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“As a white candle in a holy place, so is the beauty of an aged face.” –Joseph Campbell
According to the WHO annual report, the proportion of individuals aged over 60 years has outnumbered that of children under five years. In simple words- THE WORLD IS AGING! Thanks to modern medical advancements, in the last 20 years, human longevity has increased by more than a decade. And with this rise in life expectancy, the morbidity of the senior population has also increased correspondingly.
Table of contents:
Introduction | Types of Moisturizers | Categorization Based on Water and Oil/Lipid Concentration | Uses of Moisturizers in Older Adults | Other Characteristics of Moisturizers
Introduction
Aging is an inevitable facet of life. Just like all the other organs of the body, with rising age, the skin also becomes more liable to infirmity. The human skin sits at the frontier post for contact with all exogenous physical, chemical, and biological agents. The conservation of skin’s integrity is imperative for maintaining its barrier, sensory, thermoregulatory, exocrine, endocrine, and immunological properties. Our skin is an extraordinary organ and must be accorded an equally extraordinary safekeeping.
However, unfortunately, even the mightiest of soldiers have fallen, and our skin is no exception! With advancing age, various intrinsic and extrinsic changes contribute to cutaneous damage.
The geriatric population is perhaps one of the most neglected sects of society. Some commonly encountered geriatric dermatoses include xerosis, pruritus, atopic dermatitis, allergic/irritant contact dermatitis, accelerated skin aging, and various inflammatory and infective cutaneous illnesses.
In order to promote healthy skin practices to care for aging skin and fulfill the urgent and unmet needs of this defenseless age group of patients, the IADVL has also established a special interest group (SIG), the ‘SIG geriatric dermatology’.
It has been said that in order to be old and wise, you must first be young and stupid. However, when it comes to skincare, skipping daily moisturizing is an unforgivable transgression. The importance of moisturizers for aging skin just can't be overstated.
Types of Moisturizers
The term ‘moisturizer’ is a neologic word coined by the Madison Avenue marketers, with no scientific bearing. These moisturizers can be broadly classified into four groups: occlusive, emollients, humectants, and protein rejuvenators.
Occlusives: They are the heaviest form of moisturizer. When applied to moist skin, occlusives sit on the top of the epidermis and help to seal in all the water in the stratum corneum. Examples include petrolatum, paraffin, beeswax, mineral oil, coconut oil, and plant butters like shea and cocoa butter. However, plant butters like Shea butter might be comedogenic. So, keep that in mind while deciding which moisturizer to use. Some occlusives like ceramides, cholesterol, and free fatty acids can also restore the faulty intercellular matrix lipids.
Emollients: These agents are lighter than occlusives but still heavier than humectants. They get soaked into the skin and act by filling the crevices or gaps in the parched stratum corneum. This property of emollients makes them ideal candidates for adding a smooth texture to gracefully aging skin. They also help in preventing Trans-Epidermal Water Loss (TEWL) to a certain extent. Some commonly used emollients are ceramides, cholesterols, and squalene. Other examples include triglycerides, alcohol benzoate, fatty alcohols, and esters.
Humectants: These are the lightest of all moisturizers. When applied to dry skin, a humectant draws water from the environment and supplies the same to the upper layers of the skin. They only have a marginal effect on preventing the evaporative TEWL. Popular examples include glycerine, propylene glycol, hyaluronic acid, urea, alpha-amino acids, and sorbitol. These substances also compensate for the age-related loss in the stratum corneum’s natural moisturizing factor (NMF).
Protein rejuvenators: These are small molecular weight proteins that supposedly reload the epidermal and dermal protein agents like keratin, collagen, and elastin.
Categorization of Moisturizers Based on Water and Oil/Lipid Concentration
These moisturizers can be further categorized based on water and oil/lipid concentration:
a) ointments,
b) cream,
c) lotions,
d) gels and aerosols.
Most of these formulations also contain additives for antipruritic/soothing/analgesic effects, like menthol, pramoxine, and lauromacrogols. Lately, the concept of moisturizing syndet bars has also emerged. They contain synthetic non-drying detergents like sodium cocoyl isethionate, sulfosuccinate, etc.
There is another category of moisturizers called Oral skin moisturizers. These are generally capsules or tablets containing evening primrose oil, plant ceramides, collagens, and vitamins C and D.
Uses of Moisturizers for Aging Skin
The uses of moisturizers in older adults are:
Xerosis and pruritus: Courtesy of increased life expectancy and urbanization, the incidence of xerotic dermatoses is rising. Apart from the modernization of society, a downfall in traditional practices like regularly massaging the skin with oils has also contributed to a hike in the prevalence of xerosis. The epidermal cracks can allow the percolation of allergens and irritants into the skin if left unattended. These exogens lead to pruritus, which further promotes skin scratching, contributing to exacerbated skin damage. This vicious ‘causal nexus' situation throws the inflamed skin into the so-called ‘itch-scratch cycle'. Moisturizers, with their anti-cytokine action, help in down-regulating this cycle.
Eczematous dermatoses: In the case of atopic children, the model of ‘proactive’ management using emollients has been successfully employed. The same principle can also be applied to geriatric patients suffering from eczema. The use of barrier emollients also protects sensitive patients from allergic contact dermatitis.
Anti-aging: Dr. Howard Murad very famously said, “Aging is a fact of life. Looking your age is not” and I couldn’t agree more! The veil of misinformation and mass hysteria surrounding the cornucopia of ‘age-reversal’ serums and creams that promise to iron out one's wrinkles is as old as time. Unfortunately, most of these barely have any scientific backing, unless it's products like argireline, matrixyl, or retinoids. However, when it comes to anti-aging modalities, even the most basic of moisturizers have proven their mettle persistently. Moisturizers containing hyaluronic acid, peptides, and ceramides hold promising anti-aging prospects and can dramatically prevent and reduce crinkles, fine lines, and wrinkles when used regularly and consistently.
Photo-protection: There is no denying the fact that nothing will give more merit to one's skin in their 60s than a good sunscreen started in their early 20s. Various commercially available sunscreens are now formulated as moisturizers for easy applicability and greater cosmetic acceptance.
Other Characteristics of Moisturizers
Apart from their hydrating, antipruritic, and anti-aging actions, moisturizers are also a vital part of dermatology for their following properties:
Anti-inflammatory: Moisturizers down-regulate the synthesis of pro-inflammatory prostaglandins by inhibiting cyclooxygenase.
Anti-mitotic: This property of moisturizers is utilized for inflammatory dermatosis like psoriasis.
Anti-microbial: With the current prevailing situation of the pandemic, the masses have become overtly conscious of their personal hygiene. Practices like frequent hand washing, sanitization, and bathing multiple times a day have been observed to turn into an obsessive-compulsive disorder in geriatric individuals. This might break the integrity of their cutaneous barriers. Moisturizers sit on the top layer of skin and act as a physical occlusive barrier to potential pathogens and help heal damaged skin in such individuals.
In conclusion, aging gracefully is a choice, and moisturizers are the doorway to it.
If fragrance-free moisturizers are what you are looking for, you can head over to our article on the best fragrance-free moisturizers in which Dr. Alpana has made her recommendation based on her review of the ingredients.
While moisturizers are important for everyone, this doesn't mean that you should use just about any moisturizer you get your hands on. The moisturizer you need depends on multiple factors. Here's a tool we have built to make this choice extremely easy for you: