Skin Rejuvenation Bhattarai sl, Rijal A2, Sapam R3

Assistant Proffesor1, Associate Professor, Department of Dermatology and Venereology, B. P. Koirala Institute of Health Sciences, Dharan. Junior Consultant Dermatologist3, Imphal Hospital & Research Centre.

Introduction N on-surgical therapy: Massage, face packs and To become old without looking old has been a masks, iontophoresis, micro current therapy. dream almost as old as mankind. Skin in old age Surgical therapy: Chemical peeling, radio -whether the result of decades of life or artificially surgery, dermabrasion, micro dermabrasion, aged by excessive sun exposure, smoking, and lasers, dermal fillers, botox, and face lifts. other noxious influences - looks wrinkly, lax, shallow, without sheen, and with blotches and Pharmaceutical products and procedures for wrinkles, telangiectasia, and pigmentary the elderly irregularities. 1 Non Surgical methods Skin aging is a continuous time-dependent and multifactorial phenomenon of reduction in size Sunscreens and sunblocks and number of cells and reduction in the rate of The sunscreen agent is thought to prevent cellular many organic functions, both at the cellular and damage and thus prevent dehydration. It may molecular levels. Many skin functions decline bechemical, physical, or a combination of both. with age, such as cell replacement, injury response, It can cause an apparent reversal of some barrier function, chemical clearance, sensory photo aging and keep the skin youthful looking by perception, immune and vascular responsiveness, 6 formation of neocollagen and new elastic fibres. - thermoregulation, sweat production, sebum 11 production, and vitamin D production.2-5 That is why it is worth to keep researching cosmetic Moisturizers and keratolytic agents products and procedures for the elderly because The continuous loss of water content of the stratum as said by Irene Ravache, a famous Brazilian corneum through evaporation on the surface to actress, "only those who die early don't age," and the environment leads to xerosis. The cells by Mario Quintana, one of the most well-known accumulate, giving the skin a white and scaling Brazilian poets, "aging is wonderful because the aspect. However, xerotic skin is due to more than other option is worse ... ,,5 simply low water content, and electron Besides, multiple other factors affect the way skin micrographic studies demonstrate a thicker, ages: heredity, sun exposure, chronologic age, fissured, and disorganized horny layer. This emotional stress, repeated weight gain and loss, characteristic tends to increase with age due to a 6 8 diet/nutritional' supplements, and exercise. - decrease in the inherent water content of the stratum Rejuvenation is a recent concept in cosmetology corneum, and probably an abnormal desquamatory that encompasses the entire gamut of therapy process is also present. Moisturizers decelerate available to preserve and return a youthful the loss of humidity from the surface of skin by appearance to the skin. It has been dominated by deposition of an oil film, avoiding evaporation; the manipulation of the dermal layers to correct help minimize the aspect of fine wrinkles; and the effects of aging. maintain appropriate level of skin humidity.12-13 There are many moisturizing agents, such as The rejuvenation programme consists of the use hydrocarbon oils, silicone oils, vegetable and of following modalities alone or in combination. animal fats, fatty acids, fatty alcohol, polyhydric alcohols, phospholipids, and sterols, among others. Protection from extrinsic factors Keratolytic agents act in the xerosis of the elderly Daily skin care: Cleansing and moisturizing. by preventing accumulation of excessive stratum Habits: Adequate sleep and fluid intake, corneum and removing the cohesive attachment reduce/avoid smoking and alcohol. of the cornified cells. The oldest keratolytic agent Adequate therapy and antioxidants. is salicylic acid, a betahydroxy acid. Others are Cosmetic camouflage: an effective means of propylene glycol, retinoic and glycolic acids, concealing ageing skin problems. propylenoglicol in water, and lactic acid, which Cosmeceuticals: Alpha hydroxy acids, also act as moisturizers. 12,14,15 g tretinoins, hydroquinones and vitamin c. Topical application of retinoids and analogs are sebum secretion, so their regular use should prevent used for aging skin and the ones currently available dry skin and skin wrinkling.31 Hormone are retinol, retinaldehyde, retinoic acid, isotretinoin, replacement therapy contains two main ingredients: adapalene, and tazarotene. 16-23 estrogens and progestagens. Hormone therapy was shown to significantly improve parameters Antioxidants involved in skin aging such as hydration, elasticity, Ultraviolet A light acts indirectly through and skin thickness. These findings support the generation of ROS, as well as UVB light, which clinical impression that an early hormone also generate ROS by induction of DNA damage. substitution therapy may restore the initial features The induction of MMP also plays a role in the of hormonally induced skin aging. 32 The evaluation pathogenesis of photoaging. UV light induces a of skin condition of postmenopausal women after wide variety of an ever increasing family of topical treatment with creams containing estrogens MMPs.28 If the generation ofROS is an important (estriol and estradiol) showed a significant proximal step in the UV signaling, which mediates reduction of wrinkles as well as increased elasticity photoaging, then the appropriate use of antioxidants and better vasculature of the skin.33 may be an effective prevention strategy. Although countless commercial products containing one or Makeup more of alleged antioxidant exist, no data have The skin, as a most important presentation of a proven that any of them really affects the UV person to its counterparts, is essentially the visual response. Antioxidants include vitamins A (retinol), calendar by which the years are measured.45 -47 C (ascorbic acid), and E (tocopherols); B-carotene; Cosmetics of the skin, hair, and nails represent an and bioflavonoid. Antioxidants act as oxygen area of great importance for the practicing scavengers, and seem to affect primarily the dermatologist. Cosmetics aspects of aging skin number of sunburn cells, the apoptotic are of intense interest in most societies and the keratinocytes, which appear after UV radiation.24 products now available can actually improve the Topical applications of a-tocopherol or ascorbic appearance of the skin. Lipliners, lipsticks, mascara, acid decrease UVB-induced erythema and edema nailpolishes, shampoos, hair additions are widely and decrease the number of sunburn cells. used for improving the clinical appearance and Carotenoid preparations and synthetic phenolic camouflaging of diseases. antioxidants similarly are reported to reduce UV­ induced erythema and retard development of Surgical Methods squamous cell carcinomas in the hairless mouse model. Intervention modalities that would enhance Chemical peels cellular DNA damage repair would be of utmost Destruction of epidermis and, in some cases, importance for maintaining health in the elderly. 24,25 superficial dermis does produce edema and, hence, appreciable improvement in appearance. There is Caloric restriction documented evidence that some of these substances Caloric restrictions have a beneficial effect on and procedures can induce formation of new some cutaneous functions, but do not seem to collagen with normal staining properties. 15 ,34,35 affect all functions. 26 It is possible that decreasing Trichloroacetic acid 10-35% is used to accomplish energy metabolism by restricting calories would superficial chemical peelings on facial and reduce the rate of ROS generation and increase nonfacial areas and may be repeated every 7 to lifespan. Caloric restriction or undernutrition 28 days. Jessner's solution is a combination of without malnutrition is well documented to affect resorcinol, salicylic acid, and lactic acid in ethanol. longevity. Its application can be light or intense and may be repeated after 3--4 min. Jessner's solution amplifies Estrogens the effect of 5-fluorouracil and this association is Skin aging process increases rapidly in called the fluorhydroxy pulse peel. Salicylic acid postmenopausal women after the age of .50 The is a a-hydroxy acid and can be used as a 50% external symptoms of skin aging observed in this ointment on the dorsa of hands and forearms or period are connected with a decrease in collagen as a 35% solution in ethanol for the face. Erythema content, which is conditioned by the same and edema are minimal and the peel can be repeated mechanisms that regulate its contents in bone every 2- 4 weeks. Peels of glycolic acid are tissue.27-3o Estrogens influence the amount of excellent facial rejuvenating therapies. Although collagen synthesized by fibroblasts, increase the the irritant power of glycolic acid is often directly synthesis of hyaluronic acid, and promote water related to its low pH, irritancy of the vehicle must retention. Skin fibroblasts have receptors for both also be considered.36-39 Other a-hydroxy acids androgens and estrogens. Most estrogen receptors include lactic, malic, citric, and tartaric acids; the are found on facial skin. They also increase most commonly used in dermatology are glycolic synthesis of the extracellular matrix and inhibit and lactic acids. A new era in dermatologic treatment began with the introduction of retinoids changes will attract more and more the attention two decades ago. Topically and in higher of physicians and merit a response for their caring. concentrations than the ones used for the keratolytic Thus careful examination of the patient, evaluation effect, some retinoids may be used as peelings of the patient's wishes, and expectations govern agents with very good results. 16-23 the methods adequate for each individual case.

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