Inside Out Skin Health: Expert Advice From Dr Vania Sinovich
Nutrients for Skin
Carotenoids which are the orange and red pigments that give pumpkin and tomatoes their characteristic bright colour are excellent antioxidants neutralising the reactive oxygen species before they can do damage. They excel at protecting against longer wavelengths found in UVA light, protecting against the free radicals that cause skin ageing, wrinkling and cancers. Carotenoids can’t prevent the direct DNA damage caused by the rays themselves so they cannot be considered a replacement for sunscreen.
Vitamin C, found in citrus fruits, is also a good antioxidant. It stimulates collagen production , vital in ensuring the skin's structure and firmness. The combination of Vitamin C and vitamin E ( found in nuts and seeds) protect natural fats, the vital lipids in our skin from becoming oxidised by free radicals.
Other excellent antioxidants are Polyphenols such as resveratrol, found in grapes and apples, and sulphoraphane, found in broccoli and cauliflower. Minerals such a selenium, manganese, copper and zinc, found in nuts, legumes, grains, fruit, and vegetables, are also good antioxidants.
In summary a multicoloured diet leads to a brighter complexion. Alcohol depletes your skins antioxidants necessitating supplementation.
Do treatments improve our skin health?
Our skin inevitably lose some of its elasticity as we age. In the past, the main weapon against wrinkles and sagging skin was to go under a face lift. Today there’s a wealth of less invasive alternatives that can firm up and rejuvenate our skin. Everything from Botox injections to devices that blast light or ultrasound into the skin. Given that healthy skin brings wider health benefits do these treatments rejuvenate from the outside in. Is this just vanity or are you going to help your future self? Well it depends on the type of treatment.
Ageing comes with many transformations but the primary cause of our wrinkles is a reduction in collagen and elastin, proteins that provide firmness and elasticity. Treatments such as injection of botulinum toxin to prevent muscles contracting will do nothing to stop these changes though they can be an effective way to prevent frown lines when injected into certain facial muscles. Likewise injections of gel like substances called dermal fillers beneath the skin can smooth wrinkles and add volume to sagging tissue but don’t address the underlying structural changes and come with risks.
In recent decades a number of laser, radio frequency, ultrasound and intense pulse light devices have been introduced that can ostensibly restore that youthful glow. Developed from treatments to promote wound healing and reduce scarring, these technologies all involve waves of energy penetrating the outer layers of the skin to heat it from within.
If you heat the skin up enough you basically stimulate a kind of wounding response which then encourages the body to produce collagen and elastin to heal the damage.
So you’re playing with the bodies ability to repair itself.
Tiny injuries:
Another therapy, microneedling, in which tiny needles puncture the skin to create micro-injuries, is also based on these wound healing principles. High-quality large-scale studies in this field are lacking but evidence suggests these treatments can boost collagen and elastin levels with noticeable effects on the skin’s s appearance. They need to be regularly repeated and the long-term benefits are unclear. At The Skin company we combine it with exosomes to aid delivery of growth factors and peptides enhancing its effect.
An ideal treatment would also rejuvenate individual skin cells so that they resemble younger versions of themselves, through other changes in their biochemical processes. The most promising results so far come from research led by Anne Lynn Chang at Stanford University, California on the effects of the Sciton broadband light treatment on the skin of women aged over 50. The treatment resulted in demonstrably less wrinkled skin despite no increase in collagen or elastin levels. The researchers reported that rejuvenation was seen at molecular level with a number of genes linked to the ageing process being altered in expression after treatments to more closely resemble young skin hence the name BBL forever young. In other words it reprograms your skin to look younger.
This is why at The Skin Company we have invested in the Sciton BBL Forever Young technology aiming to keeping your individual skin cells resembling younger versions of themselves.
There is less evidence for ‘vampire facials’ which use platelet rich plasma injections. This is where your blood is taken from the arm and spun down to extract components called platelets hopefully rich in fibroplasts ( which are the construction makers of collagen and elastin) which are injected into your face to supposedly reduce wrinkles. Evidence is still inconclusive. It does however seem to have more evidence for improving the hair thinning in female and male pattern balding although well controlled studies are still needed.
How does a mental state influence our skin?
There is a very strong connection between the brain and the skin, and a connection between stress and skin diseases. Psychological stress, whether it be acute or chronic, causes our body to produce hormones called glucocorticoids which keep us more alert and provide energy for the flight or flight response in dangerous situations. But they also harm the skin in two ways.
First they can diminish the functioning of the epidermis, the top layer of skin that locks in moisture and serves as the first layer of defence between our bodies and the environment. Consistently high levels of some of these hormones like cortisol can also cause inflammation.
Second glucocorticoids decrease the production of antimicrobial proteins in the skin. The combined effect is skin that is dry and inflamed, prone to infections and heals more slowly, leading to heightened susceptibility to clinical skin conditions.
We know that adolescent acne is 23% more severe and inflamed right before an important exam compared with recent return from a school vacation.
We know that stress aggravates eczema and psoriasis as well as autoimmune conditions like alopecia areata.
The benefit of meditation and mindfulness for eczema and psoriasis are becoming increasingly evident.
How can we boost the skin microbiome?
Look under the microscope at any square centimetre of human skin and you’ll find it teaming with bacteria, fungi mites and viruses. It might sound gross but your skin’s microbiome is an important defence against invading pathogens.
The skin microbiome together with our gut microbiome helps train our immune system during childhood, teaching it to attack pathogens and ignore harmless stimuli. This could explain why people who have greater diversity of skin bacteria are less likely to have allergies.
Beneficial skin bacteria could also be the key to maintaining a smooth, wrinkle free appearance.
Our skin is like a fortress constructed from layers of skin cells packed together. In between the cells are lipids that keep the skin supple and plump.
Certain bacterial species help to replenish those stores. ‘Cutibacterium’ stimulates the skin to produce sebum which protects the skin, reduces water loss and increases hydration. ‘Staphylococcus epidermis’ and ‘Streptococcus Thermophilus’ can produce ceramides which also reduce water loss and protect the skin barrier.
The Skin Allies
As we age the delicate balance of the skin microbiome can be disrupted, as the ‘good ’ bacteria that protect us from infection and keep our skin hydrated are replaced by harmful pathogenic species.
This state of skin ‘dysbiosis’ has been linked to acne, rosacea, psoriasis, eczema and delayed wound repair. Given these benefits, it should be no surprise that scientists are looking for ways to keep our skins allies happy.
One idea is to use probiotics or nutrients that feed and encourage the growth of good bacteria. These include inulin, a dietary fibre found in asparagus and bananas which can be eaten to support gut health or applied topically to the skin.
In addition scientists are exploring whether slathering live good bacteria, known as probiotics directly on the skin could allow them to become established there. Making a working probiotic is easier said than done however, At The Skin Company we have Biojuve which is a novel topical Skin Microbiome formulated by a US company which has shown amazing results in our patients with acne rosacea, skin sensitivity, perioral dermatitis, acne and dermatitis.
The third idea is Postbiotics which involves applying the products of beneficial bacteria to the skin as a supplement. Some researchers advocate using sphingomyelinase, an enzyme produced by a bacteria like ‘Streptococcus Thermophilus’ that boost production of ceramides.
Studies for prebiotics, probiotics and post biotics are ongoing.
Gut Skin Axis
We know that the bacteria in your gut can influence your skin health through what is called the skin-gut axis. This might explain why diets high in unhealthy foods, like fast food may trigger acne whilst eating lots of fibre can help symptoms of eczema at least in mice
As ever a healthy diet with fresh wholefood is always the answer.