce fine lines and wrinkles, increasing levels of both collagen and elastin.
BE SUNSCREEN SAVVY
This will always be the cornerstone of anti-ageing prevention as the sun remains the biggest cause of premature and accelerated skin ageing, responsible for fine lines, wrinkling, uneven skin tone, pigmentation and textural changes.
Sunlight contains a mixture of several types of light, UVA and UVB, responsible for the majority of skin ageing, but also visible light and infrared radiation, thought to generate free radicals in skin cells which also accelerate the ageing process.
From an anti-ageing point of view, sunscreen should be worn daily. In the winter months, particularly in the northern hemisphere, using a moisturiser or make-up with SPF is satisfactory if you are going to be indoors during the day (although a separate sunscreen is even better).
In the spring and summer months, however, aim for a broad-spectrum sunscreen (i.e. one that offers protection against UVA and UVB) with an SPF 15–30 as a minimum.
Using an antioxidant serum, which can neutralise the free radical damage caused by visible light and infrared, in conjunction with a standard sunscreen, is a sensible precaution, although there are some products which blend antioxidants and UV protection, such as Heliocare 360 Oil-Free (£28, dermacaredirect.co.uk), EltaMD Broad-Spectrum SPF 30 (£17, uk.strawberrynet.com) and Solero Facial Anti-Ageing Suncream SPF 30 (£4, lloydspharmacy.com).
DO THE BARE MINIMUM
I know not everyone has the time or money to spend on their anti-ageing routine, which is why I’ve developed a guide to anti-ageing skincare even the laziest woman can do. It incorporates the most effective products mentioned above into the simplest regime possible.
Every morning make sure you . . .
Cleanse
Moisturise
Apply antioxidant serum
Apply sunscreen
Every evening make sure you . . .
Cleanse
Apply retinoid
YOU CAN USE A CHEAP CLEANSER . . .
The choice is huge and the best product for you depends on your skin type, personal preference and budget. There is a common misconception that expensive products work better than their cheaper counterparts. More often than not, the extra pennies are going into pretty packaging and clever marketing.
One thing I will say is that wipes are a no-no unless you’re using them as a last resort at the gym or on the go. This is because they can cause skin irritation, and smear dirt, make- up and oils across the skin’s surface.
AND DITCH EYE CREAM
I have heard some odd claims about moisturisers making your skin ‘lazy’ and less able to hydrate itself, but I can’t say there is any robust data to back this up. On the contrary, moisturiser is necessary to maintain the elasticity and flexibility of the skin’s upper layers. This keeps it healthy and allows it to function as a barrier.
Moisturisers can improve the texture or quality of skin, treat dryness and provide sun protection. There is plenty of scientific evidence to support their use.
A quick word about eye cream: no amount will improve age-related sagging or puffy eyes regardless of what the product promises. The skin around the eyes is vulnerable to damage from the sun’s radiation, and while an eye cream will moisturise, plump the skin and temporarily improve fine lines, wearing SPF around the eyes is vital to prevent premature ageing.
Moreover, you do not necessarily need a separate product: if a product is suitable for the face, it should be fine to use around the eyes.
What skin regime is best for the menopause?
Skin problems are a huge issue during the menopause. And, although life expectancy continues to rise, the average age of the menopause has changed relatively little over the past century.
This means there are far more women suffering with skin issues associated with the menopause for a much longer period of time.
In the run-up to the menopause, or ‘perimenopausal’ period, women will notice changes in their skin. This starts from about the mid-40s onwards, when oestrogen levels start to decline.
For some women, this can lead to the development of acne. As oestrogen falls, levels of male hormones, which women also produce, become proportionately more dominant, which can drive oil gland activity.
Others, however, may start to notice dryness and red patches. Once women reach the menopause, the body goes into a relatively oestrogen-deficient state. Lack of oestrogen is the most common cause of post-menopausal skin issues.
Oestrogen is what keeps our hair and skin youthful, and hormone replacement therapy (HRT) may help maintain skin elasticity, moisture and thickness. However, not everyone is suitable for, or wants to take, HRT, and this decision needs to be made after discussion with your doctor.
Common problems:
Skin dryness
There is a reduction in skin metabolism. Skin functions less effectively as a barrier, resulting in increased water loss. This will leave the skin vulnerable to the elements. Alongside this, there is reduced oil and lipid production.
Wrinkles
After the menopause, women’s skin thickness decreases by 1.13 per cent per year owing to falling collagen levels. In the first five years after menopause, collagen content is thought to decrease by as much as 30 per cent. Collagen is needed for the skin’s support structure. Hormones and sun damage work in synchrony to promote wrinkles and sagging.
Increased fragility
As the skin thins with age, there is also loss of fat and connective tissue support around blood vessels which makes them more susceptible to injury. Oestrogen has a protective role in wound healing and reduced levels after menopause mean the skin takes longer to heal following trauma.
Redness/sensitive skin
Redness can occur due to hot flushes associated with the menopause. Rosacea can also develop for the first time, leading to redness and sensitivity.
Facial hair
Straggly facial hair often starts to appear on the chin and upper lip due to a change in the ratio of oestrogen to male hormones in the bloodstream. Hairs can be tweezed, plucked, threaded or waxed, or removed with electrolysis or laser if they are dark.
Getting skincare right after the menopause is important. Using a retinoid-based product at night will boost collagen production and an antioxidant serum will limit potential damage to already fragile skin.
Here are my top tips for dealing with menopausal skin:
Choose cream cleansers for dry skin rather than foaming washes.
Hydrate the skin and moisturise with rich creams rather than gels morning and evening.
Use a daily broad-spectrum SPF 15–30.
Keep up with regular exercise to boost blood flow to the skin.
Exfoliate regularly to help fade brown marks.
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