All your life, your skin has been making a first impression for you. It can reveal whether you're hot or cold, tired or rested, sick or healthy. As you age, your skin changes in response to the elements that assail it, particularly the sun. On the inside, you may feel as good as ever, but the toll of years on your skin may send a different message. Medical conditions ranging from dryness to skin cancer become more likely. Meanwhile, cosmetic changes alter the tone and contour of your skin.

To some extent, your genes determine how well your skin stands the test of time. But environmental factors play a big role as well. Each year, physicians diagnose more than one million cases of two highly curable forms of skin cancer-basal cell carcinoma and squamous cell carcinoma. But for nearly 45,000 people, the diagnosis will be melanoma, a potentially deadly form of skin cancer. For the past three decades, melanoma cases have increased by about 3% per year. That's why it's so important to take steps to prevent skin cancer by avoiding the sun's ultraviolet rays, and this report describes the most effective ways to do so.

There has been significant progress in treating aging skin and skin disorders, including cancer. In addition to treatments for medical conditions, effective techniques that rejuvenate the skin are rapidly entering the market. But it's important to choose your treatments with care. Check and double-check the reputation and accreditation of clinicians performing invasive skin procedures. Choose skin care products wisely. The market for anti-aging creams, face lifts and cosmetic surgery is skyrocketing. Anti-aging skin care products comprise an estimated $1.6 billion market worldwide. Cosmetic procedures such as Botox injections and laser therapy to improve the skin's appearance rose to 4.9 million in 2005 in the United States, a 20% increase since 2003.

This report will help you make informed choices about skin protection. Whatever choices you make, you have more options today than ever before.

What is Skin?

The skin is the body's largest organ, weighing about nine pounds. It carries out a number of functions that help maintain health. Skin
is a complex fabric of tissues working together to form a basic control system. Skin helps control your body temperature by sweating and dilating its blood vessels to cool you down. When you're cold, those blood vessels constrict to conserve heat deep inside your body.

The skin is also a sensory organ. Nerve endings on its surface pick up and relay information about the surrounding environment to your brain. Your brain then translates these nerve impulses into the sensations of heat and cold, as well as touch, pressure, and pain.

In addition, the skin helps ward off infection by way of its Langerhans cells, part of the immune system that fights off foreign invaders such as bacteria and viruses. The skin is also a manufacturing plant, using the sun's energy to make vitamin D, essential to making bones strong.

Nails, skin, and hair

Your nails are skin, too. They're a thickened, hardened form of epidermis. Nail cells originate from the base of the nail bed. They die quickly, but unlike the keratinocytes, they aren't sloughed off. They're also composed of a much stronger form of keratin. Thus, a nail is simply a much harder and thicker sheet of keratin than the topmost layer of skin. Hair, however, is a thin fiber made of many overlapping layers of keratin, which is produced in the hair root.

It seems a paradox: The top layer of skin is replaced about once a month, so why does skin age? Part of the aging process is genetic. Just as your genetic makeup determines your eye color and whether your hair is curly or straight, genes also have some say in whether your skin retains a firm
texture into your 60s and 70s, or begins to wrinkle and sag during your 40s. The breakdown of collagen and elastin that leads to droopy, lax skin occurs at different rates in different people.

Chronological aging

Time takes its toll. As the years go by, skin undergoes a number of biochemical changes. Epidermal cells don't slough off as easily, and the supportive fibers of collagen and elastin break down. Skin doesn't retain as much moisture as it once did. The skin's ability to fight infection, feel sensations, and regulate body temperature also diminishes. Over several decades of sending instructions for new cell production, the DNA can become damaged and allow cells to grow out of control, with skin cancer as the result.

The deterioration of collagen and elastin and the pull of gravity can result in some of the classic signs of aging skin: fine lines around the eyes, deepened expression lines at the corners of the mouth and acrossthe forehead, and sagging skin. The nails usually become more brittle, and hair may begin to thin.

Photoaging

The single biggest cause of damage to skin as you age is not aging itself-it's sun exposure. This damage is called photoaging. Over the years, sun exposure causes fine and coarse wrinkles; baggy skin with a yellow, leathery appearance; and dry, scaly skin. It also increases the risk for skin cancer. Because sun exposure diminishes collagen, which supports a network of blood vessels, photoaging can cause skin to bruise more easily.

You can easily distinguish the effects of photoaging from those of chronological aging. Look at the lines and pigmentation of the skin on your face and the back of your hands; feel its texture. Now do the same on a part of your body that hasn't received much sun exposure, such as your lower abdomen or buttocks. The difference can be great, especially if you've been a sun worshipper throughout your life. People are spending billions of dollars annually to try to counteract the effects of photoaging.

Skin damage from sun exposure is caused by ultraviolet (UV) radiation. Not all the sun's rays are created equal. Some wavelengths of UV radiation penetrate the skin more deeply than others. Realizing this difference has prompted researchers to question whether some types of UV rays mainly cause wrinkles and the brownspots (sometimes called "age spots" or "liver spots") while others speed the development of skin cancer.

Other sources of skin damage

In addition to the sun and the normal effects of aging, your skin can take a beating from many other sources.

Cigarettes. Cigarette smoking has long been recognized as a cause of wrinkles. Researchers haven't determined exactly how this happens, but they know that cigarette smoking damages the connective tissue, which is the basis for the skin's smooth appearance. Smoking-related wrinkles may not appear for a decade or more after the first puff, but damage occurs with every cigarette smoked. The combination of smoking and sun exposure is particularly toxic. Considering how harmful smoking is, not just to your skin but to every other part of your body, the healthiest
choice is to avoid cigarettes. If you're trying to quit, support groups, nicotine gum and patches, and the drugs bupropion (Zyban) and varenicline (Chantix) can be useful smoking-cessation tools.

Irritants. Skin becomes thinner and doesn't heal as easily as you age, so take care in handling and working with irritants.

Facial expressions. Laughter may be the best medicine, but it can add to creases and lines that develop through the years from repeated facial expressions. Every time you smile, squint, or frown, facial muscles contract and cause accordion-like lines and creases to form in your skin. Young skin bounces back. But as aging skin loses its elasticity and firmness, those lines and creases tend to become etched in the skin. Even sleeping with your face scrunched in a pillow at night may wrinkles.

Three-step daily skin care

For daily skin care, limit your regimen to three simple steps: cleaning, protecting your skin from the sun, and tending to any specific skin problems you may have such as dry skin, acne, or fine lines and wrinkles.

1. Cleaning: Choose your skin cleanser based on whether your skin is dry or oily. If you have dry skin, choose a mild cleaning agent and avoid products containing alcohol, including toners.
For oily skin, choose a soap that removes the oil and cleanse more frequently throughout the day.

2. Protecting your skin from the sun. Choose a broad-spectrum sunscreen with an SPF of 15 or higher and wear it every day.

Higher SPFs are useful if you plan to spend hours outdoors but if you spend most of your time indoors, SPF 15 is generally sufficient.

3. Customize this last step to your particular skin needs. For dry skin, effective and inexpensive moisturizers are available

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