A lifetime of healthy skin: Implications for women

During her lifetime, a woman faces the possibility of seeking dermatologica l assistance for a myriad of conditions, including acne, rosacea, striae, p hotodamage, and skin cancers. It is important for clinicians and patients t o be aware of the symptoms of these conditions as well as the most benefici al approaches for prevention, diagnosis, treatment, and management. The lif e expectancy of women has increased and predictions for the year 2050 estim ate the average age at 81 years. This will place women at greater risk for dermatological problems, especially photodamage and skin cancer. In additio n, various ethnic groups may manifest these conditions differently. Although acne is most prevalent among teenaged males, most can expect cleav ing by age 25. Females may continue to experience acne into the adult years , sometimes beyond the age of 40. Although it is not a life-threatening dis ease, acne may have psychosocial and quality-of-life consequences. Treatmen ts for acne can be topical or systemic, and include retinoids, antibiotics, benzoyl peroxide, azelaic acid, and hormonal therapy. Rosacea is more common in women (especially during menopause) than in men. It is a chronic condition that can cause complications, including telangiec tasia, conjunctivitis, and blepharitis. Although there is no cure, rosacea can be managed and controlled with medication. Topical antibiotics, such as metronidazole, and systemic antibiotics, such as tetracycline, clarithromy cin, and doxycycline, are used to manage rosacea. Striae, or stretch marks, occur most frequently in pregnant women, adolesce nts experiencing growth spurts, weight lifters, and the obese. Although not a health threat, they can be psychologically distressing. There are not ma ny treatment options for striae, but topical tretinoin and the pulsed dye l aser offer promising results. Intrinsic, or normal, aging of the skin results from the process of chronol ogical aging. Photodamage is skin damage caused by chronic exposure to ultr aviolet (UV) light. it is the leading cause of extrinsic aging, or alterati ons of the skin due to environmental exposure. Estimates indicate that almo st half of a person's UV exposure occurs by age 18. Photoaging causes numer ous histologic, physiologic, and clinical changes; it also increases the ri sk for skin cancer. Photodamage can be prevented through the use of sun scr eens, protective clothing, and avoidance of the sun during peak intensity t ime. The only product approved by the FDA for the treatment of photodamage (fine wrinkles, mottled hyperpigmentation, and skin roughness), topical tre tinoin emollient cream, may help prevent additional photoaging when it is u sed to treat existing photoaging. Other management options for photodamaged skin include alpha-hydroxy acids, antioxidants, antiandrogens, moisturizer s, and exfoliants. In patients with excessive manifestations of photodamage , surgical management may be needed, including dermabrasion, chemical peels , soft tissue augmentation, laser resurfacing, botulism toxin, and Gortex(R ) threads. Clinicians must educate their patients about the most appropriate skin care regimen as well as approaches for preventing and treating common afflictio ns. In this way, women will have the best opportunity for having and mainta ining healthy skin.