Healthy Skin Women and Dermatology


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Slide 1 : Healthy Skin Women and Dermatology Suguru Imaeda, M.D. Chief of Dermatology, Yale University Health Service Chief of Dermatology, WHVAMC Assistant Professor, Yale Medical School
Slide 2 :
Slide 3 : Overview Normal structures of the skin Changes in the skin over time Sun and skin Skin cancer Maintaining healthy skin
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Slide 5 :
Slide 6 : Periorbital - 0.02 mm Body - 0.035-0.050 mm Palms/Soles - 2-3 mm Epidermis
Slide 7 : the largest organ key role in normal healthy functioning of the body Disorders range from those limited to the skin to manifestations in the skin of internal disorders plays important role in social and psychosocial functioning of the individual undergoes changes with aging and in response to external environmental factors and internal hormonal influences
Slide 8 : 4 25 50 70
Slide 9 : Gender differences Fundamental differences in structure and function of the skin Differences impact on presentation of skin disease and its management Hormonal influences affect common disorders such as acne, rosacea, lupus erythematosus, psoriasis, lichen planus, anogenital pruritus, hidradenitis suppurativa, and atopic dermatitis
Slide 10 : Infancy gender differences seldom play a role in skin disease Toddler to adolescence few dermatologic ailments are gender specific
Slide 11 : Adolescence Trichotillomania Compulsive hair pulling Traction alopecia Hair styles – tight braiding, pony tails, corn rowing Acne excoriee Compulsive picking of mild acne
Slide 12 : Body piercing presents risks for multiple possible complications nickel allergy secondary infection with staphylococcus or streptococcus ear cartilage destruction from pseudomonal infection candidal infection of the navel or genitalia Keloids traumatic tears
Slide 13 : Tattoos Infection Granulomatous reaction Photodermatitis Difficult to remove
Slide 14 : Melasma Brown patches on forehead and cheeks Very sensitive to sun exposure More common in Hispanics, Middle Easterners, and Asians Most common cause is oral contraceptive use or pregnancy
Slide 15 : Melasma management Discontinuation of oral contraceptive Avoidance of sun/tanning bed Daily application of broad spectrum sunscreen 4% hydroquinone or 20% azelaic acid ? laser
Slide 16 : Intrinsic aging Changes of chronologic aging gradually become apparent Influenced by genetics, gravity, and hormones Clinically, the normal aging process leads to fine wrinkles, dryness, sallow color, thinner skin, laxity and purpura
Slide 17 : Aging skin Decreased function as environmental barrier, sensory organ and immune organ Epidermal and dermal atrophy with loss of appendages Decreased sweat production leads to dryness Decreased body and scalp hair Decreased ovarian estrogen production leads to decreased collagen and increased wrinkling Overall thinner, paler, drier, with fine wrinkling and decreased elasticity
Slide 18 : Histologically dermal thinning decreased vascularity decreased subcutaneous fat reduced cellularity of the dermis elastic fiber loss
Slide 19 : Histologically dermal thinning decreased vascularity decreased subcutaneous fat reduced cellularity of the dermis elastic fiber loss
Slide 20 : Environmental factors on skin create extrinsic damage major effect is from photoaging with wrinkling, laxity (sagging), lentigenes, dyschromia, coarseness, sebaceous hyperplasia, and telangiectasia 90% of visible skin changes of aging Visible as early as age 20
Slide 21 : 4 25 50 70
Slide 22 : Smoking shown to decrease both hyaluronic acid and glycosaminoglycan synthesis causes decreased capillary blood flow in the skin changes accelerate wrinkling
Slide 23 : The twenties Skin is smooth and coloring is even Little need for emollients Skin care is simple - variety of products are tolerated May be persistent acne associated with hormonal activity manifest by flaring during the week prior to the menstrual period.
Slide 24 : The thirties thinning of the skin beneath the eyes skin is less elastic Fine wrinkles begin to appear around the mouth and lateral periorbital region Increased fat and sluggish blood flow contribute to puffiness and darkening of the skin beneath the eyes
Slide 25 : The forties More sallow and less supple Skin surface not as smooth Liver spots, solar lentigenes, appear on areas of chronic low grade sun exposure - face, dorsal hands, back or dorsal feet Thin red spider angiomas appear on the legs Weight gain leads to sagging skin Cellulite appears on thighs and buttocks Deep furrows develop on forehead and lateral periorbital areas (crow’s feet) Skin becomes drier - sweat glands grow smaller and become less effective
Slide 26 : The fifties and sixties Wrinkles are deeper - skin begins to sag and droop Skin tone is lighter from decreased circulation More solar lentigines form Collagen and elastin are thinner Collagen is estrogen dependent therefore skin is both thinner and drier Dryness occurs from thickening of the stratum corneum Moisturizers help keep the skin moist and supple Alpha hydroxy acid-containing products help by reducing the thickness of the stratum corneum, promoting thickening of the epidermis and dermis, and promoting synthesis of collagen, elastin, protein and glycosaminoglycan
Slide 27 : Pregnancy rosy complexion - increase in vascular circulation hyperpigmentation on the nipples, vulva, anus and inner thighs from hormonal stimulation Freckles (ephelids) and birthmarks may also darken Melasma, the mask of pregnancy, from hormonal changes, sun exposure and genetic factors Skin tags develop on the neck, chest, inframammary area, inner thighs, and face Spider angiomas, purpura and capillary hemangiomas Stretch marks, striae distensae Varicosities and hemorrhoids
Slide 28 : Sun protection Signs of extrinsic photoaging not intrinsic genetic aging usually prompts the visit to the dermatologist Therefore, it is most important to incorporate into the daily routine a sun protection regimen
Slide 29 :
Slide 30 : Tan Coco Chanel declares tanning “in” in 1920’s Suntan seen as symbol of health, youth, status Skin’s reaction to damage from UV radiation Melanocytes produce melanin
Slide 31 : Indoor tanning Increasingly popular, esp among young women in 20’s Advertised as safe, “healthy glow”, little risk of skin cancer Controlled tanning protects against sunburn by building up melanin Vitamin D helps prevent breast, prostate, colon cancer
Slide 32 : Dripping faucet Your skin = empty glass Dripping water = ultraviolet radiation Rate of drip = amount of sun exposure Rate of evaporation of water = skin’s ability to repair DNA damage caused by UV radiation Your glass is full = you’ve reached your limit of sun exposure Water starts spilling over the top = getting skin cancers
Slide 33 : Ultraviolet radiation UVA Long wavelength = low energy = penetrates deep into skin UVB Intermediate wavelength = higher energy = penetrates less into skin UVC Short wavelength = high energy = germicidal Primarily absorbed by ozone layer
Slide 34 :
Slide 35 : UVA 95% of solar UVR Present during all daylight hours year round UVB varies by season, location, time of day Exacerbates cancer-causing effects of UVB Photoaging
Slide 36 : Sun myths Sunscreen use causes Vit D deficiency Don’t need sunscreen on a cloudy day 40% of sun’s UVR 80% of sun exposure occurs during childhood <25% of total sun exposure by age 18 Men over 40 spend most time outdoors
Slide 37 : 2007 Skin Cancer Facts Skin cancer = most common cancer in US Lifetime risk = 1:5 Americans 1:3 Caucasians >90% skin cancer caused by sun exposure Doubled lifetime risk with 5+ sunburns BCC > 1,000,000/yr SCC = 250,000/yr + 2,500 deaths/yr Melanoma = 59,940/yr + 8,110 deaths
Slide 38 : Basal cell carcinoma and Squamous cell carcinoma
Slide 39 : Melanoma
Slide 40 : Probability of Melanoma (2001-2003) Men Women <39 1:775 1:467 40-59 1:187 1:237 60-69 1:178 1:347 >70 1:76 1:163 Lifetime 1:49 1:73 Age
Slide 41 : Sunburn is bad Blistering sunburn - >2-fold increased lifetime risk for melanoma Lifetime sun exposure – increases risk of SCC and BCC
Slide 42 : Melanoma Incidence 59,940 Deaths 8,110 Men 33,910 5,220 deaths Women 26,030 2,890 One person per hour dies from melanoma 1:59 lifetime risk Cost of care = >$740 million annually
Slide 43 : Melanoma White men > 50 yo #1 cancer in men > 50 yo (prostate, lung, colon) #3 cancer in women 20-39 Men > 40 yo spend most time outdoors; highest annual exposure to UVR Women <40 yo – BCC rate 3x in last 30 yrs SCC rate 4x in last 30 yrs
Slide 44 : Indoor tanning Big business - $5 billion-a-year industry 28 million Americans 2.3 million are teenagers 70% Caucasian women 16-49 yo 7-fold increased risk of melanoma 2.5 fold increased risk of SCC 1.5 fold increased risk of BCC
Slide 45 : IARC (International Agency for Research on Cancer) Clear increase in melanoma risk associated with sunbed use in one’s teens and twenties 75% increased risk Similar increase in risk of SCC for those who used sunbed tanning as teenagers Possible decrease in skin’s immune response
Slide 46 : Sunless tanning Dihydroxyacetone Safe Dyes outer dead layer (corneal layer)
Slide 47 : Tanning pills Canthaxanthin – carotenoid found in carrots Hepatitis Urticaria
Slide 48 : Sun Protection Factor SPF 15 93% blockage 90% 70% SPF 30 97% blockage 96% 90% SPF50 99% blockage 98% 95% Measures only UVB protection Need to reapply secondary to photodegradation In vitro CT FL
Slide 49 : New proposed labeling guidelines for sunscreens UVB Low 2-14 SPF Medium 15-29 High 30-50 Highest 50+ UVA Low Medium High Highest
Slide 50 : Sunscreen Apply 1 oz (shot glass full) every 2 hours Apply 30 min before sun exposure to allow sunscreen to bind to skin Reapply every two hours to replenish sunscreen UV stabilizers – octylcrylene, Helioplex
Slide 51 : UV Index Scale 1-15 Predicts ultraviolet radiation level Calculated daily Adjusted for ozone level Cloudiness Altitude Latitude Season
Slide 52 :
Slide 53 : Anti-aging treatments Prevention Retinoids Lasers Chemical peels Dermabrasion Botox Fillers $35 billion/year industry
Slide 54 : Prevention Daily use of sunscreen or moisturizer with sunscreen SPF 15+ Clothing Avoiding unnecessary UV exposure Avoiding sun exposure between 10a-4p
Slide 55 : Retinoids Tretinoin and tazarotene Vitamin A derivatives Even out skin tone Rebuild collagen Repair minor sun damage Inhibit tumor growth Decrease inflammation
Slide 56 : Lasers Ablative - vaporize top layer of skin – softer, smoother skin surface, reduced wrinkles Nonablative – IPL – intense pulsed light -stimulates collagen remodeling and growth to soften fine wrinkles, remove dilated capillaries – delayed effects up to 6 mos
Slide 57 : Chemical peels Chemical ablation of superficial skin layers Mild to moderately strong acid solution Recovery period needed Lunchtime peels
Slide 58 : Dermabrasion Small high speed rotating metal brush or file Physically abrades upper layers of skin Requires local or general anesthetic Microdermabrasion – tiny particles to gently scrape away superficial skin layer to stimulate new cell growth
Slide 59 : Botox Botulinum toxin Temporarily paralyzes muscle to relax furrowing of skin Frown lines between eyebrows, horizontal forehead lines, crow’s feet, vertical lip lines, neck banding
Slide 60 : Fillers Injected under skin to round out contours, correct wrinkles, furrows, hollows Bovine collagen polymer implants hyaluronic acid autologous fat
Slide 61 : General skin care total sun protection regimen with avoidance of unnecessary exposure to sun between 10 am and 4 pm daily sunscreen use with reapplication every 2 hours if exposed to sun performance of monthly skin self-examinations moisturization with changing environmental, seasonal and aging processes gentle products to avoid irritation from skin care products and excessive removal of skin oils which will lead to dryness and further skin irritation
Slide 62 : Skin Care Tips Sun protection Hydration Healthy diet – fruits, vegetables, fish Gentle skin care products – soaps Moisturize Don’t smoke
Slide 63 :
Slide 64 : Sun Protection Factor Sunscreen SPF > 30

 


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