Skin care in your forties and fifties

The fourth and fifth decades of life are characterized by a marked decline in the levels of various hormones and growth factors. Cell damage has accumulated in many tissues; the skin is one of the most affected. As a result, the rate at which the skin renews and repairs itself becomes much slower.

Women in their 40s and 50s experience particularly dramatic hormonal changes because they either approach or undergo the menopause, which causes a dramatic decline in the hormones produce by the ovaries: estrogens and progesterone. The loss of these hormones causes a decline in the synthesis of collagen, elastin and other components of skin matrix, reduces the production of sebum (skin oil) and thus leads to skin thinning, dryness and other negative changes. Notably, the effects of declining testosterone in men are somewhat similar but not as marked or abrupt.

Another problems of older skin is excessive inflammation. While usually not visible to the naked eye, age-related skin inflammation manifests in higher levels inflammatory mediators (cytokines, prostaglandins and others) and abnormal activity of certain immune system cells. Inflammation increases the production of harmful free radicals and leads to increased cell damage, degradation of skin matrix and other problems.

All of the above results in a number of visible changes:

• Thickening and drying up of the outer layer of the epidermis (stratum corneum) leading to the dull, parched appearance.
• Thinning and weakening of the skin's middle layer (dermis), which is the layer responsible for the skin's strength, firmness and resilience. This leads to the accelerated development of fine lines and wrinkles.
• Progression and deepening of motion wrinkles and creases. Motion wrinkles are those developing in the area where facial movements result in skin folding. Weakened dermis cannot cope with continuous folding of the skin, which leads to a rapid deepening of motion wrinkles.
• Development of uneven pigmentation, discolorations, broken capillaries, redness and other blemishes associated with skin aging.
• Loss of subcutaneous fat and slackening of facial muscles, both of which contribute to tired, haggard look and facial sag.

While aging remains inevitable, you don't have to passively accept all those negative changes in your appearance. Some can be reversed, while others kept under control or slowed down.

What you can do to fight back

The scope of this article is too narrow to cover all possible treatments for the problems common in 40-50 year old skin. Below we list the key skin care steps/treatments potentially useful after forty. (For further information, browse the rest of our site.)

Ensure hydration
Skin dryness is exceedingly common after 40. Even though proper hydration alone is insufficient for optimal anti-aging routine, it is needed for all other steps to work properly. See our article on moisturizing; also see skin hydration tips contributed by our visitors.

Treat wrinkles and fine lines
Wrinkles and fine lines and common after 40. A few agents have been shown in published research to reduce existing wrinkles and fine lines and prevent or slow down the emergence of the new ones. The agents backed by the most evidence are retinoids (e.g. tretinoin a.k.a. Retin A) and vitamin C family (L-ascorbic acid and some of its derivatives). Additional agents that might help but are far less proven include lipoic acid, copper peptides, and a few others. Each has it pros and cons and may be right for some people but not for others. See our topical treatments section for further details.

Topical estrogens and progesterone
Research shows that replenishing skin levels of the sex hormones, particularly estrogens and progesterone, via topical application improves skin hydration, reduces wrinkles, increase epidermal renewal rates and produces other beneficial effect in women near or past menopause. However, since small amounts of topical estrogens are absorbed into the bloodstream, such treatment should be undertaken only under the care and with approval of your physician. Do not attempt this without medical supervision. See our topical treatments section for further details.

Exfoliate - if you need to
In the forties, your epidermis (the outer skin layer) is likely to become considerably drier and thicker because its cells (keratinocytes) are not replaced as quickly as before. As a result, your skin may look dull and have dry, uneven texture. If you notice these changes, periodic exfoliation may help restore a more youthful feel by removing the excess of dead keratinocytes from your skin's surface. However, it is important not to exfoliate too much. If you exfoliate to the point of chronic skin irritation, you may end up accelerating the aging of your skin. You could start with mild mechanical exfoliating agents (such as table sugar scrub); if those are insufficient and your skin still looks dull, try mild chemical exfoliants, such as alpha and beta-hydroxy acids. (See also exfoliation tips contributed by our visitors.)

Reduce skin matrix degradation by inhibiting MMP
One of the reasons skin matrix degrades more quickly as we age is the increase in the activity of the so-called matrix metalloproteinases (MMP). While research into the role of MMP in skin aging is relatively new, taking steps to inhibit their activity might help. See our article on MMP inhibition.

Treat pigmentation problems
Skin pigmentation problems, such as blotchiness and age spots, are exceedingly common after 40. Most are caused by abnormal (usually increased) production of the skin pigment melanin. Oftentimes this problem can be improved by topical skin lightening agents, most of which inhibit the synthesis of melanin. See our article on the treatment of pigmentation problems.

Motion wrinkles are helped by botulinum toxin (Botox)
Motion wrinkles are relatively pronounced wrinkles that develop in the area where facial movements result in skin folding. They are very common after 40 and tend to resist treatment with topical anti-wrinkles agents or even such procedures as laser resurfacing and chemical peels. However, motion wrinkles usually respond surprisingly well to the injections of botulinum toxin (Botox). The main reason is that Botox reduces or eliminates their cause, i.e. the movement that crumples up the skin. In most cases, Botox dramatically improves horizontal forehead creases, scowl lines between eyebrows, crow's feet, and vertical wrinkles of your upper lip. Its usefulness for nasolabial folds a.k.a. smile lines is less clear (smile lines are often treated by dermal fillers). Botox is ineffective for wrinkles not caused by facial movement. (See our article on Botox).

Stubborn problems may yield to second line treatments/procedures
Many problems of the 40-50+ year-old skin may be stubborn enough to resist topical agents and other simple self-administered treatments. At that time, you should consider second-line treatments/procedures usually performed by medical professionals. It is critical to pick the right treatment for a particular problem and find the right doctor to administer it. Depending on the problem to be corrected, such second-line treatments may include lasers, dermal fillers, chemical peels, botulinum toxin (Botox) injections and others. Many treatments are non-invasive or minimally invasive while others involve incisions or other types of open wounds. See our treatments section and doctor search for more information.