Managing the aging process

Getting on in years need not signal the inevitable onset of health problems, not if you sit up and take charge of how you age. TAN SU YEN reports

YOUR parents have diabetes and hypertension and if you remember correctly, your grandfather died from a heart attack. So even if you go on the South Beach diet and start hitting the gym, it might not make a difference now that you're on the wrong side of 40. Nice try, and certainly an approach that Dr Julinda Lee of Pacific Healthcare Specialist Centre, a member of Pacific Healthcare, is familiar with.

'There are people who are perpetually in denial and there are those who feel it is much easier if they drop off dead from a heart attack or stroke. It isn't just lay people who have this point of view, there are doctors who feel the same way too.'

Adds Dr Lee who has a special interest in anti-ageing medicine: 'The truth of the matter is that most people don't die from a stroke or a heart attack, although many of us wish that would happen. Unfortunately, many people live to suffer the consequences of things like strokes and heart attacks which can be very detrimental.'

Far better, say the advocates of anti-ageing medicine, to do what you can to avoid the slippery slide into chronic illness in the first place. Says Dr Lee: 'Conventional medicine is focused on the disease process. If you have high blood pressure, we treat it with an anti-hypertensive; if you have diabetes. we treat you with medication to bring down your blood sugar levels.

'What anti-ageing medicine does is to identify certain predispositions even before the disease develops so it is really about active prevention. In previous times, we focused on the disease and looked at reducing secondary complications - you have high blood pressure, you want to reduce the risk of heart disease, you have diabetes, you want to reduce the complications arising from diabetes. With anti-ageing medicine, we are trying to make changes much earlier, in the sense that we want to reduce the risk of high blood pressure or diabetes.'

As with other forms of prevention, an early start makes all the difference. Says Dr Lee: 'The earlier you start the less work there is to do. If you've had those risk factors or symptoms for a much shorter period of time, it is much easier to change that than to wait for certain things to happen and for complications to come up.'

For the individual, managing the ageing process requires a mindset change. In practical terms, it means consulting a doctor about maintaining your health rather than treating your illness; it also means submitting to a series of clinical, laboratory and radiological tests to determine your health status. These tests are part of a process known as health profiling - a systemic approach to defining the individual's risk profile, which includes in-depth one-on-one consultation over and above the tests.

A typical consultation might feature a slightly overweight middle-aged person who makes an appointment to see a doctor because of a general sense of malaise. Says Dr Lee: 'They may come to me with non-specific reasons like they are very tired, and sex may not even come up in the discussion till later but from the family history we see diabetes or heart disease as being very prominent. If we assess them we would find that they have an issue of testosterone deficiency and subsequent replacement of testosterone helps to reduce their risk largely by changing their body composition.'

By 'body composition' Dr Lee is referring to the truncal fat that some men develop in middle age. Euphemistically referred to as a 'paunch' or a 'beer belly', this fat around the middle carries certain health risks. Says Dr Lee: 'A paunch actually contributes to insulin resistance and the development of metabolic syndrome and this is a very significant risk factor for diabetes and heart disease. By reversing their hormone status to improve their testosterone level, we actually can change their body composition.'

Testosterone therapy may be an emerging area in anti-ageing medicine that is not without its detractors but for the most part health profiling leads to tried and tested methods of managing health risks, and doing so while there is time to make a significant impact. Take for example a pre-menopausal female patient, 'her bone mineral density scan may reveal that she isn't osteoporatic as such but the rate at which she is losing bone may indicate an increased risk of osteoporosis. It would be up to us to advise on lifestyle changes as well as calcium and vitamin D supplementation with or without Hormone Replacement Therapy'.

Anti-ageing medicine is essentially a process of education. Says Dr Lee: 'In age management, our goal is to educate the patient. Above all, we want to empower the patient to be in control of his or her health.'

How not to let your skin give away your age

By TAN SU YEN

WHEN anti-ageing creams priced at $1,000 a jar made their debut here recently, some baulked at the prices and others rationalised that the super luxurious creams were an investment in their future. Another group of women, notably the savvy, private banking clients also known as tai tais, not only lapped up the creams, but also went through them in double quick time, lavishly slathering the rich, expensive potions onto their hands as well as their faces.

Extravagant? Definitely, but a smart move, assuming money is no object. The skin on our hands, like the skin on our faces, tends to show the most visible signs of ageing compared with the skin on the less exposed parts of our bodies like our inner thighs for example. The culprit? Sun damage, the single most potent cause of what dermatologists refer to as extrinsic ageing.

Says Dr Patricia Yuen, consultant dermatologist, Pacific Healthcare Specialist Centre: 'The sun causes free radical damage which can affect collagen production. In Asian women, sun exposure accentuates pigmentation problems that are caused by hormonal imbalances during pregnancy and menopause.'

Those are certainly problems we could all do without when you consider how no one is spared the toll the passing years take on our skin. Dr Yuen explains the relentless process of intrinsic aging: 'The skin is made up of three layers, the epidermis which is the topmost layer of the skin, the dermis and fat. As people get older, the natural exfoliation process in the epidermis is not so efficient and it doesn't retain moisture as well as it used to. As a result, the skin gets rougher and dryer.

'The dermis is the support system for the skin; it is made up of collagen and elastin fibres, which gives the skin its firmness and elasticity. As we age, the collagen layer decreases so there is less support for the skin and wrinkles start to form. Tissue shrinkage combined with gravity also leads to sagging and the appearance of groove lines.'

The key to staving off the inevitable, or at the very least limiting its damage, lies in maintenance. Says Dr Yuen: 'It's easier to maintain good skin than to restore bad skin.' All the same, being religious about your skincare regime is just half the equation, the other part of it lies in selecting the right products for your skin, and these need not be the latest or most expensive products available.

Says Dr Yuen: 'Even with something very basic like a moisturiser, it is important to use a suitable moisturiser for your skin. You don't want to use a moisturiser that is too thick or too rich for your skin or for our weather. I have patients who get oil seeds from using expensive creams designed for cooler climates and drier Caucasian skin.'

And given all the evidence about sun damage, both men and women shouldn't leave home without sun block. Says Dr Yuen: 'I am a big advocate of sun block and would recommend it for every one. Sun block technology is now very advanced so you don't just slap on any sun block. If your desk is by the window in the office and most of your walking is from the car to the office, I would recommend an SPF 20. If you golf or do water sports, consider an SPF 60 that is specially formulated for sports.'

Maintenance aside, people with sun-damaged, aging or problem skin now have recourse to an entire repertoire of non-invasive cosmetic dermatology treatments. And just as well. According to Dr Yuen, patients are increasingly opting for procedures that involve no knives, little or no downtime and no big surprises. 'People like treatments that retain the way they look or subtly enhance their features. They don't want any drastic changes.'

Some of the more popular non-invasive aesthetic dermatology procedures at Dr Yuen's practice are:

eLaser & eLight

These new generation treatments combine intense pulse light technologies with radio frequency energy to improve skin texture and colour more efficiently and less painfully than previous techniques. The eLight or Aurora is intended for reducing pigmentation, spider veins and for skin rejuvenation while eLaser or Polaris is used for wrinkle and scar removal.

Iontophoresis

This treatment involves applying a Vitamin C serum onto the skin followed by a low level electrical current that increases the depth of penetration of Vitamin C. A powerful antioxidant, Vitamin C repairs the skin's damaged collagen and lightens deep pigmentation.

Sciton MicroLaserPeel

The most advanced laser resurfacing technique, the MicroLaserPeel uses an epidermal laser to smooth scars, ablate fine lines, tighten pores and remove blemishes. It is effective for overall facial rejuvenation as it gently 'peels' problematic skin and promotes healthy vibrant skin growth. It is also known as the 'weekend' peel as healing takes two to three days.

Don't ignore that strange looking mole...

By TAN SU YEN

THOSE wrinkles, grooves and assorted wobbly bits may be unwelcome, but they are very much a part of the natural process of ageing. Most people respond by striking a balance between accepting these changes with as much grace as they can muster and doing what they can to preserve their looks.

Some other skin conditions that tend to come on in middle-age - such as psoriasis, certain eczemas and pre-cancerous and cancerous growths - are more challenging to live with and require medical attention. Both psoriasis and eczema are linked to increasing dryness in our skin as we get older.

Dr Wong Su Ni, consultant dermatologist, Pacific Specialist Practice, a member of Pacific Healthcare, explains: 'Sebum production is at a maximum in early adulthood, and as we age, sebum production drops and we find that with less oil produced the skin does feel drier. As the skin ages, it is also less able to hold water in the cells, and this contributes to the dryness in the skin. That's why from our thirties we start to notice that the skin on our arms and legs starts drying, and this is accentuated by environmental factors like air conditioning, frequent washing, hot showers and travel to colder, drier climates.'

Eczema

Skin that is very dry often itches and cracks creating the preconditions for skin inflammation. Dr Wong says: 'When dry skin gets so bad that it starts cracking, you get a crazy paving kind of pattern on the skin. The area around the cracks starts getting inflamed and red, and that is where you get dry skin eczema, also known as 'eczema craquee' for 'cracked' in French. This form of eczema is common among the older population and typically affects the limbs. In temperate zones, it tends to flare up in winter.'

Another form of eczema that affects the middle-aged is what is known as varicose eczema or stasis eczema. Commonly afflicting those over 50, this form of eczema occurs around the ankles, and is characterised by skin that is reddened, scaling, darkened and itchy. It comes about because of blood that is pooling around the ankles due to high pressure in the veins as a result of varicose veins. This condition is associated with poor wound healing such that a minor scratch may become a chronic ulcer.

Dermatologists typically prescribe topical corticosteroids to manage eczema as they address the inflammation and the itch and allow healing. Eczema patients are encouraged to avoid severe flare-ups by actively managing their dry skin on a daily basis. Bath oils, oatmeal-based products and soap substitutes are recommended to reduce the dryness caused by bathing and washing, and moisturising regularly at least twice a day is a must. Dr Wong says: 'There is no cure for eczema as such. Treatment settles a particular episode but patients must maintain their skincare to minimise the frequency and severity of subsequent episodes. My advice to patients is to always keep your skin moist, never let it dry out.'

Psoriasis

Psoriasis is a chronic inflammatory skin condition characterised by salmon-pink patches that produce silvery flakes. Dr Wong says: 'There are two peak ages for the onset of psoriasis, the 20s to 30s and the 50s to 60s. It may turn up for the first time in the form of flaky dry skin like severe dandruff on the scalp, or dry, flaky skin on the elbows or elsewhere. If dry skin is persistent and it is symptomatic, it is a good idea to see a dermatologist.'

Psoriasis commonly occurs on the scalp, the elbows, the knees and the lower back, and is caused by an immune condition in which the skin grows too fast. Skin normally renews itself in a 28-day cycle; in psoriasis patients this cycle of skin renewal could be reduced to as little as a week. Approximately one in 10 psoriasis patients may also develop psoriatic arthritis, a condition in which the joints become painful, swollen and progressively deformed.

Topical medication is the first line of therapy in managing mild to moderate psoriasis, and here, Dr Wong, who used to head the Psoriasis Unit at the National Skin Centre, favours a combination therapy of mid-potency steroids with coal tar or Vitamin D cream as the safest approach.

Moles and skin cancers

Moles are harmless skin lesions that tend to follow a growth pattern. Dr Wong says: 'At first, moles may be flat and tan, pink, brown or black. Over time, they enlarge and some may develop hairs. As the years pass, some may change slowly, becoming more raised and lighter in colour. Others may not change at all. What we know is that moles have a higher than average risk of becoming cancerous, and may develop into a form of skin cancer known as malignant melanoma. Therefore it is important to recognise the early warning signs of malignant melanoma.'

To do this, examine your moles with the ABCDE rule in mind: A stands for Asymmetry, when one half of a mole doesn't match the other; B stands for Border, when the border or edges of a mole are ragged, blurred or irregular; C stands for Colour, when the mole is not the same throughout or if it has shades of tan, brown, black, red, white or blue; D stands for Diameter, when the diameter of a mole is larger than 6mm; E stands for Evolution, when the mole bleeds with no injury, itches, swells, hardens or becomes red.

Dr Wong says: 'If a mole changes and displays one or more of the ABCDE criteria, do consult a dermatologist as soon as possible.' Darkly pigmented lesions that first appear in middle-age may not be moles but something more sinister, like a melanoma or a pigmented basal cell skin cancer, especially if they are found in sun-exposed areas.

Another type of skin cancer, squamous cell carcinoma, often develops from solar keratoses which are pre-cancerous lesions that look and feel like a rough scale on reddened skin, on a background of sun-damaged skin. Dr Wong advises: 'People with sun-damaged skin should be screened by a dermatologist regularly, as early detection and treatment of solar keratoses prevents progression to squamous cell carcinoma. Early detection and treatment of skin cancer also reduces the chances of spread.'

Source: Business Times, 13 October 2006