Beneath the Surface

Over the years medical science has made its share of claims. Many have led to improved lives, and others were outright laughable. Old magazines carry ads with physicians touting the health benefits of smoking. And during the 1950s, as breast cancer rates in post-war America increased, many suspected that the cause was bras. After all, didn't all women who developed breast cancer previously wear a bra?

Today the debates continue. The Internet clogs mailboxes with accounts of incredible secrets and scams, which range from "Your shampoo causes cancer!" to "Toothpaste creates acne." The most outlandish declarations often make headlines and are accepted as truth. Conversely, well-established facts-such as that increased sunshine exposure is responsible for skin cancer-are universally ignored. It's quite a paradox to march against breast cancer, which continues to decline, while refusing to use sunscreen.

Forgotten in all the health-scam hullabaloo is that rates of cancer have continued to drop over the past few years. And two cancers that continue to climb-lung and skin-are each highly preventable by lifestyle decisions.

As a nation that trips from one media-generated scare to another, it's best to take a breath and talk sensibly. Good people have reasonable concerns, so let's take a look at a few of the claims.

Claim: "Deodorants and antiperspirants are dangerous." The National Cancer Institute categorically states that deodorants, which mask unpleasant odors created by skin bacteria, have never shown any danger to humans (outside of the occasional contact dermatitis reaction that can occur from using the same product for too long). Deodorants are placed in the same category as perfumes and colognes, which hold a pleasing fragrance in a safe, alcohol-based vehicle.

As for antiperspirants, the American Cancer Society flatly denies any danger. That said, a careful examination of the recent research reveals these cautions included in reports: "As far as we know . . ." or "Current thought . . ." Scientists are still trying to determine what connection-if any-exists between breast cancer and women who shave their armpits and then apply a product containing an aluminum compound (which is present in nearly all antiperspirants). The aluminum may undergo a change when absorbed in a person's body and have an estrogen-like effect. Increased levels of estrogen have been found in women with breast cancer.

There is also worry of aluminum products increasing a person's chances of developing Alzheimer's disease. This allegation appears to have originally been made by manufacturers of aluminum-free products and remains completely unproven.

Personally, I use an antiperspirant only for long public events in the summer; otherwise, a deodorant is my first choice. I tell my patients to avoid using any antiperspirant or deodorant right after shaving and to never use a product on broken or irritated skin. It's best to shave armpits in the evening and apply deodorant in the morning.

Claim: "Sunscreens cause skin cancer." The few studies in question have all included mice, whose skin is quite different from humans. And it was never determined whether certain chemicals in the sunscreen caused the skin cancer or whether it was the enormous amounts of ultraviolet light the mice were exposed to. In addition, in order for the mice to reach a tumor-induced state, the levels of the sunscreen chemicals in question were enormous.

Undisputed is that all tanning causes DNA damage, whether by natural sun exposure or a tanning bed. And all DNA damage can lead to skin cancer formation. In fact, melanoma is now the number one killer of women aged 20 to 29.

Zinc oxide and titanium dioxide are referred to as physical sunscreens, since they reflect and scatter UV rays. Because they are not absorbed into the body, these are considered very safe.

In question are chemical sunscreens, because while they disperse UV rays, the chemicals can also be absorbed by the skin. Chemical sunscreens have been approved by the FDA and the American Academy of Dermatology. Yet independent research continues into possible systemic side effects of oxybenzone and avobenzone, key ingredients in many formulations. The bottom line is that no evidence-based research has ever shown that the chemicals widely used in sunscreens cause skin cancer. But research has shown that sun exposure causes skin cancer.

So my advice is not to avoid sunscreens entirely. If you're concerned, use SPF broad-spectrum zinc oxide or titanium dioxide formulations. In addition, consider lightweight sun-protective clothing and hats, UV-protective sunglasses, and shade during the hottest times of the day. Of course, if you want a truly organic option, hippo sweat has recently been shown to have superior sun protection, and as a bonus, it repels biting flies!

Claim: "Americans are deficient in vitamin D and need more sunshine." Yes and no. Americans really do need more vitamin D than they are receiving, and sunlight is efficient in producing it. Vitamin D, necessary for developing healthy bones and promoting muscle performance, is produced in the skin under ultraviolet radiation effects.

But more sunshine is not necessarily the answer. The average Caucasian living in Chattanooga, Tennessee, can get all the sunshine they need for vitamin D production in five minutes on a July afternoon. Any more time than that can reverse the benefit, increasing DNA damage.

So sorry, indoor tanning industry. I warn my patients about tanning beds and also advise them to be sensible about how much time they spend in the sun, especially without sunscreen. In the wintertime it might be wise to supplement with fortified orange juice, Total cereal, yogurt, oral supplements, and multivitamins.

Claim: "My tan protects me from sunburn and cancer." The browning of the skin, while still somewhat aesthetically pleasing in our society, is the result of the body shooting melanocytes to the surface to absorb ultraviolet light. Around 35 to 40 years of age, some sun-worshipping women will develop permanent dark patches on their face called melasma and round "liver" spots on the chest, shoulders, arms, and backs of hands. Basically, the body is saying, "Hey, you haven't been protecting me very well from the sun, so I am sending my own sunscreen out. Sorry, it's not very even and quite dark, but I need to survive."

However, this action of the skin marks a dangerous time. If during this cascade one tiny melanocytic cell "switches on" and begins to replicate, we have melanoma.

Claim: "Some moisturizers and face products cause breakouts." This is true on the simple basis that some of these products contain certain oils that can clog pores. When this happens, you get comedones, or blocked follicles, that are wonderful places for bacteria to breed. That action results in breakouts.

My advice is to look for products that are advertised as noncomedogenic. These are generally mild, soap-free, and hypoallergenic.

Claim: "Sodium laureth sulfate in shampoos is harmful." According to one bogus e-mail and multiple "healthy" or "organic" Web sites that want to justify some very expensive products, this ingredient makes cyanide look like candy. Sodium laureth sulfate (and sodium lauryl sulfate, a variation of it) is said to cause multiple irritations and reactions, including blindness, hair loss, and even cancer.

If something so prevalent were that dangerous, I would expect a large body count. But in reality, sodium laureth sulfate is a very effective and inexpensive surfactant, which means that it makes things foam. One key argument against this chemical is that while it is being manufactured, it may become contaminated by known carcinogens. The other objection is that it is found in both personal and industrial applications. But this is true of many products, including gum, water, and shortening. It is a fact that this chemical is an irritant to the eyes.

Claim: "Antiaging products are a rip-off." In the United States manufacturers do not have to demonstrate either safety or the promised action of their products before selling them. Many try very hard to meet certain standards, but legally they don't have to. So it's up to the consumer to understand what's in that lotion or cream.

In addition, the current antiaging landscape is filled with products advertised with green tea extracts (a documented photoprotective agent-or sun protector-when used orally and/or topically), lavender, chamomile, aloe, and flaxseed, just to name a few organic compounds. Does one drink it or put it on the face? What's the research and science?

Because the topic is so enormous, it's safe to say that if you like a product, think it works, and can afford it, by all means, be my guest. At least you're doing your part to keep the economy going.

But some basics remain. Retinoid (tretinoin cream .1%), a derivative of vitamin A, really does prove in study after study to be useful in the treatment of early-stage active stretch mark and wrinkle formation. Kinerase is available without a prescription and can knock down fine wrinkles, make skin smoother, and lighten darker spots. Any product with copper peptide really can induce some collagen synthesis, and over time lactic acid bases create an illusion of lessening the effects of cellulite. Glycerin and beeswax are used to moisturize skin and smooth the normally rough surface keratin.

Among longtime professional colleagues in dermatology, it is understood that the first three ingredients in any formulation are the "giveaway" to what it really is; everything else is window dressing and marketing.

More than claims

Overall, skin aging signs begin at about age 30. Surface texture changes occur due to slower cellular turnover in the epidermis (the top, outer layer). The results are fine lines, wrinkles, and dryer skin. And cushiony collagen in the dermis (the second layer from the top) decreases by 1 percent yearly after age 30. This results in decreased elasticity, deeper wrinkles, and thinner skin.

Melanocytes decrease up to 20 percent by decade, resulting in more easily obtained burns. Hair follicles stop producing hair, or, because of estrogen loss, women can experience hair growth on the face.

While you can't change your age, you can change your lifestyle. So, what are the well-researched, proven strategies for skin-care health? Here are five:

1. Avoid smoking and sun exposure. The two worst activities to prematurely age skin are unprotected ultraviolet light
exposure and smoking. Studies since 1856 have documented an affiliation between smoking and skin wrinkles. Smokers have five times more wrinkling than nonsmokers, as well as thinner skin, grayer hair, deeper wrinkles, and increased skin cancers. And we've already talked about the damaging effects of sun exposure.

2. Eat a nutritious, balanced diet that includes plenty of water. Diet impacts skin health much more than it's given credit for. Avoid excess salt, which promotes a bloated look. Whole grains, fish, red and green vegetables, citrus, and nuts are filled with the right vitamins that improve skin health. And if your body is two thirds water, don't substitute Diet Coke. Give your skin hydration through drinking water.

3. Get a good night's sleep. Those dark eye rings will respond and fade after adequate rest. Cold cucumber or potato slices for 15 minutes constrict blood vessels and are an added boost for special outings or photos.

4. Use mild soaps or soap-free cleansers daily. Strong soaps encourage extra drying, which the body compensates for with more oil output, creating a vicious cycle. So use mild soap or soap-free cleansers, then gently pat, don't rub, your face dry. When finished, apply a water-based moisturizer with 30 SPF UVA/UVB sunscreen. You can apply makeup afterward.

5. Consider a weekly exfoliation. Use either glycolic foam or wash. This routine promotes healthy hydration, creates a smoother texture, helps control annoying adult acne, allows for even moisturizing, and even stimulates collagen production. Follow with an antioxidant serum containing vitamins C and E.

Your skin is the largest organ of the body. It is assaulted by more diseases and disorders than any other system, but it was designed to be one of the most easily influenced. Take care of it, and it will take care of you.

Victor Czerkasij, FNP-C, APRN-BC, is a dermatology nurse practitioner in Cleveland, Tennessee. (For a full-length biography, you can access www.fhea.com and click on "Faculty Biographies.")

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