Battling the elements

National report - Constant assaults from sun, wind and rain.

The introduction of new and often foreign treatments, both internally and externally. Changing patient attitudes about skin treatments and health. Patient misconceptions and overly aggressive consumer treatments. All of these impact how the epidermis fights its daily battle to protect us.

Outside elements take their toll on the epidermis.

In an aging baby boomer population obsessed with health and youthfulness, the effects of sun and wind damage are simply not as acceptable, which poses a great challenge to dermatologists nationwide.

And the incidence of skin cancer is on the rise.

"I don't know whether it's the depletion of the ozone layer, as much as it's simply people staying out in the sun longer," Dr. Alster says.

Even though consumers are becoming increasingly educated on the need to use products such as sunblocks and sunscreens to protect against melanoma, there has been something of a backlash effect, she says.

"Many people simply think you can slap on a sunscreen once, and then stay outside for 10 hours without re-applying it," she says. "And it has become much more socially acceptable to have a tan."

The next stage, wrinkling, is more of a dermal response to the outside elements.

And the way people respond to wrinkles can create even more damage.

Nonphysician treatments

Working without the benefit of formal medical training, many consumers will turn to at-home products or salons and spas for skin treatments.

"Many of these home microdermabrasion treatments or even chemical treatments may actually put them at risk for damage to the epidermal barrier," says Patricia Farris, M.D., who specializes in treatments for facial rejuvenation in her practice in Metairie, La.

"Some of the more aggressive products, if they are not used properly, or are overused - especially if you exfoliate the skin - can damage the barrier."

Estheticians in salons and spas may also be overly aggressive in their treatments. Or they simply may not know the consumer's history - whether a client has had a treatment and whether the skin has been given time to effectively heal.

Some at-home and spa microdermabrasion treatments contain aluminum oxide crystals and other abrasives, Dr. Farris notes.

In addition to outside elements and at-home treatments, the epidermis - especially in younger patients - is constantly being assaulted by various chemicals present in today's consumer goods.

"I do see a lot of allergic contact dermatitis presenting in children," Dr. Jacob says. "Children today definitely have different exposures than, say, children did in my generation or before, including disposable diapers (with fragrances/unscented chemicals), baby wipes and aspartame (present in diet soda, children's chewable vitamins and chewing gum), etc.