EJE DEL SISTEMA NACIONAL
Primada AUMC
It is well established that sun avoidance and sunscreen use are important adju- vants to antiaging regimens. Obviously, sun avoidance is not always possible and hardly a popular behavioral adjustment for many patients. However, patients should be discouraged from engaging in unnecessary sun exposure, particularly between 10 AMand 4 PM, and any expo-
sure to tanning beds. Sunscreen should be recommended for use on a daily basis, even when the patient remains indoors. Patients should be reminded that UVA rays have the capacity to pass through glass, thus individuals are at risk of solar exposure even in their cars and homes as well as at work. UVA shields can be placed on windows, providing some pro- tection. Sun protective clothing, such as a broad-brimmed hat and SPF 45 cloth- ing, should be encouraged for patients planning any protracted exposure to the sun. Many patients believe that their sun exposure is minimal and does not war- rant daily use of sunscreen. Use of a Wood’s or a UV light to reveal solar dam- age is a helpful way to convince patients of the necessity of sun avoidance. Such a demonstration will also make them more likely to employ preventive mea- sures, such as sunscreens, antioxidants, and retinoids, when sun avoidance is im- practical. Sunscreens, antioxidants, and retinoids are discussed in upcoming chapters.
SUMMARY
Rough, dry skin, mottled pigmentation, and wrinkling epitomize the clinical appearance of photoaging. Extensive or severe photodamage can also be a precur- sor to skin cancer. Despite increasing awareness of the risks of prolonged sun exposure, too many people remain unaware that the proverbial “healthy tan” is, in fact, evidence of photodamage and indicative of premature aging. It is incum- bent upon the dermatologist to educate patients on the ravages of the sun, the importance of sun avoidance and sun- protective behavior, and, as always, tailor treatments to individual patient needs.
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CHAPTER 6
■
COSMETIC DERMA
TOLOGY
:
PRINCIPLES
AND PRACTICE
42
C H A P T E R 7
Cigarettes and
Aging Skin
Leslie Baumann, MD
Sogol Saghari, MD
fibers as a result of smoking.2In 1999,
Demierre et al. noted that case–control studies and other reports suggest a higher prevalence of facial wrinkling among smokers and that smokers, more often than nonsmokers, appear older than their stated age.1A significant asso-
ciation between smoking and gray hair was also observed in a different study.1
A German literature review article from the mid-1990s concluded that smoking is at least culpable for promoting, if not actu- ally causing, various skin changes.5This
report noted the strong association between cigarette smoking and yellowed fingers as well as increased facial wrin- kling, particularly in women. An elevated incidence of precancerous lesions and squamous cell carcinomas on lips and oral mucosa, as well as vasospasms and deteri- oration in large arteries and microvascula- ture were also linked to cigarette smoking in this report. In addition, smoking has recently been shown in an observational study to have a strong correlation with androgenetic alopecia by dint of a multi- factorial array of mechanisms.6