Your skin is a storyteller – not just of your health and mood, but also the influence that time and environment has on you. Expert inputs from Dr. Divya Sharma. Illustrations by Kanupriya Singh

All your life, your skin has been making a first impression for you. It can reveal whether you’re hot or cold, tired or rested, sick or healthy. As you age, your skin changes in response to the elements that assail it, particularly the sun and more importantly your inner health. Skin is a very dynamic organ and is very sensitive to changes in the inner microenvironment as well as external agents. Over the years, everyday stresses and exposures alter your skin’s tone, texture, and contour.

When it comes to skin treatments, there’s lots of good news regarding therapies for medical conditions as well as cosmetic concerns. Nonetheless, it is important to choose your treatments with care and to thoroughly check and double-check the reputation and accreditation of clinicians performing invasive skin procedures. In the next few issues of Good Vibes, I will try to collect as much information as I can and share it with you. Once I learnt that skincare has an important role in health span, I did a small online course to understand some science and what modern medicine has to offer about Skincare from the Harvard Medical School. I worked along with my dermatologist Dr Divya Sharma to write a couple of newsletters on this subject. Also, she has agreed to do one space in the coming weeks on this subject.

Please note: The information provided in this newsletter is not medical advice, nor should it be taken as a replacement for medical advice. I am not a medical Doctor, so I don’t prescribe anything. Most of the tools suggested are based on scientific research and/or my experiments with them. Your healthcare and your well-being are your responsibility. Anything we suggest here, please filter it through that responsibility.

The Basics

Often overlooked, the skin serves as much more than a simple protective covering. Weighing in at approximately nine pounds, it is the body’s largest organ and performs multiple functions that contribute to overall health.

At a basic level, the skin acts as a defensive barrier, shielding internal organs from harmful external agents such as viruses and bacteria. However, the outermost layer of skin contains Langerhans cells that actively combat infections, acting as the front-line defenders of the immune system.

In addition to its protective properties, the skin is also a sensory organ. Nerve endings located near the surface of the skin pick up and transmit information about the surrounding environment to the brain. This enables the brain to interpret sensations such as heat, cold, touch, pressure, and pain. For example, if you touch a hot surface, warning signals cause an instant reaction, preventing further damage. Similarly, if the environment is too hot or too cold, the skin signals the need for a fan or a sweater. The skin also contributes to temperature control by dilating blood vessels and sweating when hot and constricting blood vessels to preserve heat when cold.

Lastly, the skin plays a crucial role in manufacturing vitamin D, which is essential for many bodily functions. Using the sun’s energy, the skin produces this vital nutrient.

Time takes its toll. As the years go by, our skin undergoes several biochemical changes. For one, epidermal cells don’t slough off as easily, and the supportive fibres of collagen and elastin in the dermis break down. The deterioration of collagen and elastin and the pull of gravity can result in some of the classic signs of skin ageing: fine lines around the eyes, deepened expression lines at the corners of the mouth and across the forehead, and sagging skin. The nails usually become more brittle, and hair may begin to thin and turn grey from decreased pigment production.

Age-related bone loss in the skull also affects your appearance. Many people develop smile lines, which run from each side of the nose to the corner of the mouth. These lines are not merely a result of drooping skin; they’re actually due to underlying changes in facial fat pads. The same is true for marionette lines, which run from the corners of the mouth to the chin. Ironically, though we gain fat everywhere, the face seems to lose fat pads leading to ‘sagging skin’.

Skin changes in many more ways than just fine lines and wrinkles. With ageing, skin doesn’t retain as much moisture as it once did and hence aged skin looks coarser. Its ability to fight infection, feel sensations, and regulate body temperature also diminishes. A part of the ageing process is genetic. The breakdown of collagen and elastin that leads to droopy, lax skin occurs at different rates in different people.

My conversations with Dr Divya Sharma

Q- What is skin ageing?

Dr Divya– Intrinsic ageing is an inevitable process which is natural and no one can escape that while extrinsic ageing results from exposure to environmental factors such as air pollution, smoking, poor nutrition, and sun exposure. Intrinsic ageing is visible as thin, dry skin while extrinsic ageing manifests as coarse wrinkles and uneven textured skin. Sun exposure perhaps is the most important factor in preventing extrinsic ageing.

Q- What is the microscopic difference between intrinsically aged skin and prematurely aged skin?

Dr Divya– The intrinsically aged skin shows a decrease in the size of the basal layer (mother cells which continue to replicate and skin regrows) and this reduces the contact between the epidermis and dermis. This leads to a decrease in nutrition supply and hence, cellular ageing or natural ageing. There is a decrease in the ability to retain water as collagen and certain natural humectants decrease in size and quantity.

In skin which is ageing faster or prematurely due to environmental exposure, there is a thickening of the epidermis and this leads to the uneven texture of the skin. There is a decreased contact between the epidermis and dermis leading to wrinkles and an increase in elastotic tissue which leads to a waxy appearance. Prematurely aged skin will look coarse, and uneven and may show more prominent open pores.

Q) Which is the single most important factor deciding extrinsic ageing?

Dr Divya– Sun exposure or UV exposure contributes to 80% of extrinsic ageing and hence sunscreen is a must for every skin type to delay ageing. Even if you are indoors, sunscreen application is a must. Chase the right formulation but never give up on sunscreens!

Q) What kind of daily routine helps prevent or delay skin ageing?

Dr Divya– Skin is a dynamic organ – Like any other organ your skin is subject to continuous internal and external assaults. Hence. it may change its type and characteristics as your body changes. Gaining weight is one of the easiest slides to go down in your skin health. Weight gain not only ages you faster but increases pigmentation.

Refined sugars and processed foods increase oxidative stress and hence, cause premature ageing. Avoid high carbohydrates in your diet every day to keep your liver healthy and hence skin happy.

Sleep is essential for skin to regenerate itself and hence is a must for delaying ageing

Q) What skin products are most essential for delaying skin ageing?

Dr Divya– Gently cleanse daily but avoid exfoliation and over-scrubbing. You should use a cleanser best suited to your skin type and outside weather.

Sunscreen- The quintessential anti-ageing skincare routine. One has to test various formulations prescribed by his/her Dermatologist before one gets the most aesthetically pleasing sunscreen that one likes to wear every day. Do that effort to delay skin ageing.

Hydration- It is a must to delay skin ageing. Apart from using moisturisers that improve the barrier like ceramides to hyaluronic acid-containing moisturisers in mature skin, all tend to compensate for the loss of natural hydration that takes place in dry skin.

Retinoids- As a molecule, it increases skin cell replication and helps in collagen remodelling to some extent. Very dry and sensitive skin may not be the best candidate for a retinoid-based routine. There are certain alternative options available for retinol-sensitive skin like bakuchiol or retinol-hyaluronic acid combinations.

Vitamin C- Along with vitamin E and ferulic acid, does work as a topical antioxidant and delays oxidative stress. Although there are many options available, very few are stable and actually deliver what they promise. Choose a stable formulation and always a small bottle, as Vitamin C tends to oxidise very fast once the bottle is open. It causes a mild stinging sensation in sensitive skin sometimes.

Dr Divya Sharma is a renowned dermatologist and trichologist based out of Bengaluru. She is on the scientific committee of various national regional dermatology congresses and is often invited as faculty to the Indian Academy of Dermatologists, Venereologists and Leprologists (IADVL), Association of Cutaneous Surgeons of India (ACSICON) national conferences. A member of IADVL special interest group (SIG)- Aesthetics. She runs her own practice, Dr Divya’s Skin and Hair solutions in Bengaluru and may be reached through her website can connect with her on Twitter @divya_sharmaMD

For daily skincare, limit your regimen to three simple steps: cleaning, protecting your skin from the sun, and tending to any specific skin problems you may have such as dry skin, acne, or fine lines and wrinkles. Products for all three steps are available for very little cost at retail stores. Buying expensive skincare lotions with exotic or pseudoscientific names will not produce better results.

1. Clean your skin. Choose your skin cleanser based on whether your skin is dry or oily. If you have dry skin, choose a mild cleaning agent and avoid products including toners that contain alcohol. For oily skin, choose a face wash/cleanser that removes excess oil and reduces shine. Facial blotting sheets are inexpensive and effective options for absorbing excess skin oil. They are preferred over washing our face multiple times which actually increases oil secretion

2. Protect your skin from the sun. Choose a broad-spectrum sunscreen with an SPF of 30 or higher and wear it every day. Higher SPFs are useful if you plan to spend hours outdoors, but if you spend most of your time indoors, SPF 30 is generally sufficient. If you have skin that’s easily irritated, choose a sunscreen designed for sensitive skin. There are gel, lotion and aqua fluid formulations for oily, dry and combination skin. It is a myth that sunscreen causes pimples or causes darkening. Ask your Dermatologist to prescribe the right formulation

3. Treat your particular skin needs. For dry skin, effective and inexpensive moisturisers are available. The first line of defence against dry skin is a moisturiser that softens and smooths skin with water and lipids (fats). Some moisturisers attract water to the skin and seal it in, while others prevent skin from losing water by coating it with a thick, impermeable layer.

For acne-prone skin, the first line of treatment usually falls into one of these two categories:

Salicylic acid washes: These formulas loosen dead skin cells and help dislodge plugs from pore openings, seen as whiteheads and blackheads. Salicylic acid washes are available in over-the-counter and prescription formulations. Avoid using salicylic acid if your skin is sensitive which can happen in a few patients with adult acne.

Benzoyl peroxide gels, lotions, and washes: These products reduce inflammation, and bacterial load and may help clear blocked pores. They are available in over-the-counter and prescription versions. They can induce side effects such as dry and peeling skin if the formulation is too strong or is used excessively, or if a person has very sensitive skin. Use a good moisturiser to keep the skin barrier normal while using these products. Very strong preparations can cause bleaching of the skin sometimes.

If you want to try a product that moderately reduces lines and wrinkles or fades brown spots, a variety of products that you can use daily are available. A few cosmeceuticals show some promise in protecting against the effects of ageing and photo-damage. Studies demonstrate that they smooth skin texture, diminish wrinkles and age spots, and reduce the yellow hue that comes with age. Consult your dermatologist who can guide and prescribe such treatments that are suitable to your needs.

How to do a Skin Self-Exam

To detect skin cancer early, examine your skin all over your body and watch for changes over time. By checking your skin regularly, you’ll learn what is normal for you. The best time to check your skin is after a shower or bath. Use a full-length mirror and a hand-held mirror in a room with plenty of light. If you find anything unusual, see your doctor.

The National Cancer Institute in the USA recommends these steps to check yourself from head to toe:

  1. Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move your hair so that you can see better. It may be hard to check your scalp by yourself, so consider asking a relative or friend to check through your hair.

  2. Look at the front and back of your body in the mirror. Then, raise your arms and look at your left and right sides.

  3. Bend your elbows. Look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.

  4. Check the back, front, and sides of your legs. Also, check the skin all over your buttocks and genital area.

  5. Sit and closely examine your feet, including your toenails, the soles of your feet, and the spaces between your toes.

Learn where your moles are and their usual look and feel. Check for anything different, such as

  • a new mole (that looks different from your other moles)

  • a new red or darker-coloured flaky patch that may be a little raised

  • a change in the size, shape, colour, or feel of a mole

  • a sore that doesn’t heal

  • a new flesh-coloured firm bump.

Write down the dates of your skin self-exams and make notes on how your skin looks on those dates. You may find it helpful to take photos so you can check for changes over time.