By Brian Russell, MD
It goes without saying that men are different from women, right? If we weren't, there would be no need for magazines like this one and even less necessary to have an issue of Women's Inc. dedicated to men. The differences between the sexes are evident to me in my practice on a daily basis. I could not count the number of times that men tell me that they only scheduled their visit with me because their wives made those oh-so-subtle suggestions that husbands know (and fear). It could be disheartening to a doctor to know that the person they are visiting with is there under duress. But I try not to let it get to me.
There are several tips I can offer men to help them maintain the health of their skin and prevent them from having to come see me. The nice thing about dermatologic advice for the male patient is that the goals are usually straightforward and the expectations are typically reasonable and attainable. In other words, for most men, I keep it simple. One general principle is this: you do not have to spend a fortune on skin care products. There are a number of excellent items available at pharmacies and large retailers that cost under ten dollars that I recommend and use. When I mention them below, bear in mind that I have no financial ties to any of the companies - they are purely based on my own experience and assessment.
This is an absolute necessity that we all learn at birth. In our first dozen years or so of life, our skin is so resilient, healthy and virtually oil-free, that the primary reason for cleansing is to remove accumulated dirt and odors. As we age, our skin changes. In some cases, it becomes more oily and in these patients I recommend twice daily washing with a targeted oily-skin cleanser like Cetaphil Normal to Oily or Neutrogena Face Wash for Men. However, it is often the case that as our skin ages beyond its 20s and 30s, its capacity to moisturize itself diminishes and our skin becomes drier. This is actually more problematic. Dry skin is more prone to itching and other complications and leads to more dermatology consultations. In dry skin, less is more: over-washing is more harmful than under-washing. In these patients, I suggest very mild cleansers for the face such as Cetaphil Gentle Skin or Cerave and restrict washing to once daily in general. For patients with shaving problems or acne-prone skin, try a product with salicylic acid or benzoyl peroxide first. If these are not helpful, see your doctor, as prescription agents can be more useful.
There are two types of aging that our skin experiences: intrinsic and extrinsic aging. Intrinsic aging is unavoidable and is purely a chronological phenomenon. Genetics play a role in how we look as we age chronologically, and there are few things that can be done to change this. We attribute about 20-30% of the skin's normal senescent changes to intrinsic events. However, extrinsic aging is variable. Unlike most other organs in our body, our skin is susceptible to the external world. Just like the exterior of our homes, our skin has to be tough to handle the elements like rain, wind, wide ranges of temperature , traumatic injury, and, of course, sunlight. The effects of these influences accumulate and become more obvious the older we get. Out of all the insults we incur, ultraviolet radiation from the sun and artificial sources (i.e. tanning beds) is by far the most damaging long term. The link between sunlight and skin cancer is well documented and beyond the scope of this article; however, what is less publicized is the relationship UV light has with aging of the skin. It is thought that 70-80% of the skin's aging process is due to UV radiation. For those who doubt this, take a look at a fair-skinned 70 year old. Have them show you their forearm. Look at the top, then turn the arm over and compare. Those brown spots we call lentigines are often due to sunlight. The fine, crepe-paper wrinkling - sunlight. And the one I get asked about most, the easy purple bruises we call Bateman's purpura - sunlight.
I said all that to give you the most critical advice I can give to slow down the aging of your skin: Wear your sunscreen! For the face and neck, sunscreen should be applied every morning. Facial sunscreen is coupled with moisturizers in many instances. The men's lines by Neutrogena and L'Oreal are very good, but broader-spectrum sun protection is afforded by Neutrogena Healthy Defense and the new Cetaphil facial moisturizers with sunscreen. For below the neck, Neutrogena Ultra Sheer is an outstanding sunscreen as is one that's a little harder to find, Blue Lizard. Men also like aerosol sprays for their convenience.
There, I told you I would keep it simple. Wash and wear your sunscreen. Those are the most important parts of a man's skin care regimen. There are numerous things that can be added like-hydroxy acids, prescription products such as retinoids, and anti-oxidants. Talk to your dermatologist about these and other options to see if they are necessary, but in most cases prevention of damage is the best strategy. Be consistent and be safe. And if your wife tells you to go see your doctor, do.