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With the plethora of articles featuring skincare - what they can and cannot do, and whether the expensive ones are offering anything more than the cheap ones? For these questions, how accurate are your answers, and where are you gaining your information in offering responsible and accurate answers as a skin care therapist to such questions?
To help set the record straight, we asked Dr Des Fernandes to answer some commonly asked questions. We trust his responses will shed further light and empower you with answers that are both scientific and credible.
Q1. Is it vital to moisturise your skin? If so why?
It is vital to protect the skin from drying out. We often find ourselves in environments that promote dry skin such as air-conditioned or heated buildings, or maybe in climates that dry out the skin. A dry skin cannot function properly and as a result it becomes prone to irritation, allergic reactions and infections. Now most people make the mistake of believing that dry skin should be treated with a very oily ointment-type of product. While heavy ointments such as Vaseline etc may prevent the loss of water from the skin they do not do anything to treat dehydrated skin. We need exactly the opposite type of cream that will promote the water-retention properties of the skin. Glycosaminoglycans need to be boosted and the waterproofing barrier of the skin, which is created by certain keratins and ceramides among others. Adequate vitamin A nutrition of the skin will do a great deal towards restoring the waterproofing barrier and increase the level of water-retaining glycosaminoglycans in the skin.
Q2. I have noticed a few broken veins across my nose and around my eyes.
What are these caused by and can I get rid of them or at least reduce their visibility? Broken veins on the nose and around the eyes are most probably due to UV-A irradiation. The nose, because of its position on the face is subjected to a major level of sun damage. Because the UV-A irradiation in summer and winter remains virtually the same except on heavily clouded days, people are more prone to UV-A irradiation than they think. UV-A rays can penetrate into the depths of the skin and damage the fine veins and arteries immediately under the epidermis. A relative lack of vitamin C may also aggravate the damage and result in inadequate collagen deposition around the little arterioles and thereby lead to weakening of the vessels and dilatation.
The dilated vessels also become more visible because of thinning of the skin due to chronic dry skin and a chronic deficiency of vitamin A, which is destroyed by UV-A exposure. The way to treat this problem is to first of all address the thinning of the skin. Skin can be made thicker by applying topical vitamin A. This will thicken the layers of the epidermis, and also cause more deposition of collagen in the upper layers of the dermis.
That will make it more difficult to detect the "broken veins" under the skin. The collagen deposition will also facilitate in supporting the arterioles and venules. The addition of vitamin C will not improve the antioxidant status of the skin, but will lead to even more deposition of collagen and the broken veins will gradually minimise over about three to six months if the correct dose of vitamin A and C is used.
Q3. They say you are what you eat. How true is this? Do chips and chocolate really give you spots?
We certainly are what we eat, but we are not certain about the dietary causes of spots. There is general consensus that chocolate or chips will not give you spots. An acne spot or pimple takes about 3-5 days to develop, so if it is something that we eat then it has to be something that we ate several days before the spot appears! Diet may influence the type of sebum that is secreted. Oral vitamin A can change the sebaceous secretions and for that reason high levels of fish liver oil or tablets of vitamin A are recommended for people with acne.
The level required may be about 30,000 i.u. per day which at this stage is way above the levels recommended by dieticians. The chances of vitamin A toxicity at this level is neglible. There is a suggestion that a diet deficient in vitamin B5 may pre-dispose to acne formation. However, we do not know enough about the influence of diet on sebum secretion. Hormones affect the sebum secretion much more. Surface problems causing clogging of the follicles are also of major importance and a pimple cannot occur without a clogged follicle. The infection is secondary.
Q4. Can an inexpensive skin moisturiser do the same job as an expensive make?
The price of a product is not, unfortunately, generally an indication of its activity. Marketing has led us to believe that you get what you pay for. However, the ingredients that have the greatest value for skin, are also very unstable and generally expensive. Some are priced the same as gold weight for weight, so that means that a really effective skincare product cannot be inexpensive unless it is simply trying to be a simple moisturiser.
A cream with good levels of moisture promoting properties without any nourishment can be inexpensive. However, simple moisturisation (expensive or not), contrary to popular belief, cannot prevent the ravages of exposure to light.
Q5. Since reaching my 30s, my skin actually looks worse than it did when I was a teenager. Around my chin and my cheekbones I have what looks like red speckles, which never actually come to anything. Is this hormonal or stress related? What can I do to improve this condition?
By the time you reach your 30s then you have accumulated a significant debt of vitamin A as a result of continuous degradation of vitamin A by light. The nose, the cheeks and the chin are the principal areas to be damaged by light. Therefore, these areas lose condition faster. The living epidermis is thinner, while the surface is rougher because of a thicker, horny layer. The thicker, horny layer may cause obstruction of the follicles and this would predispose to spots. The deterioration of the blood vessels in the dermis would also show up as broken veins.
The way to improve this is to use continuous nourishment of the skin with vitamin A and C and the other natural antioxidants to reduce the daily free radical assault and protect the cutaneous vitamins as much as possible by adequate sun protection. People with this type of skin may well discover that they have a problem adapting their skin to using vitamin A. That is the paradox, because although vitamin A is what their skin desperately needs, they may react with a retinoid reaction (sensitivity, dry and pink skin).
The reason for this is that the chronic exposure to light without vitamin A replenishment causes loss of the special receptors for vitamin A that are on every cell. Because there are few or almost no receptors on the skin cell membranes, it may appear to the skin that there is a "toxic state". While sunlight destroys these special receptors, fortunately, vitamin A stimulates their development. That is why after a short while, the skin no longer reacts to vitamin A and the skin regains vitality. With more receptors on the cell membrane surface, more vitamin A is taken into the cell and as a result, restoration of normality can be activated. Vitamin A is the vitamin to normalise skin.
I advise people to use a low-dose vitamin A product in the beginning and then gradually increased the strength to the maximum level. In people with severe depletion of the vitamin A receptors, I occasionally even advise that the vitamin A product should be left in contact with the skin for only a few hours in the beginning, and then washed off. After a time, it may be left on without any problem when their vitamin A receptors have been restored.
The best way to deal with this problem is to avoid the vitamin debt by replacing vitamin A, C, E and beta-carotene from an early age.
© APAA 2004