Author: Oliver Belcher

Ageing skin is a gradual process that begins around the age of 25 and tends to accelerate in the 40’s, and again in the 70’s. While it is an inevitable part of life, understanding the mechanisms and causes of ageing skin are just as important as addressing it—because the right knowledge paired with targeted ageing skin treatment can turn back the clock on your complexion.

Overview

The visible signs of ageing skin—fine lines and wrinkles, thinning and fragility, dull skin, and dry skin—affect different parts of the body in unique ways.

The face shows the most significant impact, accounting for 50% of visible ageing symptoms. The neck follows, displaying 25% of the effects, while hands exhibit 15%, often presenting signs such as thinning and dry skin. Knees account for 10% of ageing changes, commonly manifesting as sagging skin.

Ageing skin occurs through two mechanisms: intrinsic and extrinsic ageing. Both contribute to visible changes, but are driven by different causes.

Subtype	Description	Common Areas
Intrinsic Ageing (Chronological)	The normal course of ageing, closely linked to the biological clock and passage of time. It occurs gradually, irrespective of external factors.	Affects the entire body, including less exposed areas like the torso, back, and buttocks.
Extrinsic Ageing (Photoageing)	Premature ageing caused by external factors, which accelerate intrinsic ageing. It involves preventable damage to the structural components of the skin, impeding its natural repair mechanisms.	Impacts exposed areas such as the face, neck, arms, and legs.

When it comes to gender, biological and environmental factors intersect differently for men and women. Women’s skin intrinsically ages faster than men’s, though men are often more affected by extrinsic factors, such as lifestyle choices.

Skin tone also plays a role in how ageing manifests. Lighter skin tones tend to show wrinkles more visibly, while darker skin tones often retain a smoother appearance for longer. However, darker skin tones may experience more pigmentation changes as they age.

While intrinsic ageing cannot be mitigated, it is becoming increasingly possible to reduce extrinsic ageing.

Causes

The primary cause of ageing skin is the loss of the skin’s ability to regenerate two essential proteins: collagen and elastin. These proteins are crucial for maintaining skin strength and mobility.

Collagen is a protein that provides structure and elasticity to the skin. From around the age of 25, production begins to declines by about 1% per year.

Elastin is the fibres that help the skin return to its original shape after stretching. As elastin depletes, it causes the skin to become less resilient and more prone to sagging.

Intrinsic ageing is driven by biological processes:

Cause	Description
Genetics	Genetics influence the rate at which cells replicate, repair, and respond to environmental stressors. Mutations or variations in specific genes can cause faster cellular breakdown, leading to fine lines and wrinkles.
Cellular	Cells replicate about 50 times before they can no longer accurately copy genetic material. As cells become senescent and accumulate, the skin thins, loses elasticity, and becomes fragile.
Hormones	Hormones, particularly oestrogen and testosterone, decline over time, reducing skin elasticity, hydration, and overall resilience.

The extrinsic factors that accelerate ageing include:

Contributor	Description
Photoageing	Photoageing is caused by UV radiation, particularly sun exposure between 11am and 3pm, and the use of tanning beds, which trigger thousands of DNA alterations in skin cells every day, breaking down collagen and elastin. This leads to age spots and rough texture.
Nutrition	Nutrition, including diets high in sugar and processed foods cause glycation, which binds sugar molecules to proteins like collagen, reducing skin flexibility. Conversely, antioxidant-rich foods, like fruit and vegetables, help to combat oxidative stress. Additionally, lack of hydration can increase the risk of skin thinning.
Medications	Medications, such as immunosuppressive agents, along with immune deficiency diseases and the psychological stress they treat, can accelerate cellular damage and reduce skin resilience.
Smoking	Smoking, particularly due to nicotine, narrows blood vessels and reduces blood flow, limiting the amount of oxygen and nutrients that reach skin cells. This results in a sallow complexion.
Alcohol	Alcohol, when consumed excessively, dehydrates, and damages the skin, diminishing its natural glow.
Skincare	Skincare becomes increasingly important as the natural exfoliation process slows with age. Not cleansing properly can cause a buildup of dead skin cells, oil, and dirt, resulting in a dull complexion.
Environment	The environment, and pollution, such as particulate matter and smoke, can clog pores, lead to inflammation, and leave the skin looking dull. Harsh working conditions and chronic stress can have an adverse effect on hormonal levels, worsening skin health.

Diagnosis

Monderma determines the extent of premature ageing by examining exposed areas of the skin to identify its underlying causes.

The normal course of ageing includes predictable symptoms that develop over time:

Age	Symptoms	Description
25-30	Fine lines on the forehead and around the eyes.	The skin begins to thin, reducing its barrier function and natural UV protection. Collagen mass and flexibility starts to deplete by about 1% per year.
30’s	Fine lines on the cheeks, around the mouth, and on the neck, with mild hyperpigmentation.	The skin’s barrier function weakens, cell metabolism slows, and hyaluronic acid production declines, increasing moisture loss, and the first effects of sun damage from teenage years and the 20’s start to appear.
40’s	Moderate wrinkles on the forehead, around the eyes, cheeks, and mouth, as well as dull, and dry skin, and reduced volume in the cheeks and neck.	Outer skin layers no longer lie in their proper order, resulting in a more pronounced dull appearance. Existing skin cells shrink, and fewer new cells are formed, reducing skin volume.
50’s	Thinner, less elastic skin, with moderate hyperpigmentation.	Connective tissues in the skin’s middle layer lose their fibrous structure and ability to retain water. Fat tissue in the lower layer thins.
60’s	Deep wrinkles, sagging, and significantly dry skin.	The skin’s natural lipid production declines, as does the production of collagen and hyaluronic acid, resulting in deeper wrinkles and slower skin regeneration. The skin becomes more fragile and prone to dry skin.
Over 70	Impaired wound healing and severe hyperpigmentation.	The skin’s immune function weakens significantly, making it more vulnerable to infection. Wound healing slows, and hyperpigmentation becomes more severe due to prolonged exposure to environmental factors.

Treatment

While intrinsic ageing cannot be prevented, extrinsic ageing can be addressed through skincare treatment. Monderma’s custom formula includes up to 3 of the following types of active ingredients:

Topical Ingredient	Properties
Retinoids	Retinoids, such as tretinoin and adapalene, promote skin cell turnover to reduce pore size, clear spots, and smooth fine lines.
Lightening Agents	Lightening agents, in particular hydroquinone, reduce the production of melanin to lighten patches of darker skin.
Anti-Inflammatories	Anti-inflammatories, including azelaic acid, inhibit inflammation-causing molecules to reduce redness, calm inflammation, and lighten patches of darker skin.
Antioxidants	Antioxidants, like niacinamide, repair and strengthen the barrier function of the skin to lock in moisture and improve suppleness.

Daily use of broad-spectrum sunscreen with SPF30 or higher is essential for ageing skin treatment. Lasting results typically take at least 8 weeks to appear, so it is important to follow a treatment plan.

Complications

As the skin ages, cumulative damage from both intrinsic and extrinsic factors result in a series of changes that affect its appearance and function. These changes are visible in several forms:

Complication	Description
Fine Lines And Wrinkles	Dynamic wrinkles, such as frown lines, crow’s feet, and laugh lines, are most noticeable when the muscles beneath them are active due to repeated facial movements. Static wrinkles, like forehead lines, cheek wrinkles, and marionette lines, are present even when the face is at rest. Gravitational wrinkles, including jowls and neck wrinkles, appear where the skin begins to sag as it loses elasticity. Atrophic wrinkles are fine lines resulting from decreased skin thickness and elasticity. Compression wrinkles, such as sleep lines, form due to external pressure on the face.
Thinning And Fragility	Thinning skin becomes more fragile and prone to injury as it loses its protective cushioning. This increases the risk of wounds, tears, and bruising, while slower healing from impaired cell regeneration and a weakened vascular network, further increasing the risk of infection. Loss of fat tissue beneath the skin leads to a hollowed appearance, especially around the temples and cheeks.
Dull Skin	Dull skin is often the first visible symptom of ageing skin. Reduced ability to shed dead skin cells and generate new ones leads to a buildup of cells on the surface and a lacklustre complexion. Limited blood flow reduces oxygen and nutrient delivery, further diminishing vibrancy. Without the ability to reflect light effectively, ageing skin appears matte and flat, making pores and pigmentation more noticeable.
Dry Skin	Dry skin becomes more common with age as the skin’s ability to retain moisture and produce natural oils declines. Sebaceous gland activity decreases, weakening the protective lipid barrier and increasing dry skin. Reduced hyaluronic acid production leads to moisture loss from deeper layers of the skin, resulting in a rough, flaky texture that can cause irritation and itching.
Hyperpigmentation	Hyperpigmentation is often caused by slower cell turnover, hormonal changes, inflammation, and cumulative sun damage. Dark spots and uneven pigmentation become more pronounced as the skin’s ability to renew itself diminishes with age.
Rosacea	Rosacea becomes more common as the skin ages. Blood vessels near the surface become more visible and susceptible to dilation and damage. The skin’s reduced ability to repair itself and control inflammation increases the likelihood of developing or exacerbating redness and sensitivity.
Psychosocial	Psychosocial factors related to early physical changes in appearance and societal attitudes toward ageing skin can negatively affect self-esteem, particularly in those in their 30’s and 40’s.

Understanding and managing these complications is essential for treating ageing skin and promoting overall wellbeing as one ages.

In Conclusion

Ageing skin is the result of a combination of intrinsic and extrinsic factors. While it is a natural part of life, advances in prescription skincare offer effective ways to manage and mitigate its effects to great effect.

By understanding the mechanisms of ageing skin and adopting effective treatment, you can improve both overall skin appearance and function. Take control today by completing Monderma’s short, free online skin consultation to see if prescription skincare would be right for you.

Compounding in dermatology has led to the emergence of personalised skincare, revolutionising the way people treat common skin conditions. It aims to provide tailored prevention and treatment strategies for defined groups of people to clear acne, reduce the effects of ageing, lighten hyperpigmentation, manage rosacea, as well as address other skin conditions.

Personalised skincare typically involves a dermatologist or pharmacist working with a compounding pharmacy to assess a patient’s skin and reported symptoms in order to prescribe a formulation. Compounding pharmacies typically use three types of ingredients to then produce these formulations; namely active ingredients, excipients, and base creams. Different combinations of these ingredients are compounded in precise doses to create higher-strength, more targetted treatments than traditional over-the-counter or online cosmetic products.

Active Ingredients

Some active ingredients are only available with a prescription in the UK. The most commonly used active ingredients in dermatology are retinoids, such as adapalene, which is available up to a concentration of 0.3% and tretinoin up to 0.1%. Retinoids regulate the growth of cells on the skin’s surface, improving its texture and tone.

Another commonly used type of active ingredient are lightening agents, like hydroquinone, with a concentration of up to 6%. Lightening agents reduce melanin production to lighten areas of dark pigmentation.

Anti-inflammatories include azelaic acid, which is available over-the counter in concentrations as high as 10%, and up to 20% if prescribed. Anti-inflammatories slow keratin production, reducing redness and inflammation.

Antibiotics, like clindamycin are available up to a concentration of 1%, and metronidazole up to 0.75%. Antibiotics reduce the number of bacteria on the skin’s surface, inhibiting acne-like lesions.

Antiparasitics, including ivermectin, which is available up to a concentration of 1%, reduce the number of dermodex mites to prevent redness and inflammation.

Antioxidants, such as niacinamide, which is available both over-the-counter and by prescription in concentrations of up to 10%, has a wide range of uses, including lowering oxidative stress to improve skin elasticity and even out skin tone.

A custom formula typically contains two or three active ingredients, while most retail prescriptions only contain one.

Excipients

Excipients play an important role in dermatology as they enhance the properties of active ingredients, ensure their stability and efficacy, improve absorption, and extend their life.

Butylated hydroxytoluene, citric acid, and sodium metabisulfite are common examples of excipients that act to preserve active ingredients, as are ethoxydiglycol, polyethylene glycol, and propylene glycol, which improve absorption.

Bases

Bases are available in a variety of forms, depending on their intended use. Cream bases are a popular choice for formulations that need to be lighter, more spreadable, and easily absorbed by the skin.

Ointment bases are often used to create a thicker, more emollient texture, and long-lasting moisturisation or hydration.

Anhydrous bases are appropriate for formulations that should be free from water, need to be sterilised, or need to have a longer life.

Lipid-based creams replenish lipids in the skin, maintaining the skin’s natural barrier function, and treat dry skin conditions.

In Conclusion

Compounding in dermatology is transforming how dermatologists and pharmacists treat their patients. It is widely acknowledged that the “one size fits all” approach is inadequate and each person’s skin chemistry, lifestyle, and goals are unique.

The future of personalised skincare holds great promise, with advances in science and technology enabling the development of more targetted and effective treatments. As our understanding of dermatological ingredients, formulations, and conditions continues to grow, we can expect to see widespread adoption of compounding to produce increasingly advanced personalised skincare treatments.

Scientific research is increasingly focusing on the relationship between diet and skin. The nutrients found in foods can have both a positive or negative impact on the appearance and health of our skin. A healthy diet can promote clear, youthful skin, whereas poor dietary choices may contribute to skin conditions and the premature ageing of the skin.

Diet is the primary source of energy and nutrients for the body, and these habits, or preferences for food or drink, are an important aspect of life that are influenced by historical, cultural, and religious factors. The seven nutrient classes can be divided into macronutrients, which are nutrients required in large quantities, and micronutrients, nutrients required in small quantities. Macronutrients include water, carbohydrates, fibre, fats, and protein, while micronutrients are vitamins and minerals. Collectively, both macro and micronutrients are required for the skin to protect the body from external aggressions.

Carbohydrates

It is increasingly accepted that there may be an association between sugar and some food processing methods such as frying and baking with ageing skin, with the mechanisms linked to skin advanced glycation end products (AGE’s). A high-sugar diet, ultraviolet irradiation, and eating barbecued fried foods contribute to the accumulation of AGE’s and acceleration of ageing skin. Furthermore, high-salt, spicy, and vegan diets can have a detrimental effect to long-term skin health. Therefore, scientific, reasonable, healthy, and diverse eating habits and eating some antioxidant-rich foods are essential to maintaining skin health. Carbohydrates should generally account for 45-55% of total energy intake.

Proteins

Proteins form an important part of body tissues and organs. Their primary physiological functions are to build and repair tissues, mediate physiological functions, and provide energy. All tissue cells in the body are constantly renewed, and only sufficient protein intake can maintain normal tissue renewal and repair within the skin’s renewal cycle of 28 days. Protein deficiency or excessive intake can cause metabolic disorders and affect physical health. Protein deficiency can cause issues such as brittle hair, dry or flaky skin, nail changes, and impeding the healing process of wounds. Proteins should typically account for 10-15% of total energy intake.

Fats

Obesity, diabetes, fatty liver, and ageing skin are all associated with a high-fat diet. High-fat diets slow the healing of the skin by increasing oxidative stress and inflammatory responses, reducing protein synthesis. Fats should consist of 30-35% of total energy intake.

Fibres

A high-fibre diet can bind and eliminate toxins from your body, improving the health and appearance of your skin. Fibre acts as a prebiotic, feeding the good bacteria in the gut and promoting a healthy gut-skin axis, lowering the risk of skin problems. Fibre has anti-inflammatory properties that can help reduce inflammation in the skin while also improving its overall health and appearance. An adequate intake of fibre is considered between 25-30g per day.

Vitamins

Vitamin deficiencies have an impact on skin health. The lack of vitamins in the body can cause skin disorders. For example, lack of vitamin C causes the symptoms of scurvy such as fragile skin and impaired wound healing. Vitamins, as skin antioxidant defence ingredients, are primarily obtained from food; thus the content of vitamins in the diet is closely related to skin antioxidant capacity and physiological functions.

Minerals

Trace elements include iron, iodine, zinc, and copper and refer to elements which make up less than 0.01-0.005% of the human body’s mass. Despite their low abundance in the body, trace elements have significant physiological and biochemical effects. Trace elements are closely associated with skin immunity and inflammation.

Water

Water is a vital component of the body, helping to maintain balance and tissue function. Water in the body and cells primarily serves as a nutrient, solvent, and transportation carrier, while also maintaining body volume and regulating body temperature. A lack of water in the body can cause tissue dehydration and functional disorders such as ageing and inflammation. Drinking 2l of water per day improves skin physiology and promotes superficial and deep hydration.

In Conclusion

The consensus is that diet may have a significant impact on skin health. By incorporating a diet rich in healthy fats, antioxidants, and essential vitamins and minerals, the skin could serve as a mirror to reflect overall health, and it is anticipated that in the coming years, it will become clearer how diet affects its vitality and resilience.

The practice of researching, diagnosing and treating skin conditions has evolved remarkably throughout the ages. From the earliest known account of skin conditions on clay in ancient Mesopotamia 5,000 years ago to the current use of artificial intelligence, important individuals and discoveries have shaped the specialty’s perspectives. New knowledge and technology continue to broaden our capabilities, improve quality of life, and contribute to longer life expectancies.

Antiquity

Modern humans evolved in Africa around 315,000 years ago, and while visible changes to the skin have been recognised since the beginning of time, it was the Mesopotamian peoples – in present-day Iraq and north-eastern Syria – who first took an interest in understanding skin conditions from the beginning of recorded history around 3100 BCE. This took the form of religion and astrology, and was often considered as a sign of divine retribution. Mesopotamia is observed to be the first civilisation to define acne, moles, and warts.

Among the oldest preserved medical accounts relating to skin conditions date back to ancient Egypt from around 1600 BCE. These scrolls describe how to diagnose and treat rashes, burn wounds, ulcers, and even tumours through the use of herbs and natural ointments, as well as surgical procedures. Medical practice in Egypt was inextricably linked to religion, with priests providing care in temples and skin conditions being attributed to the will of the gods.

Beginning around 1200 BCE, ancient Greece rejected the use of incantations as a form of treatment, but similarly to the Egyptians, saw skin conditions as a sign of humoral imbalance: black bile, yellow bile, blood, and phlegm. Greek medicine placed a strong emphasis on a healthy diet and exercise, as well as the harmony between internal goodness and external beauty. They described the anatomy and physiological functions of the skin, including sweating and glandular secretion. Hippocrates, known as the “Father of Medicine,” proposed the first classification of skin conditions. He classified dermatoses into two categories: exanthematic diseases or rashes, and idiopathic diseases with unknown causes. The Greeks are credited with laying the foundation for dermatological practice.

The Roman Empire, which dates from 27 BCE, sought to preserve Greek medical knowledge. They valued water’s healing qualities, used plants for their antiseptic properties, and studied the causes of hair colour, as well as conditions like leprosy and ulcers. The Romans attributed each condition to a specific doctor; thus, some dedicated themselves to the treatment of eyes, ears, and skin, with the latter were responsible for the prescription of medicinal baths. At the height of the Roman Empire, science began to be applied to Roman medicine despite a strong medical-religious impetus.

The Middle Ages

The Middle Ages, which lasted from 500 to 1500 CE, were a time of relative intellectual stagnation in Europe, with superstitions dominating beliefs about medical care and illness. Standard medical knowledge was based chiefly on surviving Greek and Roman texts, preserved in churches and monasteries. These texts were the primary source of medical knowledge, and were relied on heavily when treating patients.

Modern History

This lasted until the Renaissance, which took place between the 15th and 16th centuries, and saw a tremendous increase in knowledge as well as a reappraisal of Greek rationality. This reignited interest in medicine, including the study of skin. It marked the transition from the Middle Ages to modernity, with an emphasis on reviving and surpassing the ideas and achievements of classical antiquity.

In 1543, Belgian physician and anatomist Andreas Vesalius examined and described the distinction between the epidermis, or outer layer of skin, and the dermis, or inner layer of skin, as well as pores, nerves, and fat, marking a significant milestone in the formalisation of skin research. In 1572, Italian physician Girolamo Mercuriali completed the first scientific study devoted to skin, emphasising the importance of future research.

As the study of the skin expanded in the 18th and 19th centuries, three major medical and research centres in Europe emerged: the United Kingdom, France, and Austria, establishing the science of dermatology. In 1736, French physician Jean Astruc wrote the first comprehensive treatise on sexually transmitted infections, and is regarded as the “Founder of Modern Dermatology”. The first great dermatology school, Hôpital Saint-Louis opened in Paris in 1801, and the first textbooks and atlases were published during this time.

By the mid-19th century, dermatology had established itself as a widely recognised branch of medicine, and publications allowing physicians to recognise symptoms in their patients were circulating. Hospitals such as Charité in Berlin began to establish dedicated dermatological departments.

In 1845, British physician James Arnott pioneered the use of freezing techniques for therapeutic purposes, observing shrinkage and analgesia. Other types of freezing emerged in the decades that followed.

In 1865, British Dermatologist Alexander Balmanno Squire, was the first to document a skin condition using photography. Throughout the history of medicine, diagnoses, and treatments had been recorded in writing through notes and medical records, as well as through oral communications between professionals. Photographs soon became the cornerstone for care and education in dermatology.

The scientific revolution and technical advancements transformed dermatology during the 20th century. Scientific societies, journals, and academic congresses helped to consolidate the specialty and attract attention from the medical and business communities. Furthermore, the practice of dermatology grew to include a wide range of surgical, diagnostic, and cosmetic procedures.

In 1963, American dermatologist Leon Goldman pioneered the use of lasers in dermatological treatment, demonstrating the selective destruction of pigmented structures of the skin, namely melanomas, but with uses as wide as scars and tattoo removal. By the 1960’s, dermatology had definitively transformed into a clinical-surgical specialty.

Dermatologists began to adopt skin rejuvenation treatments, such as fillers. In the late 1970’s, Stanford University in the United States developed the first injectable dermal implant for filling soft tissues. In 1992, Canadian dermatologist Alastair Carruthers and ophthalmologist Jean Carruthers pioneered the use of botulinum toxin, or botox, to treat expression wrinkles.

Teledermatology was first used by the United States in Somalia in 1992. It provided dermatological assistance to soldiers through satellite radio, which allowed for video meetings between soldiers and dermatologists. Since the late 1990’s and early 2000’s, information and communication technologies have revolutionised social interactions and content sharing, and in doing so expanding access to dermatology services and fostering scientific research.

In Conclusion

Skin conditions have been known to mankind since its origin, as the primarily visual component of these conditions allows for early recognition, but breakthroughs in accurate diagnosis, and effective methods of treatment showed signs of development in antiquity, but had to wait millennia for more meaningful advancement. It could be argued that we accomplished more in the 20th century than the preceding millennia, and the task at hand is to continue that level of advancement through the 21st century.