Wrinkles

Smoothing Out the Lines

Skin is like brand-new underwear. In the beginning, the elastic is snug and resilient, stretching and snapping right back into place. But after years of wear and tear, pulling and tugging and exposure to the elements, that elastic gradually gives, until one day . . . well, it's time to get new underwear.

Would that we could get new skin, too. Because after years of our laughing, crying, rubbing and, worst of all, sunning, our skin begins to give as well.

In fact, if it weren't for sun exposure, say the experts, our skin would stay relatively smooth into our eighties. That's why a dermatologist's first recommendation for wrinkle prevention is "Get out of the sun."

Sun exposure damages skin inside and out. First it attacks the epidermis, the thin, outermost tier of skin, forming a layer of dead cells that give skin a leathery appearance. Then it progressively damages the upper layers of the dermis, or the bulk of the skin, leaving them thinner, less resilient and more susceptible to wrinkling. Over time, the collagen and elastin fibers that form the dermis also break down, causing gradual drooping and sagging.

Fortunately, dermatologists say, the appearance of a few crow's-feet and laugh lines doesn't mean that you're on a slippery slope to Wrinkle City. By protecting yourself from the sun, shunning cigarettes and eating right, you can prevent many new wrinkles from occurring. You can also do some wrinkle erasing as well. Star players in getting rid of wrinkles once they've formed are some vitamin-derived compounds that are applied topically.

An A-Plus for Retin-A

Aside from plastic surgery, the best thing for getting rid of wrinkles is tretinoin, a vitamin A compound better known as Retin-A. No, it can't iron out deep lines, lift droops or undo severe damage, but Retin-A can erase the crow's-feet, fine lines and crinkling left by aging and the sun.

Retin-A, originally developed as an acne medication to unplug clogged pores, works against wrinkles by stimulating cell turnover, explains Retin-A creator Albert Kligman, M.D., Ph.D., professor of dermatology at the University of Pennsylvania School of Medicine and an attending physician at the Hospital of the University of Pennsylvania, both in Philadelphia. "Retin-A stimulates collagen production and blood flow into the dermis," says Dr. Kligman. "It creates tissue and makes the dermis thicker. In short, it returns skin to a more youthful condition and prevents many wrinkles from occurring."

But having heard that promise a thousand times before, you may wonder: Are the results noticeable?

Investigators at the University of Michigan Medical Center in Ann Arbor say they are. After studying 29 people who had sun-damaged skin, they reported that those who were treated for 10 to 12 months with Retin-A experienced an 80 percent increase in collagen formation compared with a 14 percent decrease in collagen formation among those using a cream not fortified with vitamin A.

Just don't try to get the same results by upping your dietary intake of vitamin A, warns Dr. Kligman. "When people try to get the same effects by megadosing vitamin A supplements, the results are almost the opposite," he says. "Their skin becomes dry and itchy, and their hair starts to fall out from vitamin A toxicity."

Retin-A cream comes in a variety of strengths, from 0.025 to 0.1 percent. It's available by prescription only, so your dermatologist can help determine which concentration is best for you. Generally, people beginning Retin-A treatment apply the lowest-dosage cream nightly or every other night until their dermatologists instruct them otherwise.

Because Retin-A removes the dead top layer of skin and exposes an area previously sheltered from evaporation and the elements, a common side effect is dry, sun-sensitive skin that can be irritated and scaly. Though both of these side effects typically diminish with time, if you're using Retin-A, you'll likely need a moisturizer. And you'll definitely need a sunscreen; once you start taking Retin-A, your days in the sun are over. Also, ask about Renova, an "updated" Retin-A with built-in moisturizer that has been approved by the Food and Drug Administration as a prescription cream.

C Is for Collagen

Though not as well-established in the antiwrinkle business as vitamin A, vitamin C, a nutrient known for its importance in the manufacture of collagen, is being touted by some experts as a key player in keeping the complexion smooth.

"Vitamin C is essential for connective tissue in the body, particularly for the layer where the collagen that maintains the integrity of your skin is made," explains Lorraine Meisner, Ph.D., professor of preventive medicine at the University of Wisconsin Medical School in Madison. "That's why people who eat adequate diets look younger than people who don't."

Dr. Meisner is quick to add that "adequate" vitamin C is not enough to prevent wrinkles. "The Daily Values are set incredibly low," she says. "They are enough to keep you from getting deficiency diseases but not enough to repair and maintain aging skin." Dr. Meisner generally recommends a daily vitamin C dosage of 300 to 500 milligrams. And if you smoke, you really need to boost your vitamin C intake, she says, because smoking appears to deplete vitamin C levels as well as promote wrinkles.

She also recommends topical use of high-concentration vitamin C preparation for people who are concerned about getting enough vitamin C into their skin through diet alone. "That's especially true for older people and for those who have a lot of sun exposure," says Dr. Meisner. "Their circulation tends to be impaired at the periphery, so it's harder for dietary vitamin C to get into the skin."

Topical vitamin C has also been shown to prevent the free radical skin damage that occurs following exposure to ultraviolet rays from the sun. Free radicals are unstable molecules that steal electrons from your body's healthy molecules to balance themselves. Unchecked, free radicals can cause significant tissue damage and contribute to premature wrinkling.

"It's possible that topical vitamin C, when used in conjunction with sunscreen, could prevent a significant amount of the wrinkling caused by sun exposure," says Douglas Darr, Ph.D., director of technology development at the North Carolina Biotechnology Center in Research Triangle Park.

A 10 percent vitamin C lotion called Cellex-C is available without a prescription from dermatologists, plastic surgeons and licensed aestheticians (full-service beauty salon operators) and by mail order from Caleel-Hayden, L.L.C., 518 17th Street, Suite 1700, Denver, CO 80202 (1-800-235-5392). It should be applied 15 to 30 minutes prior to sun exposure, along with sunscreen, for best results, recommends Dr. Meisner, one of the developers of Cellex-C.

For a burst of vitamin C in your diet, you can go the traditional orange juice and citrus route, or you can create a vegetable medley of broccoli, brussels sprouts and red bell peppers. But take note: If you want sun damage protection, don't count on being able to eat enough vitamin C, says Dr. Darr. "You can't get enough into your skin without applying it topically," he says.

Stopping Wrinkles with Vitamin E

Vitamin E, another free radical-fighting antioxidant, can also prevent skin damage from sun exposure when used topically, say researchers. But they recommend it for post-sun use rather than pre-sun use.

Vitamin E oil, applied up to eight hours after sun exposure, can prevent inflammation and skin damage, says John R. Trevithick, Ph.D., professor in the Department of Biochemistry at the University of Western Ontario in London, Ontario. But save it for after you come inside, as vitamin E itself can produce free radicals when exposed to ultraviolet light. Vitamin E oil can be bought over the counter in drugstores.

For additional sun damage protection, try taking vitamin E supplements, adds Karen E. Burke, M.D., Ph.D., a dermatologic surgeon and dermatologist in private practice in New York City. Dr. Burke recommends 400 international units daily in the form of d-alpha-tocopherol. "Although studies of oral vitamin E and wrinkles still need to be done, the supplements can help reduce photodamage and keep skin healthier," says Dr. Burke.

Vitamin E-rich foods include wheat germ, spinach and sunflower seeds.

Selenium Wrinkle Prevention

Like vitamin E, the mineral selenium quenches free radicals caused by sun exposure and prevents skin damage, says Dr. Burke. But because selenium is found in the soil and its concentrations vary nationwide, some people may get adequate amounts, while others are deficient, she says. People in the Southeast in particular tend to have low selenium levels, she notes.

For optimum skin protection, Dr. Burke recommends daily supplements of 50 to 200 micrograms of selenium (preferably the l-selenomethionine form), depending on where you live and your family history of skin cancer. Because selenium can be toxic in doses of more than 100 micrograms daily, it's best to supplement high amounts only under medical supervision.

For a big dietary boost of selenium, reach for tuna, as one three-ounce can packs 99 micrograms. Other good sources include garlic, onions and broccoli.

Dr. Burke is developing a selenium cream that she says will "work even better than Retin-A in reversing photoaging." (For more details on using nutrients to protect yourself from sun damage, see page 521.)