Author: Kesiree Naidoo

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The role of topical antioxidants

The role of topical antioxidants in our skincare routine has become of vital importance.

While sunscreens are able to limit the amount of UV light reaching the skin cells, they do not offer complete protection, and do not protect us from infrared (heat), visible light and atmospheric pollution which have come under scrutiny in recent years.  These environmental factors cause damage to DNA of skin cells leading to premature ageing and possibly irreparable gene mutations.

Repeatedly damaged cells can become cancerous. Damage to collagen and elastin which are proteins in our skin result in ageing, loss of elasticity, wrinkling and volume loss. Regular application of topical antioxidants create a reservoir in the skin protecting our skin from these environmental aggressors. In this way antioxidants provide us with an ‘active’ protection against skin cancer, photo-ageing, inflammation and pigmentation.

Antioxidants are multi-functional, in that they prevent sunburn, stimulate collagen production and improve the appearance of fine lines, wrinkles and dark spots, thereby reversing the effects of environmental damage . Thus antioxidants play an increasingly important role in your sun protection strategy. Antioxidants must be used in conjunction with a good sunscreen, and as part of a comprehensive anti-ageing routine.

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Antioxidants inside and out

Antioxidants are molecules that donate or remove electrons from oxygen free radicals or reactive oxygen species (ROS), neutralising and preventing them from causing damage to our cells and tissues.

Reactive oxygen species (ROS) cause extensive and sometimes irreversible damage to DNA, proteins and cell membranes, accelerating ageing and predisposing us to cancer and diseases. ROS are produced by environmental factors (exogenous factors) like ultraviolet light, smoking and pollution and internal factors (endogenous factors) like our basic metabolic processes.

While the body has its own internal systems producing antioxidants to ‘scavenge’ harmful free radicals, these become less effective as we grow older. In addition to this our internal DNA repair mechanisms become less efficient. There is growing evidence to support the benefits of oral and topically applied antioxidants to supplement our declining natural antioxidant systems and in this way slow down the ageing process and protect us from gene mutations and cancers.

The most well known micronutrient antioxidants are Vitamin E, vitamin C and beta carotene (precursor of vitamin A). Our bodies cannot make these antioxidants which is why they should be part of our diet.

The list of antioxidants superfoods is constantly growing from green tea, berries, beans, veggies and fish, to the more exotic like sumac, acai and Indian gooseberries. An entire industry is focused on finding foods with higher antioxidant potential.
While the theory seems sound that oral antioxidants protect us from ageing,heart disease, cancer and dementia, we still don’t know enough to prescribe what specific antioxidant supplements need to be taken orally, and most importantly in what quantities to be of benefit. The amount of oral antioxidants that eventually get to the skin surface is also uncertain.

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What does SPF mean?

SPF or sun protection factor is a measure of protection against only UVB.
An SPF of 30 means that you will be able to stay in the sun 30 times longer without burning, than you would be able to without wearing the sunscreen.

This does not equate to 30 min, and most importantly is different for each person, as we all burn at different rates depending on our skin type.
SPF is measured in a test environment which is nothing like real life.
It does not take into account sweating, environmental factors and the varying application by the sunscreen user. In a test environment sunscreen is applied very thickly, at 2mg of sunscreen per square centimeter. The quantity that is actually applied by people is closer to 0.5mg per square centimeter. So we are never really getting the same protection as on the label.

While it is true that SPF15 filters out 93.3% of UVB, SPF30 96.7% and SPF50 98.3%, making it seem that there is very little benefit in using the higher SPF, one needs to consider that only the amount of UV light reaching your skin is important. If you look at it this way then SPF 15 allows 6.7% of UVB to reach your skin while SPF 50 only allows 1.7% of UVB.

Dermatologist associations worldwide recommend you wear at least an SPF of 30.

SPF says nothing about the UVA cover of a sunscreen. There is at present no universally applied measure of UVA protection. Look for UVA with a circle around it on your sunscreen bottle. This denotes high UVA protection.

A final word is that we must remember that 80% of sun exposure is incidental and happens during the course of our day to day life, while we are not actively “lying down to tan”. UVA penetrates through windows and causes sun damage without causing sunburn.

If you find that you are getting sunburned, and notice the increasing appearance of “sun spots”, you are getting more exposure than you thought and need to re-look at your sun protection measures.

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Sunspots- when to see a dermatologist?

“Sun spots” is a broad term which includes a range of cancerous and benign lesions. Common types of skin cancer include squamous cell carcinoma (SCC), basal cell carcinoma and melanoma.
Basal cell carcinoma presents as a pearly white, pink or pigmented nodule, a pink scaling patch, a non healing ulcer or an unexplained scar.

Squamous cell carcinoma commonly presents as a pink or brown scaling patch.

Melanoma is the most dangerous of all skin cancers and most often presents as a ‘new’ irregular pigmented spot. Early detection can save lives.

Solar keratoses (Actinic keratoses) are precancerous lesions and 10-25% of these may persist and progress to skin cancer.
It is important to regularly check your skin and be aware of new or changing lesions (spots).

Solar lentigenes are freckles which increase in number with age and cumulative sun exposure. These spots are benign, but should be checked so that a melanoma, which is a deadly skin cancer, is not missed.

Seborrhoeic keratoses (seborrhoeic warts) are warty, pigmented or skin coloured growths, which can occur because of a genetic predisposition and sun exposure.

Visit a dermatologist if you have:
1. Personal or family history of skin cancer
2. Frequent sun exposure with a history of sunburn
3. New or changing ‘spots’
4. Scaling / crusting lesions
5. New or rapidly growing nodules
6. Wound/ulcer that does not heal

While most sun induced spots are benign, it is important to make an early diagnosis of skin cancer
Your dermatologist will be able to make a clinical diagnosis, or perform a skin biopsy if necessary for a histological diagnosis.
It is possible to treat early or newly evolving lesions with non surgical treatment options like freezing with liquid nitrogen or topical creams.
If a skin cancer needs surgery, there is a greater chance of complete cure with an early lesion.
Checking your skin yourself and regular visits to a dermatologist will ensure that all sunspots are diagnosed early and dealt with effectively.

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Sun protection – how to stay safe and when to worry

UVB(ultraviolet B), UVA (ultraviolet A) and visible light make up a small, yet significant portion of the electromagnetic spectrum of light entering the earths atmosphere.

UVB causes us to burn while UVA, which has a longer wavelength, penetrates deeper into the skin. It does not cause sunburn, but is most significant in causing photo-ageing (ageing from the sun) and skin cancer. Photo-ageing and skin cancer are both consequences of excessive cumulative sun exposure and are almost always talked about together.

Sunlight is certainly not all bad, and generally induces a sense of well-being, decreases the appetite, improves libido and assists with the synthesis of vitamin D. We also use controlled light sources of UVB and UVA to treat a range of skin conditions like psoriasis and eczema.

The harmful effects of UV light can be divided into:
Acute (short term) and Chronic (long term effects).
Acute exposure to UVB causes sunburn which damages the DNA of our skin cells. Acute exposure to UVA suppresses the immune system in our skin which protects us against skin cancer and skin infections.
Chronic exposure to UVA causes skin ageing and both UVA and UVB cause skin cancer.
Compare the skin on sun exposed areas of your body to non sun exposed skin if you would like to see the added effect of photo-ageing to the normal process of ageing, which we call chronological ageing.
Features of photo-ageing include wrinkles, sagging skin, yellowing of the skin, pigmentation, freckles, broken veins and easy bruising.
Solar (actinic) keratosis, basal cell cancer, squamous cell cancer and melanoma are examples of precancerous and cancerous lesions.

While moderate and responsible exposure to the sun is good for your well-being, it is not possible to tan without damaging skin cells, leading to accelerated ageing, and increasing your risk of skin cancer.

Tips for sun protection
1.Minimise your exposure to direct sunlight and ensure that you never allow yourself to burn. Always seek the shade if you have to be outdoors. In general, peak UV exposure is between 11am to 3pm, but this varies with the season and location.
2. Wear a wide brimmed hat, sun protective clothing and sunglasses. Covering up is the best protection from the sun.
3. Wear sunscreens on areas that cannot be covered.
Apply sunscreen, liberally, evenly and repeatedly.
Apply sunscreen 30 min before you leave the house and reapply every 2-4 hours especially after sweating or swimming.

Sunscreens past and present.
Sunscreen technology has come a long way since the greasy, cosmetically unacceptable formulations that made you sticky and grey.
Sunscreens come in creams, lotions, sprays, milks, oils and make up compacts. They are available in tinted, non tinted and sheer forms.
The sunscreen industry has made it virtually impossible for you not to find a sunscreen you will be happy with as the worldwide consensus is the best sunscreen for you is the one that you will wear!

Sunscreen active ingredients are divided into categories of physical and chemical blockers. These protect against different wavelengths of light in the spectrum and are often found in combination to ensure maximum protection and stability of the product.

Physical blockers, titanium dioxide and zinc oxide have broad spectrum cover and are suitable for children and sensitive skins.
Older sunscreens only protected against UVB, while the newer sunscreens almost always cover UVB and UVA.

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The Skinsmart 5 Steps

THE SKINSMART 5 STEPS is a guide developed by Dr Naidoo to direct patients to the most effective order in which to apply skincare products. Dr Naidoo has found that patients at her practice value a personal step-by-step note, especially if using more than two skincare products, and when the regimen includes different steps in the morning and evening.

Your product recommendations will depend on your skin type and skin concern.
Please take note of the following:
• Not everyone will require a product for each step at each time of day
• Steps 2, 3 and 4 may require different products in the morning and evening or rarely more than one product at each time
• Many of the high quality products sold on Skinsmart have ingredients that may be effective for more than one step in the 5 step process.
• Our high quality anti-ageing serums in step 2 overlap as treatments (step 3) and may even offer sufficient hydration(step 4) for certain skin types.
• Moisturisers in step 4 may have a combination of ingredients allowing certain products to act as treatments.
• Some moisturisers contain high SPF sunscreen which may be sufficient for daily wear in winter, or if you are mainly in an indoor environment, and spend minimal time driving to work.
• Prescription treatment for conditions such as acne and pigmentation may be slotted into step 3.

The Skin Assessment recommendations are displayed in terms of these 5 steps:

Step 1: Cleanse and tone
Cleanse the skin of impurities, gently remove dead skin cells and restore the skin’s PH balance.
Cleansing and toning prepares the skin for a follow-up skincare regimen.
Dr Naidoo recommends cleansing the skin twice a day i.e. in the mornings and in the evenings before bed.
There are few toners in our recommended product ranges, as most of our face washes have exfoliating ingredients to effectively remove surface impurities and dead skin cells.

Step 2: Prevent
Prevent damage caused by oxygen-free radicals; slow the process of photo-ageing, and reduce skin cancer risk.
Antioxidants such as Vitamin C and E are the primary ingredients in the products found in this step.
Antioxidants help prevent DNA damage caused by sun exposure.
Dr Naidoo excludes this step from the teenager skin assessment results.

Step 3: Treat
Target specific concerns.
Repair existing damage and promote cell turnover.
Inhibit melanogenesis and stimulate the production of collagen and elastin.
The products in this step provide intensive treatment for specific concerns, such as acne, pigmentation and ageing.
These treatment products are usually applied to the skin at night before your moisturiser.
There are some that need to be applied in the mornings or twice daily.
Please refer to the instructions for each individual product.

Step 4: Hydrate
Nourish and restore natural moisturising factors for a healthy, radiant skin.
Moisturisers or emollients hydrate the skin, restore natural moisturising factors and repair defective barrier function.
Depending on your preference, you may use the same moisturiser in the mornings and evenings or choose different products.
Day moisturisers are, in general, lighter in texture and may contain sunscreen while night moisturisers may be richer formulations with higher concentrations of active ingredients.

Step 5:Protect
Effectively protect against ageing, pigmentation and skin cancers.
Photo ageing results from progressive sun exposure over time.Sunscreen is your most important anti-ageing product.
Sunscreens help protect the skin from DNA damage and in this way reduce the incidence of skin cancers.
These products slow the development of fine lines, wrinkles and sunspots and are essential in the management of pigmentation.
Sunscreen should be applied in the mornings at least 15-30 min before sun exposure and reapplied during the course of the day as needed.
Makeup should be applied over your sunscreen.
Skinsmart offers tinted sunscreen compacts making it easy for women to reapply sunscreen during the course of the day.
There are numerous products that combine sunscreen and a moisturiser for ease of application.
It is important to note that the sunscreen in your moisturiser is not always enough and additional sunscreen needs to be applied.
An instruction note will be included with your order, and our trained therapist can assist with any queries to ensure the most effective use of your products.

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What are active Ingredients?

Active ingredients in skincare products include Alphahydroxy acids, Polyhydroxy acids, Retinol, Vitamin C, Kojic Acid and Arbutin. They are found in varying concentrations in different grades of skincare products.

The concentrations of these ingredients are higher in a special category of skincare products called cosmeceuticals. These cosmeceutical ranges are typically only available in Dermatologist’s or Doctor’s rooms.

The majority of the products sold on Skinsmart fall into this category of cosmeceutical products with high concentrations of active ingredients. These active ingredient products need careful introduction to your skin, as they may cause irritation and sun sensitivity.

The high concentration of active ingredients in these products also mean that they have better results in targeting your skin concern, particularly anti-ageing.