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Skin deep.

Mary D. starts every day by drinking a tall glass of water. "I just feel that my body needs it," she says. Later, she sits down to a breakfast of multigrain cereal drenched in skim milk and a 4-oz. glass of orange juice. After breakfast she'll slather on some sunscreen and head out for a brisk morning walk with her husband before carrying out her daily tasks and errands. Throughout the day she'11 drink several more glasses of water, during and between breakfast, lunch and dinner. She's been doing this so long she hardly gives it a conscious thought. Most nights she turns in around 10 or 711 and rises the next day at 7.

In addition to a low cholesterol count, normal blood pressure and a trim figure, Mary has smooth, healthy skin, making her look much younger than her 65 years.

What she may not realize is that these second-nature rituals may contribute as much to the healthy glow of her skin as the gobs of moisturizer and sunscreen she so religiously applies whether she's out for a ride in her car or out for her daily exercise. Indeed, a little-known but vitally important - bonus of a healthy lifestyle is healthy, younger-looking skin.

The Skinny on Skin

Skin, the largest and most visible organ of the human body, is made up of three layers: the epidermis on the outside; the dermis, composed mostly of collagen, in the middle; and the subcutis, consisting of fat, on the inside.

As your skin ages, the collagen begins to break down, resulting in thinner skin and contributing to wrinkles. In addition, the skin has a harder time retaining water in the cells, which are normally 95 percent water. To some extent, the speed with which collagen degenerates depends on genetic makeup, but keeping your skin healthy can play a big part in slowing down the process.

For this reason, it is especially important to maintain a healthy lifestyle and follow a regular skin-care routine throughout your life. The net effect of eating well-balanced meals, drinking plenty of water, getting regular exercise and proper rest, and diligently using moisturizer will be healthy dividends for your skin. And regular use of sunscreen can't be overemphasized.

"If you take care of your skin, you don't look as old, and when you look younger, you're thought to look healthier," says Dr. Paul A. Krusinski, professor of medicine in dermatology at the University of Vermont and director of the dermatology unit. "Nowadays aging is viewed not so much chronologically as it is by the signs we see in the skin associated with exposure to ultraviolet light over a lifetime (a process known as photoaging)."

While the components of a healthy lifestyle may be clear, it's a little more difficult trying to figure which skincare products you need. The barrage of products on the market - soaps, creams, lotions and the like - can be perplexing for people trying to decide what's really best for their skin. And with all the discussion about skin cancer and the deterioration of the ozone layer, choosing the appropriate sunscreen can be equally daunting. Fortunately, skin management isn't all that complicated if you're armed with enough information to develop the right habits and make good decisions.

An Action Plan

If you haven't been washing with a mild soap, it's time to start. Cleanse your skin twice a day, and each time apply a light moisturizer afterward. People with dry skin should use a moisturizer that is preferably unscented, contains a sunscreen, and is noncomedogenic - meaning it doesn't clog the pores or encourage the onset of acne, which can still affect men and women over 50, especially if they had acne as adolescents.

Inexpensive moisturizers work as well as the more expensive lotions, since all moisturizers act as a humecrant - keeping moisture in the skin cells by forming a barrier to prevent the water from evaporating. Your skin absorbs water, not moisturizer. That's why it's best to apply moisturizer directly after a bath or shower, to seal in as much moisture as possible.

It may surprise you to learn that moisturizers with special nutrients and emollients aren't able to nourish your skin; they can only lie on the surface of the skin. Vaseline, though it is sticky and hard to apply, can be as effective as a moisturizer that costs $40 a bottle.

But all the moisturizer in the world won't help if you go out in the noonday sun - or the sun at any other time, for that matter - without wearing sunscreen.

Use a sunscreen lotion with a sun protective factor (SPF) of 30 on the face and arms, and an SPF of at least 15 elsewhere on the body. The American Cancer Society recommends people use sunscreens with an SPF of at least 15, but one recent study conducted at the University of Pennsylvania found that sunscreens with an SPF of 30 are more effective in reducing the microscopic changes that occur to skin in the presence of ultraviolet light and that can eventually develop into cancerous growths.

The hot new product in skin care the past couple of years has been Retin-A, popularly called the "anti-wrinkle cream." Retin-A is the brand name for tretinoin, a derivative of vitamin A, and it's been around for 20 years for the treatment of acne. RetinA has been shown to reduce fine wrinkles improve skin texture by smoothing out rough patches of skin, but this prescription drug has still not been approved by the Food and Drug Administration for reversing the effects of photoaging.

It's not known exactly how Retin-A works, but the drug does stimulate new collagen growth in the dermis of the skin and helps restore the epidermis to its natural, undamaged state. As with any medication, some individuals are sensitive to Retin-A and many people experience dryness, peeling, redness and swelling when they use it. People who are told to use this preparation by their physicians are also advised to use sunscreen regularly, as Retin-A increases sun sensitivity.

Although Retin-A may help make your skin look and feel younger, you shouldn't relax when it comes to monitoring changes in your skin that could point out melanoma and other skin cancers.

The Melanorna Epidemic

"It's a different sun out there now from what we knew as children," says Dr. Krusinski. "I've been in dermatology for 20 years, and what I've seen change most drastically is the increase in skin cancer. When I was in residency at a major university, we saw two melanoma patients each year. And now, at a much smaller university, we see about one a month.

"It's very important to protect your skin from ultraviolet light and radiation," he continues. "With the depletion of our ozone layer and other environmental problems, this increase in skin cancer is what the scientists have predicted. The sun we're seeing now is much stronger than what we saw 30 years ago, and it's getting worse. Now it's even more important to take care of your skin."

Melanoma is an abnormal growth in the melanocytes - the cells that dictate the pigmentation of skin. Melanoma may develop in an existing mole, freckle or birthmark, or it can appear as a new spot or blemish.

Most melanomas occur on nonsunexposed skin, in contrast to basal cell or squamous cell carcenomas that most often occur on sun-exposed skin. People who live in sunny areas are also more prone to developing melanoma, as well as light-skinned people with blue or green eyes, those who tend to burn and freckle and not to tan, and those who have experienced a severe burn during childhood.

Melanoma can spread from one part of the body to another, and this growth can turn melanoma from curable to fatal over a period of time. A melanoma that is 1/32 of an inch thick is usually curable, while one that is 1/8 of an inch thick is usually not.

Early detection is vital to successful treatment. (See "Melanoma from A to D.") However, avoiding exposure to the sun by using sunscreen and limiting exposure between 11 a.m. and 2 p.m. can also prevent the development of precancerous or nonmelanoma skin tumors, as some research has suggested.

Although you can't stop the aging process, you can slow photoaging by cutting down on your exposure to the sun. Taking care of your skin is simple; it just involves some routine maintenance and a little extra attention.

Use sunscreen, take care of your health, and watch for changes in your skin. If you keep your skin healthy, you look better, you feel better and you're healthier.

Lisa Rogak is a magazine and book writer living in Vermont. She writes about health and travel, and her credits include Reader's Digest, Woman's Day, New York Magazine, Travel & Leisure and many other publications. Her books include Steroids, Vermont: Off the Beaten Path, The Quotable Cat, and the forthcoming The Cat on My Shoulder.

Arthritis-Related Skin Problems

People with some forms of arthritis need to be aware of changes in their skin, which can foreshadow a worsening condition of their disease or indicate a complication of a prescribed medication.

"Rheumatologists characteristically spend a lot of time looking at a patient's skin because it may well be the tip-off in relation to what we're dealing with on a daily basis," says Dr. Arthur Weaver, associate clinical professor of medicine at the University of Nebraska and a physician at the Arthritis Center of Nebraska. "A variety of problems can occur that are either due to the disease or to the medication used to treat the disease."

Scleroderma is a form of arthritis in which the body produces more collagen than it needs, causing the skin to thicken and become hard and tight. Scleroderma occurs in two variations: localized and generalized. Localized scleroderma occurs mainly in the skin, while generalized scleroderma can spread to other parts of the body, including the internal organs.

Psoriatic arthritis is similar to rheumatoid arthritis (RA) in many respects. It occurs in a few localized joints or in many joints throughout the body. Psoriasis is a skin disease whose most common characteristic is the appearance of white, scaly plaques on the skin. Some people get only psoriasis, while in others the skin disease is a precursor to psoriatic arthritis, which often develops in the joints after the skin changes.

Systemic lupus erythematosus is a disease that involves different organ systems. Skin lesions and photosensitivity are common skin problems associated with lupus.

Vasculitis is a rare condition that can affect the skin as well as other organs. It is an unusual complication of RA. Symptoms may include a rash, red spots, sores, hives or fingertip ulcerations.

Rheumatoid nodules are hard nodules that frequently form directly over bony prominences in people with rheumatoid arthritis.

In addition to these problems, Dr. Weaver adds that many medications taken for arthritis can cause skin rashes. If you notice any changes in your skin, contact your doctor promptly. A rheumatologist will be able to determine if the skin condition is related to your arthritis and can refer you to a dermatologist for more specialized treatment if necessary.

Melanoma from A to D

This year 32,000 people will develop melanoma and 6,700 people will die of it, according to the American Cancer Society (ACS). Since melanoma and other skin cancers are frequently indicated by a change in a mole or other skin blemish, the ACS recommends people consult a physician if they see any changes that look suspicious. Such changes include the following (called the ABCD rule):

Asymmetry: The shape of the mole or other mark is irregular.

Border: The edges of the mole are ragged and uneven.

Color: The shade of a mole is not uniform and might be blotchy in appearance.

Diameter: The size of a mole is increasing and/or is larger than a pencil eraser in diameter.
COPYRIGHT 1992 Arthritis Foundation, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:includes related articles
Author:Rogak, Lisa
Publication:Arthritis Today
Date:Jul 1, 1992
Words:1989
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