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10.05.2016
Summer is here - is your skin ready?
 
The skin is the largest organ of the human body, the well-being of which is easily forgotten. This is particularly the case when there is not yet visible signs of malignancy. Skin has been reported to reflect the overall health status and aging. Fortunately, a healthy skin has the ability to respond to challenges that would otherwise undermine its structure and function. Properly functioning skin has aesthetically pleasing properties, giving skin a healthful appearance and feeling. Additionally, skin care is important in order to avoid an early skin ageing process.
 
Dry skin
At some stage, the majority of adults will experience dry skin or xerosis. Dry skin is defined as having a moisture content of less than 10%. Normally, the stratum corneum should have a 20–35% water content. “Xerosis cutis” is the medical term for abnormally dry skin. The most common symptoms of dry skin are redness, irritation, inflammation, itchiness and broken skin. In addition to an adverse impact on the appearance of the skin, dry skin can also cause an uncomfortable feeling of the skin. Dry skin can be caused by many intrinsic and extrinsic factors such as age, health status, medications and the environment. The natural moisturizing factor (NMF) and the presence of intercellular lipids, which form a barrier to transepidermal water loss (TEWL), are the two major components to a healthy stratum corneum function. One of the key elements in skin hydration is the identification of epidermal aquaporins (AQPs). AQPs allow water to move between cells.

If there is a deficiency of the above mentioned mechanisms of skin hydration, the skin has been shown to prone to dryness. Additionally, the process of ageing results in intrinsic changes in lipid content and keratinization. Environmental factors such as humidity, temperature changes, and air flow cause dry or cool ambient air that can all contribute to alterations in skin hydration levels. Also harsh cleansers and soaps dry the skin. For older adults hypercholesterolic agents, antiandrogens and diuretics could contribute to dry skin. An excess intake of alcohol can lead to dehydrated skin.
 
Skin aging
Skin aging consists of two processes. The first is intrinsic skin aging, which represents chronological aging. Most of the intrinsic skin aging cannot be evaded. The second process is extrinsic skin aging, which is the result of external factors and environmental influence, mainly chronic sun exposure and ultraviolet (UV) light as well as smoking, pollution, sleep deprivation and poor nutrition.

In the skin we often see the first visible signs of the aging process. The effects of age on skin appearance result in increased skin fragility and laxity as well as decreased size of the dermis and reduced vascularization. These changes can lead to dull skin appearance and loss of skin’s protective ability; therefore skin damage from other sources can heighten the signs of skin aging.

Loss of collagen, damage to collagen and elastin fibres and structural changes in the junction between the dermis and epidermis may contribute to wrinkle formation. Additionally, smoking and photodamage increase skin wrinkling.
 
Sun exposure and ultraviolet (UV) light
The main exposures to UV light are through sunlight and tanning beds. Although UV light aids in vitamin D synthesis, it can damage the cells and extracellular components of the skin. Prolonged exposures to UV light can even cause permanent damage. The most apparent signs of photodamage are skin laxity, wrinkling, thickening as well as skin discoloration. Changes in skin texture, abnormal skin growth and impaired wound healing are also possible.

The cumulative effect of UV light is due to the worldwide increase in non-melanoma skin cancer, which is the most common type of cancer among the light-skinned population. Additionally, occupational exposure to UV light is high in many outdoors occupations. Skin cancer beliefs, knowledge and sun prevention practices have been assessed among Midwestern farmers and non-farmers. Although farmers identified sun protection benefits, only few reported optimal practices with 23% of farmers reporting sunscreen use always or frequently when out in the sun for 15 minutes or more. Barriers to sun protection included discomfort with wearing long pants, shirts and hats as well as forgetfulness with sunscreen use.
 
Much can be done in order to be skin smart
Prevention is an efficient way also in the work against the effects of extrinsic skin ageing. The best strategy against the harmful action of free radicals is a regulated lifestyle including caloric restriction, body care and physical exercise with low stress conditions and a balanced, anti-oxidative nutrition. Additionally, avoiding smoking and photodamage will benefit the skin tone.

Prevention of photodamage begins with reducing exposure to UV light. The basic recommendations of photoprotection includes restricted sun exposure, use of clothing and accessories (e.g. cap, hat, parasol, glasses) and topical photoprotection through sunscreen. Another important measure is the self-examination of the skin to recognize early changes of malignancy. Sunscreen use and dietary antioxidants have been advocated as protective agents of skin aging. Regular sunscreen use may even slow down skin aging in healthy middle-aged men and women.

Nutritional status plays an important role in the maintenance of a healthy skin. Antioxidants such as carotenoids as well as vitamins A, C, D and E, essential omega-3-fatty acids, some proteins and lactobacilli have been referred as agents capable of promoting skin health and beauty. Skin-friendly essential fatty acids, such as omega-3 and -6 are important to add to daily diet. Vitamin C increases collagen production in skin and it is essential for collagen biosynthesis. Vitamin C protects the skin from reactive oxygen species.

Vitamins, among other things, and a variety of plant extracts have been reported to possess anti-oxidant properties and have been widely used in the skin care industry either as topically applied products or oral supplements. For example, the oral supplement with collagen peptides has been reported to be efficacious in improving skin health and hallmarks of aging. Collagen peptides improve the water-binding capacity of the outer layer of skin. Studies have shown that hydrolysed collagen is absorbed in the gut and then delivered to the skin through the bloodstream. Daily ingestion of collagen peptides can improve skin hydration. Nutraceuticals are becoming increasingly popular.

There are many different treatment options available for dry skin. Water is essential for the normal functioning of the skin, especially for the stratum corneum. Nutritional support of the underlying epidermis or by the use of a mixture of topical ingredients, such as vitamin C or peptides, maintain the lipid barrier and NMF components of the stratum corneum.

Additionally, there are a number of cosmeceuticals to improve skin dryness. Moisturization of the skin maintain hydration and improves the appearance of the skin. Moisturisers replace natural oils and provide a soothing and protective film. However, it must be remembered that sometimes moisturisers can exacerbate dermatological problems such as acne.
 
More about skin health
American Skin Association (2012). Dry skin. http:tinyurl.com/bu8h857 (20.4.2016)

Asserin J, Lati E, Shioya T & Prawitt J (2015). The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from an ex vivo model and randomized, placebo-controlled clinical trials. J Cosmet Dermatol 14(4):291–301. DOI: 10.1111/jocd.12174

Baumann L (2007). Skin ageing and its treatment. J Pathol 211:241–251.

Birnbaum J, Le Moigne A, Dispensa L & Buchner L (2015). A Review of Clinical Trials Conducted With Oral, Multicomponent Dietary Supplements for Improving Photoaged Skin. J Drugs Dermatol 14(12):1453–61.

Borumand M, Sibilla S (2015). Effects of a nutritional supplement containing collagen peptides on skin elasticity, hydration and wrinkles. J Med Nutr Nutraceut 4(1):47–53.

Carley A & Stratman E (2015). Skin cancer beliefs, knowledge, and prevention practices: a comparison of farmers and nonfarmers in a midwestern population. J Argomedicine 20(2):85-94. doi: 10.1080/1059924X.2015.1010059.

Cosgrove MC, Franco OH, Granger SP, Murray PG, Mayes AE (2007). Dietary nutrient intakes and skin-aging appearance among middle-aged American women. Am J Clin Nutr 86:1225–1231.

Draelos ZD (2000). Cosmetic Dermatology: Products and Procedures. Wiley-Blackwell, Oxford. Fartasch M, Diepgen TL, Schmitt J & Drexler H (2012). The Relationship Between Occupational Sun Exposure and Non-Melanoma Skin Cancer. Dtsch Arztebl Int 109(43):715–720. doi: 10.3238/arztebl.2012.0715

Fries WC (2010). Natural skin care: the skinny on fats. http://tinyurl.com/od3f5oc Hughes MC, Williams GM, Baker P & Green AC (2013). Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 4;158(11):781-90. doi: 10.7326/0003-4819-158-11-201306040-00002 HydroPeptide (2014). HydroPeptide product reference manual. http://tinyurl.com/c3e86cx (20.4.2016)

Kang S, Fisher GJ & Voorhees JJ (2001). Photoaging: pathogenesis, prevention, and treatment. Clin Geriatr Med 17:643–659, v-vi. Lynde CW (2015). Moisturizers: what they are and how they work. http://www.skintherapyletter.com/2001/6.13/2.html (20.4.2016)

Makrantonaki E, Zouboulis CC & German National Genome Research Network 2 (2007). The skin as a mirror of the aging process in the human organism-state of the art and results of the aging research in the German National Genome Research Network 2 (NGFN-2). Exp Gerontol 42:879–886. doi: 10.1016/ j.exger .2007.07.002

Michels AJ (2011). Skin Health. Oregon State University. Linus Pauling Institute. Micronutrient Information Center. http://lpi.oregonstate.edu/mic/micronutrients-health/skin-health#references (21.4.2016)

Pinnell SR (2003). Cutaneous photodamage, oxidative stress, and topical antioxidant protection. J Am Acad Dermatol 48:1–19; quiz 20-2.

Rawlings AV (2003). Trends in stratum corneum research and the management of dry skin conditions. Int J Cosmet Sci 25:63–95. Rawlings AV & Matts PJ (2005). Stratum corneum moisturization at the molecular level: an update in relation to the dry skin cycle. J Invest Dermatol 124:1099–1110.

Ristow M & Schmeisser S (2011). Extending life span by increasing oxidative stress. Free Radic Biol Med 15;51(2):327-36. doi: 10.1016/j.freeradbiomed.2011.05.010

Sander CS, Chang H, Salzmann S, Müller CS, Ekanayake-Mudiyanselage S, Elsner P & Thiele JJ (2002). Photoaging is associated with protein oxidation in human skin in vivo. J Invest Dermatol 118:618–625.

Schagen S K, Zampeli AZ, Mankrantonaki E & Zouboulis CC (2012). Discovering the link between nutrition and skin aging. Dermatoendocrinol 1;4(3):298–307. doi: 10.4161/derm.22876.

Simpkin S (2015). Cutaneous adverse effects of alcohol. http://tinyurl.com/ot6wqme (20.4.2016) Telang PS (2013). Vitamin C in dermatology. Indian DermatolOnline J 4(2):143–146. Tzellos TG, Klagas I, Vahtsevanos K, Triaridis S, Printza A, Kyrgidis A, Karakiulakis G, Zouboulis CC & Papakonstantinou E (2009). Extrinsic ageing in the human skin is associated with alterations in the expression of hyaluronic acid and its metabolizing enzymes. Exp Dermatol 18(12):1028–35. doi: 10.1111/j.1600-0625.2009.00889.x.

Zanna N (2016). Defeating dry skin: treatments, topical ingredients and the role of nutrition. Journal of Aesthetic Nursing 4(10):478–485.

Urasaki M, Muradi M, Silva M, Maekawa T & Zonta G (2016). Exposure and sun protection practices of university students. Rev Bras Enferm 69(1). http://dx.doi.org/10.1590/0034-7167.2016690117i Verdier-Sevrain S, Bonte F (2007). Skin hydration: a review on its molecular mechanism. J Cosmet Dermatol6(2): 75–82.

Weber TM, Kausch M, Rippke F, Scholermann AM, Filbry AW (2012). Treatment of xerosis with a topical formulation containing glyceryl glucoside, natural moisturizing factors, and ceramide, Journal Clin Aesthet Dermatil 29(1): 37–42.

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Kirjoittaja(t):
lehtorit Maika Kummel & Susanna Mört