A dermatologist is a physician who specializes in the treatment of skin conditions and diseases. Dermatologists are certified by the American Board of Dermatology after extensive education and medical residency. They treat everything from minor skin rashes, like hives, to chronic skin diseases, such as eczema or psoriasis. Dermatologists are good diagnosticians and can distinguish between conditions that share similar symptoms. Today many dermatologists are also well versed in cosmetic dermatology procedures to help improve the appearance of skin as we age.
Skin. It is the largest organ on the human body. It creates a protective layer against heat, light, the environment, injury and infection. It helps regulate the body’s temperature; stores water, fat and Vitamin D; prevents entry of bacteria; and acts as a sensory organ. On average, an adult has between 18 and 20-square feet of skin, which roughly weighs six pounds.
There are three layers to skin:
Epidermis. This is the outer most layer that sloughs off dead skin cells and acts as a protective barrier against foreign bodies, infections and the sun. The epidermis also contains the cells (melanocytes), which are responsible for skin pigmentation.
Dermis. The middle layer of skin, the dermis houses hair follicles, sebaceous (oil) glands, sweat glands, capillaries (small blood vessels) and lymph vessels. It is held together by a protein called collagen. Sweat glands are part of the body’s cooling system. The dermis also contains touch and pain receptors.
Subcutaneous. This is the deepest layer of skin containing larger blood vessels and nerves. It is made up of a network of collagen and fat cells and plays an important role in the manufacture of Vitamin D, protecting against injury and conserving body heat.
The skin is the body’s largest organ and accounts for roughly 18% of an adult’s weight. It serves as a protective outer layer that keeps in moisture and keeps out invasive organism (like infections). It protects our organs against injury. It also helps regulate the body’s temperature and has self-healing capabilities.
The best way to maintain healthy skin is to prevent skin damage from occurring in the first place. Wrinkles, age spots and leathery patches are all the result of skin damage from overexposure to ultraviolet radiation from the sun. But the aging process for skin is unavoidable. As we age, skin becomes dryer and thinner. Repeated movements of facial muscles, such as frowning, smiling or squinting, cause wrinkles over time. Stress, gravity and obesity also contribute to aging skin. And because the skin is thinner, it is more susceptible to bruising.
The premature aging of the skin from ultraviolet light exposure is called photoaging. Photoaging occurs when ultraviolet radiation penetrates deep into the dermis, damaging collagen fibers and causing the increased production of abnormal elastin. This breakdown in fundamental skin structures leads to deep wrinkles, fine lines, discoloration of the skin (age or liver spots), leatheriness and sagging skin.
Skin Care Routine
A healthy skin care routine throughout life can reduce the symptoms of aging in the skin. Be sure to:
- Wash your face using a gentle cleanser and lukewarm water twice a day.
- Pat skin dry; don’t rub it dry.
- Exfoliate the skin twice a week to remove dead cells.
- Apply a moisturizer to skin immediately after a shower or bath.
- Wear sunscreen with a SPF of at least 15 every day.
- For women who wear makeup, be sure to leave time each day when the skin is clean and free of makeup.
- Do not use tanning beds.
- Maintain a healthy diet and drink lots of water.
- Get an adequate amount of sleep every day.
- Quit smoking.
- Avoid stress.
- Conduct a monthly self-examination of your skin to detect any changes that might lead to cancer.
- See your dermatologist once a year.
Beyond prevention, in today’s world there is a wide range of options for slowing down the affects of aging on the skin. See the Cosmetic Dermatology section of this website for more information about:
- Chemical peels
- Laser Resurfacing
Anyone who has a break in the skin is at risk for an infection. There are three types of skin infections:
There are many bacteria that live on the surface of healthy skin. But with a break in the skin, these bacteria can invade the outer layer of skin and cause an infection and rash. Staph is a common cause of bacterial infections of the skin. Impetigo is one of the most common causes of skin infections in children. Oral or topical antibiotics are used to treat bacterial skin infections.
Viruses are parasitic organisms that can live and grow inside living cells. They cause either a degeneration or a proliferation of the cell. Most causes of viral skin infections are either from Human Papilloma Virus, which causes warts, or Human Herpes Virus, which causes cold sores, chicken pox, shingles, genital herpes and mononucleosis. Viruses do not respond to antibiotics. Generally, medications are prescribed to help alleviate the symptoms of the infection, such as a rash or itch. Additionally, vaccinations are used to prevent viral infections.
Fungal infections of the human body are called mycoses and affect only the outer layer of skin. Although seen in all areas of the body, skin mycoses most frequently appear as yeast infections, thrush, athlete’s foot or jock itch.
Because of the ultraviolet radiation it emits, the sun is inherently dangerous to human skin. In fact, the American Academy of Dermatology stipulates that there is no safe way to tan. Tanning is the skin’s natural response to damage from the sun. Additionally, the Environmental Protection Agency proclaims that everybody, regardless of race or ethnicity, is subject to the potential adverse effects of overexposure to the sun. That’s why everyone needs to protect their skin from the sun every day.
How We Burn
When ultraviolet light penetrates the epidermis it stimulates melanin, the substance responsible for skin pigmentation. Up to a point, the melanin absorbs dangerous UV rays before they do serious damage. Melanin increases in response to sun exposure, which is what causes the skin to tan. This is a sign of skin damage, not health. Sunburns develop when the UV exposure is greater than the skin’s natural ability to protect against it.
Sunscreens and Sunblocks
The sun emits two types of ultraviolet (UV) rays that are harmful to human skin. UVA rays penetrate deep into the dermis and lead to wrinkles, age spots and skin cancers. UVB rays are responsible for causing sunburn, cataracts and immune system damage. Melanoma is thought to be associated with severe UVB sunburns that occur before the age of 20.
Sunscreens absorb ultraviolet light so that it doesn’t reach the skin. Look for sunscreens with the active ingredients PABA, benzophenones, cinnamates or salicylates. Sunblocks literally block the UV rays instead of absorbing them. Key active ingredients for sunblock success are titanium oxide and zinc oxide.
There is no sunscreen or sunblock that works 100%. The U.S. Food and Drug Administration regulates the manufacture and promotion of sunscreens. Sunscreens are given a SPF (Sun Protection Factor) number that indicates how long a person can remain in the sun without burning. It is recommended that people use products with a SPF of 15 or greater. Sunscreens are not generally recommended for infants six months old or younger. Infants should be kept in the shade as much as possible and should be dressed in protective clothing to prevent any skin exposure and damage.
There is no such thing as “all-day protection” or “waterproof” sunscreen. No matter what the SPF number, sunscreens need to be re-applied every 2 to 3 hours. Products that claim to be “waterproof” can only protect against sunburn up to 80 minutes in the water. Products labeled “water resistant” can only protect against sunburn up to 40 minutes in the water.
Even in the worst weather, 80% of the sun’s UV rays can pass through the clouds. Additionally, sand reflects 25% of the sun’s UV rays and snow reflects 80% of the sun’s UV rays. That’s why sunscreen needs to be worn every day and in every type of weather and climate. The sun’s intensity is also impacted by altitude (the higher the altitude the greater the sun exposure), time of year (summer months) and location (the closer to the Equator, the greater the sun exposure).
Protecting Yourself From Sun Exposure
- Look for sunscreens that use the term “broad spectrum” because they protect against both UVA and UVB rays.
- Choose a sunscreen with a minimum SPF rating of 15.
- Apply sunscreen 15 to 30 minutes before you head out into the sun to give it time to seep into the skin.
- Apply sunscreens liberally. Use at least one ounce to cover the entire body.
- Use a lip balm with SPF 15 or greater to protect the lips from sun damage.
- Re-apply sunscreen immediately after going into water or sweating.
- Re-apply sunscreen every 2 to 3 hours.
- Use sunscreen every day regardless of the weather.
- Wear sunglasses to protect the eyes from UV rays.
- Wear wide-brimmed hats and protective clothing to limit skin exposure to the sun.
- Stay in the shade whenever possible.
- Avoid using tanning beds.
Treating a Sunburn
If you experience a sunburn, get out of the sun and cover the exposed skin as soon as possible. A sunburn will begin to appear within 4 to 6 hours after getting out of the sun and will fully appear within 12 to 24 hours. Mild burns cause redness and some peeling after a few days. They can be treated with cold compresses on the damaged area, cool baths, moisturizers to prevent dryness and over-the-counter hydrocortisone creams to relieve any pain or itching. It is also important to drink plenty of fluids when you experience any type of sunburn.
More serious burns lead to blisters, which can be painful. It is important not to rupture blisters as this slows down the natural healing process and may lead to infection. You may want to cover blisters with gauze to keep them clean. Stay out of the sun until your skin has fully healed. In the most severe cases, oral steroids may be prescribed to prevent or eliminate infection along with pain-relieving medication.
According to the American Academy of Dermatology and the U.S. Department of Health and Human Services, ultraviolet (UV) radiation from tanning beds, tanning booths and sun lamps are known carcinogens (cancer-causing substances). Exposure to UV radiation during indoor tanning has been proven to increase the risk of all skin cancers, including melanomas, squamous cell carcinomas and basal cell carcinomas. In fact, the risk of melanoma increases by 75 percent when indoor tanning devices are used before the age of 30. The UV radiation during indoor tanning also leads to skin aging, hyper – and hypopigmentation, immune suppression and eye damage, such as cataracts.
Therefore, the use of tanning beds, tanning booths and sun lamps is not recommended by dermatologists.
A tattoo is created by injecting ink into the dermis (the second layer of skin) to incorporate a form of skin decoration. Tattooing is practiced worldwide and has often been a part of cultural or religious rituals. In Western societies today, tattooing has re-emerged as a popular form of self-decoration.
Technically, a tattoo is a series of puncture wounds. An electric device uses a sterilized needle and tubes to penetrate to a deeper layer of skin and inject ink into the opening it creates. The tattoo machine moves the needle up and down between 50 and 3,000 times per minute. The machine’s operator, a tattoo artist, will use a flash or stencil of the design you select. Typically the design is outlined in black, shading is filled in and then solid areas of color are completed.
Any puncture wound is susceptible to bacterial or viral infection, which is why it is imperative that you work with a licensed tattoo artist who adheres to stringent infection control standards. Single-use needles and disposable materials should be used in conjunction with sterile procedures, such as the artist wearing latex gloves, cleaning the affected area after each stage of tattooing and using an autoclave to sterilize any materials or equipment that is re-used.
After the tattooing is completed, it is important to care for the damaged skin until it fully heals. Keep a bandage on the area for at least the first 24 hours. Wash the tattoo with antibacterial soap once daily and gently pat it dry. Avoid touching the tattoo and don’t pick at the scabs as they form. You can also use an antibiotic ointment to help prevent infection. Do not use petroleum jelly because it may cause fading. If you experience redness or swelling, put ice on the tattoo. Keep your tattoo away from water and out of the sun until it has completely healed.
Complications from tattoos generally involve either an infection or an allergic reaction to the ink. If you have a skin condition, like eczema, you should probably avoid getting any tattoo.
A tattoo is designed to last for a lifetime. However, if your feelings about a tattoo change over time, there is a laser removal technology. The process tends to be expensive, requires multiple visits and can be painful. Essentially, the laser’s energy is aimed at pigments in the tattoo. The laser emits short zaps of targeted light that reach the deeper layers of the skin. This stimulates the body’s immune system to remove the pigment. It is critical that the procedure be handled in a sterile manner in order to prevent infection. Home care following laser removal treatments is similar to the care recommended for getting a tattoo.