Radiant Skin

Not only is skin our largest organ, but it is also our body’s first line of defense against unwanted bacteria and pathogens. It’s worth caring for, and two aims are key- promoting radiant skin and preventing cancer. Many auto-immune conditions and endocrine diseases impact the skin’s health. In this article, two dermatologists share what they wished everyone knew about the skin.

Tobacco Trouble

Tobacco smoke is linked to cancer, emphysema, and heart disease. Ongoing studies implicate smoking as associated with wrinkles, premature skin aging, and delayed wound healing from injury, surgery, and ulcerations from arterial disease including diabetic foot ulcers.^1,2 Additionally, several autoimmune skin disorders such as psoriasis,^3,4,5 cutaneous (discoid) lupus erythematosus,⁶ and other skin conditions^7,8 are also associated with or exacerbated by tobacco use. Smoking also delays wound healing of the skin. Clearly, avoidance of tobacco is one good way to take care of your skin.

Sun Savvy

However, the sun’s effect on the skin is another story altogether since adequate sun exposure is health-producing; it is the excess that causes harm. The sun’s rays are strongest between 10 am-4 pm in the northern hemisphere, so the skin burns more easily during these hours.⁹ Sunlight emits ultraviolet rays that affect human health. These rays include what are termed UVA, UVB, and UVC. UVA is associated with skin damage and accounts for about 95% of the UV rays reaching the earth’s surface since they are minimally affected by the atmosphere. UVB rays are the “tanning” and the “vitamin D-producing” rays.

These rays are partially blocked by the atmosphere, especially by clouds. Valuable UVC rays are known to have germicidal properties and rarely reach the earth since they are effectively blocked by the atmosphere. Sun exposure on cloudy days is often overlooked, however. Clouds and windows block UVB rays but are permissive to UVA rays. UVA rays tend to cause photo damage to the skin without producing visible tan or burn. Accordingly, skin protection from excessive sun exposure is essential even on cloudy days.

Fair-skinned people with light-colored hair and eyes have the greatest risk of photodamage because they have the least amount of skin pigmentation. Many people may believe they tan easily when in fact they are just burning themselves repeatedly. People with naturally darker skin tones do have some protection from photodamage, but the risk of sun-related skin conditions is still significant enough to warrant caution. Situations that promote excessive sun dosing include snow, sand, and water exposure because the sunrays reflect strongly off these surfaces. Intensive intermittent sun exposure during childhood is a risk factor for basal cell carcinoma and melanoma, while the accumulative lifetime UV exposure increases danger of squamous cell carcinoma.¹⁰ Sun exposure at any point in life damages the skin’s matrix and collagen, leading to laxity or looseness, lines, freckles, wrinkles, and the red, visible blood vessels called telangectasias.^11,12 The risk for skin cancer is still significantly present for darker, skinned individuals.

What About Sunscreen?

Although quality has improved dramatically and the varieties multiplied over the years, remember that a typical sunscreen only blocks UVB rays; so while you might not get visibly sunburned, UVA damage can still occur.

When selecting a sunscreen, look for one that affords broad-spectrum coverage and an SPF 30 or greater. Broad-spectrum indicates protection from both UVA and UVB rays, while SPF (sun protection factor), is a calculated measure of the UVB (but not UVA) screening capability. Additional options include “physical” and “chemical” sunscreens.

Physical sunscreens, which contain titanium dioxide or zinc oxide, literally block sunrays; chemical sunscreens absorb the sun rays. The only FDA-approved chemical sunscreen with broad-spectrum coverage is avobenzone. The protective power of the sunscreen is listed as its sun protection factor, or SPF. It is a calculated indicator of UVB protection (not UVA)—the higher the number, the greater the protection. The UV Index is a public health indicator of the level of UV radiation in a given vicinity and ranges from 1 to 10-plus.

Adults need about two tablespoons of sunscreen to adequately cover their face, neck, arms, and legs. It is crucial to reapply if outside for longer than a couple of hours, for although the SPF indicates how effective the sunscreen is at filtering out the sun rays, all sunscreens lose most of their effectiveness after a couple of hours.^13,14 (Editor Note: Mineral based, natural sunscreens are superior and safer to use than chemically based sunscreen.)

While sunflower and sesame seed oils have excellent sun-blocking abilities, the most common “skin product” in the tropics is coconut oil. It is not a sunscreen but apparently diminishes free radical damage caused by the sun while permitting the UV to attend the vitamin D production in the skin.

The Role of Diet

What you eat significantly impacts the health of your skin. Three key plant nutrients include vitamin E, flavonoids, and carotenoids. Vitamin E is an antioxidant, especially for the fats comprising the cell membranes of our skin cells. Studies show that skin vitamin E levels decrease with UV exposure. Vegetable greens, pumpkin and sunflower seeds, whole grain and fortified cereals, tomatoes, avocados, and nuts— especially almonds—are high in vitamin E.

Flavonoids are also antioxidants and have been associated with decreasing melanoma rates and skin damage. Citrus, decaffeinated green tea, berries, and almonds are rich in flavonoids.¹⁵ (Decaffeinated green tea contains the same level of flavonoids as does caffeinated, but without the harmful effects of caffeine.)

And now for the three especially important carotenoids: beta-carotene, lycopene, and lutein. Beta-carotene, a precursor of vitamin A, inhibits free radical formation and fat oxidation. Carrots, yams, orange or yellow fruits, and leafy greens are excellent sources of beta-carotene. Lycopene is the most efficient carotenoid in managing unstable oxygen. Tomatoes are especially dense in lycopene, but other red fruits and vegetables also contain high levels. Studies support not only its role in minimizing sun damage, but also show decreased skin roughness.¹⁶ Lutein is well known for its role in eye health, but is essential in skin care as well. It is a potent antioxidant and even absorbs blue light. Studies support its role in UV protection, decreased oxidative damage, and decreased skin wrinkling. Leafy greens, broccoli, and peas are rich sources. While dietary sources are more potent than creams, there is an increased benefit in using both.¹⁷

We will mention one more noteworthy affiliate of the carotenoid family, that of retinoic acid. Along with sun protection and tobacco avoidance, this naturally occurring vitamin A compound is the most documented as promoting skin longevity.

Vibrantly-colored fruits and vegetables such as carrots, cantaloupes, dark green leafy vegetables, squash, mangoes, apricots, and papayas are all rich sources of retinoic acid. It has been proven to reduce fine lines and skin coarseness and help prevent actinic keratosis, a precursor to squamous cell skin cancer. Many over-the-counter skin products contain this compound in low concentrations. Higher concentrations are available by prescription due to its potentially harmful effects in supplemental form. Topical use appears safe but is discouraged during pregnancy because of its mutagenic properties.

Nurture It Nicely

Proper skin hygiene is important because it minimizes inflammation and optimizes the skin’s natural functions. Inflammation can lead to itching, a rash, or even skin breakdown. Too little or too much washing, injudicious use of skin products or harsh soaps can cause irritation, damage, and dryness. While showering or bathing once a day is recommended, many people have sensitive skin that reacts to soap fragrances even with once-per-day use. Some brand-name dual skin cleansers and moisturizers contain ceramides, naturally occurring fats that undesirably coat the skin. Mild, soft, plant-based neutral soaps without fragrance are often the least irritating.

Moisturizing the skin immediately after showering is most effective. The skin’s pores are open then, and the natural oily layer atop the skin has just been washed off. As people age, their skin tends to produce less oil, leaving them more prone to dryness, which produces irritation and itching. Many skin problems can be greatly helped by simply maintaining well-moisturized skin.

Creams are stronger moisturizers than lotions because they have a higher oil-to-water ratio. If oiliness of creams bothers you, try applying it before going to bed. (Use caution against slipping if applying oily moisturizers to the soles.) Applying plant-derived glycerin just after a warm shower could help in moisturizing the skin, but it should be used with caution during hot and humid days. Topically applied food-grade glycerin remains on the skin longer than animal-based glycerin.

Summing It Up

If you smoke, STOP! Get help as needed. If you don’t smoke, don’t start! Get enough sunlight but not too much—clouds may not protect you from photo damage. Use sun blockers or sunscreens if you need to, and with product moisturizes, it can do double duty. There is no substitute for proper hygiene and hydration, but avoid too-frequent washing. Use mild, natural, unscented soaps to wash and plant-derived glycerin after showers. Eat a skin-healthy diet. You’ll feel better and look better too!

1. Vander Straten M. Tobacco use and skin disease. Southern Medical Journal 2001; 94: 621-34. [↩]
2. Mills, CM. Smoking and skin disease. International Journal of Dermatology 1993; 32 (12): 864-865.[↩]
3. Shahrad M.(2005). Smoking and Psoriasis. SKINmed; 4 (3): 174–176. [↩]
4. Liu Y. Psoriasis: genetic associations and immune system changes. Genes Immun. 2007; 8:1–12. [↩]
5. Naldi L. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005; 125:61–67.[↩]
6. Miot HA. Association between discoid lupus erythematosus and cigarette smoking. Dermatology 2005; 211:118–122[↩]
7. Kurzen H. What causes hidradenitis suppurativa? Exp Dermatol 2008; 17: 455–472. [↩]
8. Hana A. Functional significance of non-neuronal acetylcholine in skin epithelia. Life Sci. 2007; 80(24-25): 2214–2220. [↩]
9. Kullavanijaya P. Photoprotection. J Am Acad Dermatol 2005; 52:937–958.[↩]
10. Jou PC. UV immunosuppression and cutaneous malignancies. Expert Rev Dermatol 2011; 6:61–74.[↩]
11. Yano K. Ultraviolet B irradiation of human skin induces an angiogenic switch that is mediated by upregulation of vascular endothelial growth factor and by downregulation of thrombospondin-1. Br J Dermatol 2005; 152:115–121. [↩]
12. Rabe JH. Photoaging: mechanisms and repair. J Am Acad Dermatol 2006; 55:1–19.[↩]
13. Moloney FJ. Sunscreens: safety, efficacy, and appropriate use. Am J Clin Dermatol 2002; 3: 185. [↩]
14. Faurschou A. The relation between sun protection factor and amount of sunscreen applied in vivo. Br J Dermatol 2007; 156:716. [↩]
15. Evans JA. The Role of Phytonutrients in Skin Health. Nutrients 2010; 2(8):903-928.[↩]
16. Evans JA. The Role of Phytonutrients in Skin Health. Nutrients 2010; 2(8):903-928.[↩]
17. Evans JA. The Role of Phytonutrients in Skin Health. Nutrients 2010; 2(8):903-928.[↩]