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Erma L. Benitez, M.D.
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Mature Skin
As we grow older, we see and feel certain changes in our skin, which is the body's largest and most visible organ. The skin becomes drier, more wrinkled, and spots and growths appear. Also, after an injury our skin tends to heal more slowly.

Some of these skin changes are natural, unavoidable, and harmless. Others are itchy or painful, and come changes, such as skin cancers, are serious and require medical attention. Many of these skin problems can be prevented. Whether a danger to health or merely cosmetically unattractive, most of these skin problems can be addressed by therapies now available.

Wrinkles
As skin ages, collagen and elastin, fibers that keep the skin firm, weaken. The skin looks loose and lax, becomes thinner, and loses fat, so that it looks less plump and smooth. While all these changes are taking place, gravity is also at work, pulling at the skin and causing it to sag.

Can Wrinkles Be Avoided?
The sun is the major cause of unwanted changes in the skin with aging. How wrinkles your skin becomes depends largely on how much sun you have been exposed to in your lifetime. Cigarette smoking can also contribute to wrinkles. Wrinkles also depend on your parents - the tendency to wrinkle is inherited.

The good news is that many wrinkles can be prevented. Beginning in childhood, to avoid wrinkles caused by the sun:

Always wear sunscreen with SPF of at least 15
A hat with a brim and other protective clothing
Don't deliberately sunbathe
Try to avoid sun exposure between 10 a.m. and 3 p.m.

Remember that sun exposure as a child or teenager makes a big difference to the appearance of the skin at the age of 30, 40, or 50. If you have already sun-damaged your skin, you will still benefit from beginning sun protection as an adult. It's never too late.

"Broken capillaries" or Telangiectasia
These dilated facial blood vessels may be related to sun damage. The respond to the same treatments as other broken blood vessels (angiomas).

Treatment for Aging Skin
There are some promising treatments for aging skin. Retinoic acid, available as a cream and also used successfully in treating acne, improves the surface texture of the skin, reduces irregular pigmentation, and increases dermal collagen if applied daily for several months. It is currently the only medication approved by the FDA as safe and effective for reversing some of the effects of sun damage. Alpha hydroxy acids also show promise in reversing some of the effects of the sun.

Creases caused by facial expression such as squinting, frowning or smiling can be treated by Dr. B, using what are called injectable soft tissue "dermal fillers" such as collagen or fat. These dermal fillers are injected into the skin under wrinkles and scars to puff out creases or scars. A naturally produced toxin, botulinum (Botox), can also be injected to "relax" the small muscles and thus eliminate fixed expression lines (frown lines). Broken blood vessels accompany these wrinkles and can be treated with lasers or cautery. Fat folds such as those under the chin, around the waist and hips, and on the thighs, can be removed by liposuction under local anesthesia. Liposuction is the removal of fat by suction to eliminate unwanted bulges.

Non of these remedies can guarantee the appearance of youthful skin, but they can improve the overal appearance of your skin. Wrinkled skin may be improved by resurfacing with dermatologic surgery, lasers, dermabrasion or chemical peels. Before you undertake any home-treatment or surgery, discuss your options with Dr. B.

Dry Skin
As we age, our skin becomes drier. This can result in flaky and itchy skin, especially in cold, dry, windy climates. Milder cases of dry skin can be managed with a moisturizer used immediately after bathing, while the skin is still damp. Oils added to the bath water can cause the tub to be dangerously slippery.

Petrolatum, an ingredient in many lotions, creams and ointments, is an excellent moisturizer. Many moisturizers contain chemicals such as urea, alpha hydroxy acids, lactic acid, or ammonium lactate to reduce scaling and help the skin hold water. Some of these chemicals can irritate the skin, however. Dr. B can help you decide which is best for you.

Bathing less often and using milder soaps or a soap substitute, or soaking in a tub of warm water without soap can help relieve dry skin. Hot water is more irritating to dry skin that warm water. After bathing and drying off, a moisturizer such as petrolatum or lanolin should be applied immediately to seal in moisture.

If dry skin continues to be a problem, consult Dr. B. Severe flaky, itchy and cracked skin may by a sign of a more serious problem.

Skin Lesions
Skin growths and pigment spots become more common as we age. They may range from harmless "warts", "liver spots" or "age spots", to skin cancers that require treatment. Most are caused by years of sun exposure.

Among the most common are red or brown scaly spots called actinic keratoses. If ignored, they may become skin cancers that eventually need to be removed surgically. In the early stages they can be removed by freezing with liquid nitrogen, applying a chemotherapy cream, or by skin resurfacing.

Squamous cells carcinoma typically develops on the rim of the ear, the face, the lip, or the back of hands. These skin cancers can destroy normal tissue and squamous cell cancers occasionally spread to internal organs. If left untreated, squamous cell carcinomas can be aggressive.

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