The truth about skincare.

By Dr. Deborah Lee

All skin colors health blog
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Look in the mirror and there’s no denying it – we’re all aging. It’s not a lot of fun. The changes are slow and imperceptible day by day. Although aging affects the whole body, the most obvious sign of aging – that part of us we present to the outside world – is our skin.

If someone asks how old they look, what do we do? We take a long, hard look at their skin.

And if they don’t get the answer they were hoping for, it’s frequently because their skin has not aged well.

The skin (which includes nails and hair) is the largest organ of the body and makes up an astonishing 16% of our body weight!  Skin is also quite thick in some places – like the soles of the feet, for example. If you peeled off all your skin and measured it, it covers 22 square feet (or 2.2 square meters).

What causes the skin to age? How can we nourish and protect it? How can we help our skin age gracefully? Can we reverse aging skin?


What Your Skin Says About You

Older woman with youth-full skin

Your skin says a lot about your health and your age.   Do you have a clear complexion and the bloom of good health – or is your skin ageing? – perhaps dull,  reddened, dry, thickened and wrinkled?  Don’t despair! With good skincare, even older people can have bright, soft skin, and some treatments are proven to smooth out wrinkles.

Your skin contributes to your sense of wellbeing and your self-esteem. The way you feel inside your skin is very important. And its never too late to give your skin the attention it deserves.

Like most things in life –  there’s no quick fix. You can’t change the appearance of your skin overnight. You need to start as you mean to go on and work at this constantly.

Skin Anatomy & Physiology

The skin is made up of three layers, the epidermis (the outer layer), the dermis (the middle layer)  and the subcutaneous tissue.

Skin is a living tissue, which is constantly needing to replace itself. As old skin cells die at the cell surface, new ones move up to replace them from deeper down. A staggering 500 million skin cells are shed from the epidermis every day! This rate of cell turnover slows down as we age.

The dermis contains a network of capillaries which bring oxygen and nutrients in the blood to the skin. The epidermis doesn’t contain any blood vessels. The dermis also contains sweat glands which produce sweat, to help regulate your body temperature, and sebaceous glands, which produce sebum (oil) to lubricate the skin. It also contains hair follicles.

The subcutaneous tissue is mostly fat and connective tissue. Vitamin D is synthesised here, from sunlight.

Factors Which Influence Skin Aging

Throughout life, a variety of internal and external factors affect cellular processes within the skin, which results in the skin aging prematurely.

Internal factors  – For example, these include your genetic make-up, hormones and cell metabolism. As we age, these factors result in thinning of the epidermis, and the development of fine wrinkles.

External factors – For example, these include the effect of chronic exposure to light (U/V), chemical products, radiation, toxins, and the harmful effects of cigarette smoking.

These factors cause the following signs of aging skin – 

  • Reddening and dryness – Exposure to U/V light causes the epidermis to thicken and become reddened, and dry. 
  • Sagging and wrinkles – The skin surface may have a mottled appearance, skin laxity increases, and deep wrinkles gradually form. 

Skin starts to sag because of the loss of collagen, and because it loses its elasticity.

Collagen is the major protein in hair, skin and nails.  Levels of collagen decline in the skin by 1% per year. In addition bonds between the epidermis and the dermis are weakened, and the outer skin layers then become more flaccid, sag and wrinkle.

  • Skin thickening – As we age, new cells take longer to produce, and desquamation becomes less efficient.  Wound healing is known to be slower in the elderly.
  • Loss of skin texture Glycosaminoglycans (GAG’s)  are structural components of the skin, which crosslink with collagen and other structures to give the skin it’s stiffness. They have an important role in the dermis to bind water. As we age, GAG’s function less efficiently. This is one reason the skin loses its youthful texture.

    One important GAG is hyaluronic acid (HA). Levels of HA in the epidermis decrease with aging.
  • Gravity – Gravity also takes its toll over a lifetime, pulling the skin downwards.
  • Change in body composition – As we age, we lose muscle, and there is a natural redistribution of body fat, with a thinner layer of fat between the skin and muscle layers. 
  • Estrogen deficiency at menopause – Women produce less sebum on the skin at and after menopause. Dry skin, hair and nails are common menopausal symptoms, along with vaginal dryness.
  • General health – Your skin has a blood supply and needs oxygen and nutrients just like the rest of your body. You are what you eat. Dietary deficiency has negative consequences for the skin.
  • Skin diseases – A long list of skin conditions occur in people of all ages. Some skin diseases worsen with age.
  • Oxidative stress – Every day cellular processes in your body result in the production of potentially dangerous molecules called free radicals. Excess levels of free radicals increase the risk of serious medical conditions such as diabetes, heart disease and cancer. 

However, the immune system fights off the free radicals using other molecules called antioxidants. This whole process is called oxidative stress. Every part of your body, including your skin, is under threat from oxidative stress.

Many features of modern life increase oxidative stress. Cigarette smoke, alcohol, poor diet, lack of exercise, obesity, air pollution and stress are all good examples.

To combat oxidative stress, requires plenty of antioxidants. Antioxidants are obtained from the diet. They are present in a wide variety of foods especially leafy green vegetables, fruits and nuts. Some vitamins also have antioxidant properties, notably vitamins C and E.

Antioxidants can be taken in tablet form, but for optimal results, they are best absorbed from food. They can also be applied directly to the skin.

The Principles Of Good Skincare

There are four fundamental principles of good skincare

1. Maintain the protective barrier of the skin. The skin has an important barrier function. It ensures water retention and helps avoid dehydration. It also prevents invasion from bacteria, allergens, irritants, pollutants, free radicals and U/V light. Regular use of moisturisers has been proven in research trials to improve the overall condition of the skin.

2. Maintain the collagen structure of the skin. Loss of collagen is a major feature of skin ageing. Collagen acts as scaffolding for the skin. Research substantiates that good nutrition and use of nutritional supplements can reduce the effects of skin ageing.

Hyaluronic acid and vitamin C for example, both promote the growth of collagen.

Retinoids – which are vitamin A derivatives – promote collagen production and help reduce collagen breakdown. They are among the most effective of the anti-ageing methods to slow the ageing process in the skin.

3. Protect your skin. Wrinkles and pigment changes in the skin are often directly caused by chronic U/V skin damage. Use of sunblock protects the skin from U/V. 

4. Prevent oxidative stress. Antioxidants counteract reactive oxygen species. Antioxidants enter the body by eating a healthy diet,  and with the use of some topical skin preparations containing antioxidants.

There is robust evidence for the use of Vitamin C, Vitamin E and Co-enzyme Q in the prevention of sun damage and wrinkles. 

Lifestyle Interventions For Healthy Skin

Below is a list of factors related to lifestyle. We all have a choice and an opportunity to make the necessary changes, to modify these factors.


Your body is an incredible machine. To work properly, every cogwheel must be in good working order. It also requires power, fuel, and other essential ingredients – and if these are missing, it splutters and grinds to a halt.

Your skin, as a vital part of your body, must have an adequate intake of food, containing appropriate levels of essential vitamins and minerals. Below is a list of vitamins especially important for skin.

  • Vitamin A – This vitamin plays a vital part in skin turnover. 

Vitamin A skincare products are some of the most effective when it comes to anti-aging. They facilitate the death and removal of old skin cells, as well as stimulating the growth and differentiation of new cells. They also support the epidermal skin layer, to help the epidermis retain water and to slow collagen breakdown.  These effects lead to improvements in skin tone and texture.

Vitamin A is found in the diet in dark leaf vegetables, carrots and eggs.

Vitamin A oral supplements are not generally recommended as you should get all you need from your diet and if levels are too high this can have serious consequences.

  • Vitamin B – There are many different types of B vitamins which form the vitamin B complex. These stimulate the production of skin cells and promote wound healing.
  • Vitamin B5 is effective at reducing inflammation and leads to improved skin tone and texture. There are many skin creams which contain vitamin B.
  • Vitamin B9, otherwise known as folic acid, when applied topically, has been shown to increase the amount of collagen in the dermis. 

Meat, eggs, seafood, nuts and seeds are good dietary sources of B vitamins.

Vitamin-B complex tablets contain the full range of B-vitamins. You should be able to get enough vitamin B from your diet; however, some people choose to take vitamin B supplements. 

  • Vitamin CVitamin C  slows the skin aging process, in three ways. It has an important role in the production of collagen by skin fibroblasts.  It is also integral in helping keratinocytes (these cells make up most of the skin surface) to resist U/V skin damage. It has important antioxidant properties. 

Vitamin C levels are much higher in the epidermis than the dermis. The epidermis has no blood supply, however, there are specific transport pathways to enable vitamin C to reach the epidermis.

Vitamin C is obtained in the diet from citrus fruits, spinach, potato and butternut squash.

It can also be purchased for example, as a serum or face mask, to apply directly to the skin.

Use of vitamin C on the skin has been shown to improve texture and skin tone. It can also improve wrinkles by stimulating collagen production.

In a 2015 study in the Journal of Clinical and Investigative Dermatology, 60 women were followed up after 40 and 60 days having had regular use of Vitamin C serum. Ultrasound confirmed a statistically significant increase in collagen synthesis during the period of the study.

  • Vitamin E – This has strong antioxidant properties. It has been shown to reduce collagen break down and support the immune system. It also has an important role in protecting the skin from U/V damage.

The best source of vitamin E is from food, such as avocados, peanuts, spinach, seeds and oils. 

Vitamin E. When applied as a cream, is absorbed through the skin, and permeates all the skin layers. 


Taking regular exercise is beneficial for the skin because stimulating the circulation encourages and flushes out waste products. There are however unique mechanisms by which exercise is good for the skin.

A 2015 study in the journal Ageing reported that exercise induces production of growth hormone IL-15, which is integral to skin health. Lack of exercise results in fewer pulses of IL-15, with complex effects resulting in mitochondrial degeneration. An association between age-related disease and declining mitochondrial function has long been recognised.


There are many harmful effects of life stress on the skin. When you are stressed, levels of adrenaline and cortisol are elevated. This then leads to increased DNA damage in the skin and affects the cell repair pathway. Stress is also associated with an increase in oxidative stress.

A link between chronic stress, ageing and telomere shortening has long been recognised. Telomeres are the endpoints of each chromosome. Repeated cell division over a lifetime causes telomeres to shorten. Some authorities view telomere shortening as a marker of biological age.


Smoking is incredibly harmful to your skin. A 2012 review of the effects of smoking on the skin, reported that the skin of a smoking adult at 40 resembles the skin of a non-smoking 70 -year old.

Smoking accelerates the natural age-related changes of the skin.  It reduces collagen production and stimulates the production of tropoelastin (the elastin precursor) and metalloproteinase enzymes, which breakdown elastin and disrupt the skin matrix. Smoking increases reactive oxygen species in the skin and causes oxidative stress. There is no doubt smoking accelerates ageing. 

If you are concerned about your appearance, and your health, stopping smoking is the best thing you can do for yourself. 


Lack of sleep has been studied and found to be associated with poorer quality skin.  A 2015 study reported that poor sleepers – those who generally sleep less than 5 hours per night – had increased signs of skin ageing and poorer skin barrier function, than good sleepers.


A 2019 study reported those who drinking alcohol more than 8 units per week is associated with skin changes, notably increased upper facial lines, under-eye puffiness, loss of midface volume and prominent blood vessels.


A plethora of data now exist to connect over-exposure to U/V light and premature ageing of the skin. Sun-induced skin damage is also called photo-ageing. The features are loss of pigmentation, loss of elasticity and skin tone. Exposure to U/V  light is responsible for 80% of the signs of facial ageing.


Air pollution has been shown to negatively affect the skin.

A 2018 study reported that exposure of the skin to particulate matter

(pollution) resulted in increased skin inflammation, increased oxidative stress and interference with  collagen production

Daily Skincare Regime.

Look after your skin – and your skin will look after you!

Step one – Wash your face once a day. The reason is to remove dirt, grime, sweat, dead skin cells and pollutants which have settled there during the day. Without doing this, they will block your pores and prevent any creams or lotions from being effective. Pat your skin dry, don’t rub it.

Step two – Cleanse your skin to clear out the pores. This will help your skin to look radiant and healthy.

Know your skin type – dry, oily, or sensitive? Often a low-alcohol, pH balanced product will be advantageous.

Once or twice a day is enough – don’t over-do it.

Step three – Consider the use of antioxidants, or cell regulators.

Vitamins B, C and E are potent antioxidants.  They are small enough molecules and penetrate well through the skin. These are available as oils or as a serum. They can be applied in the morning, under a sunscreen. 

Vitamin A products have strong anti-ageing effects. A retinoid cream should be applied in the evening at bedtime.

Step four – Moisturise, moisturise, moisturise, even if you have oily skin. The skin barrier needs to be kept as healthy as possible, and skin needs to remain hydrated and supple. Facial oils trap water in the skin and prevent water loss. 

Step five  – Apply sunscreen – at least Factor 30 – 15 minutes before you go outside. Reapply during the day or after swimming.

In addition – for the best skin results

For best results and happy, young-looking, youthful skin – 

  • Eat healthily
  • Drink plenty of water
  • Take regular exercise
  • Don’t smoke
  • Reduce alcohol consumption 
  • Sleep
  • De-stress – get some rest and relaxation

Sexual & Reproductive Healthcare Specialist & Freelance Healthcare Writer / Blogger.