What Exactly Are The Signs And Symptoms Of Ageing?

From around the age of 25, the first signs of ageing start to show. The main symptoms and signs of ageing include:

-Fine lines and wrinkling
-Brown pigmented blemishes (known as solar lentigines, age spots or liver spots)
-Loss of elasticity and sagging skin
-Loss of volume
-Dry skin
-Thin skin and loss of density
-Sallow skin

Main signs of ageing

Fine lines and wrinkling: Before wrinkles develop,  fine lines can start developing in your thirties. There are many different types of fine lines and wrinkles. They might be dynamic, which means that they become more obvious with the movement of the facial muscles – especially when showing emotion. Common examples include frown lines between the eyebrows, forehead wrinkles, crow’s feet and smile lines. Static wrinkles are wrinkles that remain even when the facial muscles are relaxed and often appear at the corners of the mouth, across the cheeks and the neck.

Brown pigmented blemishes/Solar lentigines/age spots/liver spots: These are flat brown marks, which appear on sun-exposed skin, especially the face and back of the hands.

Loss of elasticity and sagging skin: The skin contains elastic fibres, which decrease as you age. This causes loss of elasticity in the skin. This shows by the sagging of the skin due to the effects of gravity.

Loss of volume: Loss of tissue in certain areas of the face can cause a hollowed-out appearance. This becomes more obvious in certain areas of the face such as loss of cheek definition.

Dry skin: The skin has a tendency to look drier as we age. In more severe cases it can even look rough, flaky or scaly.

Thin skin and loss of density: As the skin ages, the epidermal cells in the top layer of the skin proliferate and multiply much more slowly. The dermis, which is the layer under the epidermis, loses structural proteins and connective tissue, which makes it thinner. This can cause the skin to tear or bruise easily. It also contributes to the wrinkles and loss of elasticity.

Sallow skin: As the skin ages it can look sallow, giving a dull skin tone, or a translucent appearance.

How to treat the signs of ageing

Prevention: Ideally skin ageing can be prevented before it even appears. The most important steps are:

Careful sun protection, avoidance of strong sun and high SPF sunscreen with high UVA stars: UVA is actually the wavelength primarily responsible for ageing of the skin. SPF measures protection against UVB, which causes sunburn, so it is important to protect from both UVA and UVB. A lot of cosmetics have sunscreen in. Sun protection is also important to prevent skin cancers.

Sunbeds: Artificial ultraviolet can also cause ageing and skin cancers. People often like to look tanned and think it looks healthy. However, in the long term, it will make you age and increase your risk of skin cancers. I would advise avoiding sunbeds altogether!

Smoking: Stopping smoking is easier said than done, but it contributes to ageing and stopping smoking has many health benefits as well.

Diet: This is a controversial area. There are a lot of “wonder foods,” health drinks, and supplements. Often they are expensive and sometimes have no real evidence of effectiveness. However, it is recommended to have a well-balanced diet with adequate amounts of fibre, water, fruit and veg, with enough vitamins and minerals.

No treatment: Ageing is a natural process, and you can age healthily with some signs of ageing. For example, fine lines on the face, which become apparent with emotion, are important for our facial expressions, some treatments for ageing including botox can affect our ability to show emotion with our facial expressions, and can cause us to look less natural. Of course, dry skin can be managed by application of a simple moisturiser.

Topical treatments – applied to the skin:

Retinoids – These include Tretinoin and Tazarotene. Topical retinoids have been shown to reduce signs of mottled hyperpigmentation, fine lines, the roughness of the skin, and even increase dermal collagen. Tretinoin was the first retinoid used for these purposes, and there have been over 20 randomised studies comparing tretinoin to placebo or other treatments. (1-3) More recently there have been high-quality studies showing the effectiveness of the synthetic retinoid Tazarotene. One of the largest was a randomised double-blind trial of 568 patients, it showed Tazarotene was significantly more effective than vehicle at reducing fine wrinkles, mottled hyperpigmentation and tactile roughness. (4)

Hydroquinone – this is a skin-bleaching agent; it has been shown to be effective in lightening darkened areas of skin such as age spots/solar lentigines, freckles, and melasma. A Belgian study compared the daily application of Hydroquinone on one arm, to no treatment on the other side. They found the treatment was effective at lightening the solar lentigines on the treated arm. (5) It is recommended that Hydroquinone should be used alongside an effective sunscreen.

Niacinamide – is a form of vitamin B3, it is naturally found in some foods. It has been shown to improve signs of ageing including hyperpigmentation, fine lines and wrinkles, sallowness of the skin and also elasticity. It has been found to increase ceramide production in the skin, which is protective against excessive water loss, and dryness of the skin. (6, 7)

Advantages of topical treatments

Topical retinoids, Hydroquinone or Niacinamide, are all very well tolerated in general and are safe treatments. The main side effects of them all are local skin irritation. If Hydroquinone is used for a prolonged amount of time, it can cause cutaneous ochronosis, which causes a bluish grey discolouration of the skin at the site of application. This can be very difficult to treat.

Physical treatments for skin ageing are alternatives to topical treatments and include chemical peels, injections (including Botox, and fillers), lasers, dermabrasion and other surgical procedures. In general, these treatments have higher risks involved and tend to be more expensive.

For more information about Dermatica’s anti-ageing treatments contact one of our team.

Dr Tom King
Dr Tom King
Dr King is a dermatology specialist registrar working for an NHS trust in South Yorkshire. He is actively engaged in dermatology research and is involved in clinical trials for inflammatory skin diseases. Medical education is one of his keen interests, and he is currently studying for a Masters Degree in Medical Education (MMedSci) at the University of Nottingham.
Originally published July 20 2018, updated April 10 2019

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