Nothing concentrates the mind of a 23-year-old medical student more than the failure to buy a drink in a bar. I was on my elective in Australia; a two-month period spent pursuing a career-enhancing topic of one’s choice. I chose sunshine, beach sports and alcohol. Sadly the last one was eluding me. Every Australian barman seemed to think I was no more than 16 years old. It’s hard to be sophisticated nursing lemonade.
While there I learnt to perform a mental adjustment, adding about seven years in age to everyone I met. Those looking 30 were probably my age. I concluded this was the effect of sun exposure. From that time to the present day I have worn factor 50 sun cream every day, even when it’s raining in November.
If you’re a health page aficionado, you’ll be shouting about vitamin D, or lack thereof. Trust me, I have thought about it. I expose my arms and back to the sun for about 20 minutes. This amount of UVB exposure in summer is enough. I make sure I don’t burn, and I never sacrifice my face. I supplement with vitamin D3 in the winter months — not D2, it is less effective. Sunshine is a wonderful medicine. It improves our sense of wellbeing, lowers blood pressure and treats a myriad of skin conditions. But like most medicaments, it depends how you take it.
You don’t need to persuade a dermatologist of the damage sunlight can do. Patients are surprised when I point out that around 80 per cent of skin ageing is induced by light exposure. The demarcation between head and neck and trunk in some people is dramatic. Deeply tanned, lined Keith Richards lookalikes sometimes conceal alabaster-smooth-skinned bodies beneath their clothing.
What causes us to age?
The processes are multifactorial. The genetic theory of ageing is that our cells have a predetermined lifespan, coded by genes in the same way that, for example, our height is. This theory is borne out by studies that have shown identical twins to have similar lifespans, more so than non-twin siblings.
So how is longevity inherited?
One genetic theory of ageing revolves around telomeres. These are repeated segments of DNA which sit at the end of chromosomes. The number of repeats in a telomere determines the lifespan of a cell. The longer the telomere, the longer the lifespan.
Telomeres shorten with each reproduction of a cell. Once they have been reduced to a certain size, the cell reaches a crisis point. It can divide no more, and it dies. So the length of the telomere that you are born with determines the lifespan of your cells.
Of course, it’s not that simple. The processes of cell growth and division that exist in all living things involve a complex sequence of events prone to error with time; changes in the genetic blueprint known as mutations. The effect of mutational change may be a degradation of the information being passed on; in terms of ageing, consider the slackening of blood vessels, the loosening of the jawline. Occasionally mutations may result in the genesis of a cancer; something more prevalent in the older population.
Non-genetic theories of ageing relate to environmental exposures, or ‘wear and tear’ — for example sun exposure and smoking. Loss of elasticity in skin, tendons and blood vessels due to damage of the collagen that forms an integral part in the structure of our skin. The immune system has been implicated in ageing — a process whereby it starts to attack our own cells. And there is evidence that sugars bind to and cause damage to cells in a process called glycation.
It is well known that ultraviolet (UV) light causes skin damage. But one common misconception is if we are not suffering sunburn, then we are not damaging our skin. This isn’t true. UV-B (UV-Burning) causes skin redness and blistering in excess, but UV-A (UV-Ageing), while not causing obvious damage at the time, causes skin cancer and is more destructive in terms of skin ageing. UV-A damages our skin’s deeper layers, affecting the structures that keep it firm and youthful.
Other wavelengths from the sun such as Infrared-A penetrate deep into the skin. These rays cause free radical damage that cause the upregulation of an enzyme called MMP-1 that we know breaks down collagen and elastin. This same enzyme is upregulated by smoking and explains the similar skin changes we see in smokers. Most conventional sun creams do not contain the antioxidants that protect the skin against infrared damage, but a new brand called Ladival Sun Protection does offer this.
What makes us look older? Wrinkling isn’t top of the list. A study published in 2014 in Clinical, Cosmetic and Investigational Dermatology gathered 120 female participants aged 41 to 49 and had six dermatologists determine the signs of age. Loss of volume around the nose and mouth, followed by skin redness, pigmentary changes and skin texture all came above wrinkling as a marker of age.
So how does one stay looking young?
Wear a broad-spectrum sun block, such as Ladival, that protects against UVB, UVA and Infrared-A to reduce sun ageing. Leave sunbathing to reptiles or you’ll end up looking like one. If you are in the sun, sit with your back to it, seek shade and wear a wide-brimmed hat and UV-protective sunglasses. Sort out a good skincare regime. Use a very gentle skin wash: keeping your skin pH slightly acidic protects your skin barrier, which reduces redness and keeps skin hydrated and youthful. Drink water, preferably with lemon in the morning. Eat plenty of fruit and vegetables. Regular exercise at least three times a week will make an enormous difference.
For the platinum anti-ageing customer, consider the discussion at the annual American Academy of Dermatology meeting in March 2015. The focus was on light-reflective sun creams and antioxidant supplements to mitigate against free radical damage caused by sunlight, smoking and pollution. We need plenty of vitamins C and E and carotenoids. Also start looking for niacin, soy, resveratrol, coffee berry and lycopene. The consensus seemed to be that by reducing inflammation and free radical damage to skin, we not only slowed down but also reversed some of the signs of ageing.
For those considering a more interventionist approach, take this approach. Look at the face of your dermatologist or surgeon. Remember that this is their ideal, but is it yours? Personally I don’t want to be so tight and shiny that I look like I’ve been embalmed. Also, remember everything is relative; plumped 18-year-old lips will make a 50-year-old face look 70 unless it too has been, shall we say, refreshed.
Human beings are expert at facial recognition. The fusiform gyrus in the temporal lobe is devoted to it. We are programmed to recognise the smallest changes. An overtreated face becomes blank, identikit, antithetical to the human perception of beauty. Clever tweaking, with an emphasis on skin glow, works wonders. But less is always more.
Who better to end with than Socrates? When he said ‘beauty is a short-lived tyranny’, he clearly didn’t realise that, given the chance, it seems women and increasingly men are in it for the long haul.
Dr Justine Hextall FRCP is a consultant dermatologist.