Skin Care Throughout Life

Babies' Skin Care

Every new parent takes a great delight and a tender satisfaction in looking at, and touching, the delicate skin of a newborn baby. It is a lifelong challenge to maintain this delicate skin.

Some newborn babies, especially those that have arrived prematurely, have very little subcutaneous fat, with the result that their skin lies loosely over their muscles and bones. As a result they have a somewhat wrinkly start. The skin of a premature baby can comprise up to 13% of its body weight, compared with 3% in an adult.

A baby's skin plays an essential part in the bonding of a mother and her young child.

The skin of a full-term infant has a well-developed epidermis, similar to that of an adult. A premature baby, however, has fewer layers of stratum corneum. This results in increased permeability and increased TEWL (trans epidermal water loss), and is one of the reasons why very premature babies are so vulnerable. But by the age of 10-14 days, the skin of even the youngest premature babies has begun to function as a reasonable barrier to fluid and heat losses, and is less permeable to substances applied to its surface.

The beautiful undamaged skin of childhood: perhaps the healthiest we are likely to see.

Another variation in the skin structure and function involves the connection of the epidermis to the dermis. At this junction there are normally numerous anchoring rete pegs , but in the skin of premature babies these are fewer and more widely spread. Premature babies are therefore more vulnerable to blistering, and care is needed when removing adhesives to avoid stripping off the epidermis.

Soaps that are used for routine bathing include 'baby soaps', soaps formulated to have a neutral pH, superfatted soaps and even deodorant soaps with antimicrobial properties. All soaps are, at best, mild irritants to the skin, and frequent soaping increases the irritant effect. Specially formulated synthetic cleansing products called syndets are preferable to soaps (see Skin Cleansing).

Moisturizers

While lotions might play an important role in the overall health of infant skin, consultation with physician is recommended before using any product on premature infants.

Treating diaper rash

Wet areas of skin that are kept covered may be prone to damage. Diaper rash (diaper dermatitis) is seldom the result of the inadequate washing of diapers, though it may follow their inadequate drying, or inadequate washing or constant wetness of the skin. Today's technologically advanced disposable diapers, which hold urine and feces away from the skin, have helped to reduce the frequency of this condition significantly over the last 20 years. 

It is far better and easier to prevent diaper rash than to have to treat it. Methods of prevention include keeping the skin dry with frequent diaper changes, or the use of highly absorbent diapers that pull moisture away from the skin so that it is not softened by being damp for long periods.

Barrier products that also remove harmful skin bacteria are helpful in reducing diaper dermatitis.

Soreness in the diaper region (diaper rash) can make babies uncomfortable and fretful, but disposable diapers have helped to greatly reduce the incidence of this condition over the last 20 years.

Children's skin

After the early months of babyhood have passed the skin of most children has a more than adequate layer of fatty 'padding' which gives it a beautiful smooth appearance, often described as having the quality of 'purity'. All the functions are very active, and because the stratum corneum is functioning effectively the skin is very well hydrated. Indeed, by and large children's skin is the healthiest we ever see.

A child's skin shows little or no damage from sunlight. Children have more leisure time than they will ever enjoy again, however, and many of them play outside whenever they can, often spending most of the summer out of doors. There is often massive exposure to the sun during childhood, which will have long-term consequences.

The care of the skin of small children is almost entirely in the hands of parents or other carers. Nevertheless it is never too soon for them to begin to learn about skin care. The skin does not need moisturising unless there is atopy or eczema, or after prolonged exposure to sun or sea, but regular protection against the sun should begin now.

It is vital to protect the skin of children against the sun, and particularly against sunburn, to prevent the development of skin cancer in the years ahead.

Teenagers' skin

As we reach our teens that lovely smooth skin of childhood undergoes some terrifying changes.

As we have seen, this is the time of life at which the body starts to produce greatly increased amounts of hormones. Both girls and boys produce male hormones, called androgens. Under the influence of these androgens the skin produces more oil (sebum) and in most teenagers there is a tendency for acne to develop. These can be anything from simple blackheads to large pustules.

Caring for teenagers' skin is a matter of balancing the cleansing and toning needed to remove the excess oil with adequate moisturising to combat the potential over-drying effects of this cleaning. Teenagers' skins tend to hold water well, so they need far lighter moisturizers than those formulated for elderly people, whose skin tends naturally to be dry. Even at this age, cleansing and moisturising products should contain ingredients that screen against UVA and UVB.

Caring for Young, Sensitive Skin

Young skin regime: meticulous cleansing and moisturizing, part of the necessary care for a truly sensitive skin (atopic).

First remove dead squames and detritus using a mild synthetic cleanser on a cotton pad or cloth.

... then apply moisturizer to face and throat, using the fingertips to ensure even distribution.

The right amount of moisturizer to use.

Young women have to cope not only with the complexities of oily skin but with an increasing use of decorative cosmetic (lipsticks, eye shadow and liner) and their removal, all of which need to be taken into account when deciding on a skin care routine.

Reduce the signs of aging

Whatever our nationality or race, our skin changes inexorably as we get older.

A young adult's skin is well hydrated, tends to be soft, smooth and supple, and has a natural translucency; by contrast, in the natural course of things a more mature adult skin tends to function less well. Ultimately it may become dry and tend to feel tight, with a rougher texture and duller appearance, and wrinkles start to appear.

Wrinkles are the result of a combination of factors:

• a gradual reduction in the water content of the stratum corneum, lipids and sebum
• some degree of photodamage.

This gradual deterioration in skin appearance and function is what drives many people to seek skin care products that reduce the signs of aging and at the same time are effective moisturizers against the increasing dryness. The ability to procure such products and use them regularly is dependent on income and availability, which varies widely worldwide.

Cleansing may become less frequent as the excessive sebum production of adolescence declines, but the use of a heavier-duty night moisturizer without sunscreens should be added to the skin care routine. Ingredients that reduce the signs of aging are now incorporated into some high-quality cosmetic products. Exfoliation (see Additional Products) improves the 'feel' of skin, but should be regarded with caution by people who have sensitive skins: it may be used once or twice a week, depending on the skin type, need and the mildness of the product. The regular use of heavier-duty moisturizers for the hands is helpful, and indeed is essential for people in 'wet work' such as cleaners, hairdressers and cement workers.

Women of all races use decorative cosmetics: here the traditional bindhi, worn by many Indian women on the forehead. Removing cosmetics is an important part of the skin care, often forgotten by those who criticise the use of cleansers and moisturizers.

Natural skin care products

In developing countries women may have to resort to local and 'natural' products. 'Natural' does not necessarily mean 'better', however, or even 'safe'. Natural skin care products made from vegetable or animal extracts may be inherently toxic, and if prepared locally the concentrations of active ingredients cannot be controlled.

The cosmetic industry uses only ingredients that have established scientific profiles, and then only in legal and known concentrations. Many ingredients of skin care products have to be prepared synthetically, since their 'natural' counterparts are far more likely to be harmful.

Mature skin

As women get older and their skin matures, and particularly after the change of life (menopause), declining estrogen may lead to dehydration of the stratum corneum, which tends to make the mature skin look thinner and older than it really is.

For cleansing, it may be advisable to use mild superfatted soaps or soap-free cleansers for the body.

It is essential to choose a suitable moisturizing cream for use on the facial skin. If the cream is to give sufficient protection against dehydration, it must have sufficient covering power to slow down the loss of water from the stratum corneum.

The use of a moisturizing cream on the body skin can be useful, especially in winter when mature skin tends to be drier. Modern shower products contain moisturizers as well as cleansers. It is however best to avoid long scalding soaks, as well as harsh soaps and bath foams if the skin is sensitive as this combination disrupts its barrier function.

This mature lady takes great care of her skin, always using mild cleansers and a regular moisturizer formulated for mature skin.

Elderly skin

By the time we reach old age our mature skin may well have experienced decades of sun exposure, even if only at very low levels. This is associated with the effects of intrinsic aging. The result as we see it is almost always a balance of the two.

Elderly skin can be very dry and almost paper-thin, with the structures in the dermis clearly visible. The TEWL is increased, and the skin becomes more fragile and prone to injuries: with the lack of protection from the dermis, the small blood vessels become vulnerable to breakage and bursting ('broken veins').

Regular care is now especially important, including the use of mild cleansers. Good-quality day and (especially) night moisturizers will help to combat the decline in mature skin's barrier function. It is still important to continue protecting the skin against the sun, although most of the damage has been done by now.