The aging process. It is inevitable if you are a living being. None of us can avoid it, and for most of us, it can be a sign of immense privilege to be able to age well. 

Nonetheless there are many things that we can do to help influence our overall ageing so it is kind to us - this includes many preventive habits such as eating well, exercising and keeping active physically and mentally to enable us to make the most of our time on earth. 

Where our skin is concerns, with time, we all get visible lines on our face. With age our faces lose some of their cherubic fullness; our skin becomes thinner, drier and more prone to bruising. While our genes largely control when these changes occur ie intrinsic aging, this accounts for some 20% of the ageing process in our skin, the remaining 80% being more under our control, ie extrinsic aging. 

What are the factors that affect extrinsic aging? 

Our environment and lifestyle choices can cause our skin to age prematurely. Common examples of factors influencing this type of aging include UV exposure and smoking as well as poor diet, among others. 

The WHO classifies UV exposure as a carcinogen yet there continues to be confusion around what constitutes UV exposure in Australia at least, where, in my weekly skin cancer work, I continue to hear from patients “I never go out” and “I avoid the sun” who nonetheless commute daily to work without much sun protection and who understand sun protection to mainly be necessary when going to the beach or playing outdoors sports for extended periods of time. 

So why is sun avoidance our best anti ageing habit? 

1. Effects of ultraviolet radiation on the skin 

• UVA triggers damage to the DNA in the presence of melanin (pigment) 
• UVB causes damage independent of melanin and directly affects DNA.
• The UVB triggers release of pro-inflammatory cytokines which cause sunburn
• DNA damage also causes the loss of structural integrity in the skin and photo-ageing.
• The accumulation of unrepaired DNA and UVR induced immunosuppression, increase the risk of mutations and the development of skin cancer. (Source dermnet) 

2. Effects of chronic sun exposure and sun damage on the skin 

• Tanning is triggered by UVR induced damage to DNA and other skin parts.
• Chronically  sun-exposed skin such as on a bald scalp or face, neck, and hands has unique characteristics compared to skin that has not been exposed to UVR:
  • Photo-aged skin is thinner than non-sun-exposed skin in the same individual.
  • Photo-aged skin is dryer. Over time sunspots aka actinic keratoses appear in the most sun-exposed skin sites; these are tender, red, scaly lesions that may eventually turn into squamous cell cancer. 
  • Sun-damaged skin is less elastic than skin in other areas and develops a dull yellowish undertone due to solar elastosis.
  • Photo-aged skin has more uneven pigmentation than other sites due to freckles, solar lentigines, and hypopigmented and scarred areas. There are often prominent blood vessels 

3. Effects of ultraviolet radiation (UVR) on skin cancer risk 

As noted above by the WHO, UVR is a major carcinogen. It damages the skin by producing free radicals that damage proteins, fats, RNA and DNA. It is thought that UVR increases tumour risk through mutations in your DNA and UVR is a tumour promoter and causes progressive tumour growth once the process has begun. 

4. Effects of UVR on the eyes 

UVR causes free radical damage to mitochondrial DNA in the retina. UVR can also promote inflammatory changes within the eye, increasing risk of: 

• Inflammatory disorders of the eyes 
• Pterygium (that white stuck-on looking film over the eye) 
• Cataract
• Age-related macular degeneration
• Cancers of the eyes
  
  • BCC —  > 90% of eyelid cancers
  • SCC — the most common cancer affecting the cornea and conjunctiva
  • Melanoma — the most common primary cancer within the eyeball.

So how do we prevent skin ageing?

Intrinsic ageing is unavoidable but given it is typically only responsible for some 20% of skin aging there is much that is within our control to minimise the effects and impact of the remaining 80% of aging. 

In perimenopausal women, systemic hormone replacement may delay skin thinning - the skin is less dry, with fewer wrinkles, and wound healing is faster than without treatment. Menopausal hormone therapy (MHT) is less effective at improving skin ageing in the postmenopausal decades. See your doctor if this is a consideration for you. 

Careful and regular sun avoidance is essential at all ages. 

• Be aware of daily UV index levels or better yet, establish the daily habit of sun avoidance and sun protection irrespective of the weather during daylight hours.
• Avoid outdoor activities during the hottest parts of the day.
• Wear sun protective clothing (eg, a broad-brimmed hat, long sleeves and trousers or skirts).
• Apply very high sun-protection factor (SPF > 30), broad-spectrum sunscreen to exposed skin. Apply enough to get the advertised protection, and reapply often. 
• Do not smoke, and where possible, avoid exposure to pollutants.
• Obtain plenty of exercise — active people appear younger than inactive people as the increased blood flow has a beneficial effect on skin. 
• Eat fruit and vegetables daily.
• Get enough sleep, since sleep is where the skin repairs itself 
• consider adding in oral niacinamide tablets especially if you are outdoors regularly for work and can’t avoid the exposure. 

Many oral supplements with antioxidant and anti-inflammatory properties have been advocated to slow skin ageing and to improve skin health. These include carotenoids; polyphenols; chlorophyll; aloe vera; vitamins B, C, and E; red ginseng; squalene; omega-3 fatty acids as well as collagen supplements. Their role in combatting skin ageing is as yet unclear.

Last but not least, get regular skin checks for cancers before they occur or progress. If photo ageing bothers you, there are many options available to help improve skin quality, but as always, prevention is better than cure. 

Ready to book in for your skin cancer check?