Skin Deep Longevity: Evidence-based ways to support skin longevity - Insights from the Innersight Podcast #29

Understanding Skin Health: Insights from a Dermatologist

Skin health is a critical aspect of overall wellness, particularly in sunny regions such as South Africa, where exposure to ultraviolet (UV) radiation increases the risk of skin conditions, including skin cancer. At Innersight, we emphasize proactive care, and to provide expert guidance, we regularly consult with specialists. In this discussion, we are joined by Dr. Barbara van der Westhuizen, a board-certified dermatologist based in Durbanville, in the northern suburbs of Cape Town.

Dr. van der Westhuizen’s practice encompasses a comprehensive range of dermatological care, including the diagnosis and management of skin cancer, inflammatory conditions such as acne, psoriasis and eczema, and a limited scope of aesthetic procedures. She emphasizes the importance of skin in both longevity and overall well-being, highlighting that healthy skin is not only vital for survival but also for maintaining its appearance over time.

The skin, the body’s largest organ, serves as a protective barrier, retaining moisture, shielding against pathogens, and safeguarding internal organs, muscle and fat. In the context of preventative health, regular skin screening, particularly for skin cancer, is essential. At Innersight, the screening process begins with a risk assessment through a questionnaire. Patients identified as higher risk are then referred for a professional evaluation.

Dr. van der Westhuizen recommends that every individual undergo a comprehensive skin examination at least annually. This check should ideally be conducted by a trusted general practitioner or directly with a dermatologist. A thorough assessment includes examination of all skin surfaces: the face, scalp, palms, soles and other less obvious areas. For children, initial screenings are advised after puberty, when hormonal changes may reveal acne and moles. Individuals with higher risk factors or a history of pre-cancerous or cancerous lesions require more frequent follow-ups, ranging from every six months to every few months in the first years after a diagnosis. Over time, if no new lesions are detected, follow-ups may return to an annual schedule.

Structured screening, tailored to age, risk and medical history, remains central to effective skin care and early detection of skin conditions.

The Importance of Early Detection: Understanding Skin Cancer Types

Skin cancer remains one of the most significant health risks, particularly in populations with high sun exposure. Early detection is crucial; individuals who have never undergone skin screening may unknowingly develop serious conditions. For the general public, skin cancers are typically categorized into two main groups: melanoma and non-melanoma skin cancers.

Melanoma is the most aggressive form. It often presents as a new or changing dark mole, and early recognition can be life-saving. Dermatologists use the “ABCDE” criteria to identify suspicious lesions:

• Asymmetry - one half of the lesion differs from the other

• Border irregularity - edges are uneven or notched

• Color variation - multiple colors within the lesion

• Diameter - generally larger than 6 millimeters

• Evolving - changes in size, shape, color or symptoms

  
  

Some melanomas, including amelanotic types, appear as pinkish or skin-colored bumps, making them harder to detect. Other variants, such as acral melanomas, develop on the palms, soles or under the nails and are often diagnosed late due to their less visible locations. Remarkably, only about 20% of melanomas arise from pre-existing moles; the majority develop as new lesions, highlighting the importance of regular screening for early detection.

Modern dermatology utilizes dermoscopy, a technique employing specialized lenses with polarized and non-polarized light, to examine the upper layers of the skin. This allows trained dermatologists to identify early changes that may indicate melanoma, often when lesions are only a few millimeters in size.

Non-melanoma skin cancers include squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), which are more common among lighter-skinned individuals with chronic sun exposure.

• Squamous cell carcinoma often originates from precursor lesions and can invade deeper tissues. Early lesions may appear as reddish or pink papules, sometimes resembling a pimple or patch of eczema, commonly on sun-exposed areas such as the scalp, ears, neck, chest, and forearms. Early detection allows for simple treatments such as cryotherapy, followed by regular monitoring.

• Basal cell carcinoma typically manifests as shiny, pinkish, or skin-colored papules without precursor lesions. Although it grows slowly and rarely metastasizes, BCC can be locally destructive, particularly in areas like the nose, ears, temples, and around the eyes. Complete surgical removal at an early stage usually ensures an excellent prognosis.

While Squamous cell carcinoma is more commonly encountered, melanoma remains the more aggressive type, capable of rapid metastasis. Skin screening, including mole mapping, significantly improves early detection. However, patients sometimes present with advanced melanomas due to delays in seeking care, often influenced by personal circumstances such as caregiving responsibilities or coping with a family member’s illness.

Advances in Skin Screening: Mole Mapping and AI Integration

The field of dermatology has experienced remarkable advances in recent years, particularly with the adoption of mole mapping and artificial intelligence (AI). Mole mapping, once a relatively new practice, is now considered a standard of care for dermatologists. It involves capturing detailed images of all moles on a patient’s body, allowing for precise comparisons over time and early detection of suspicious changes.

Modern mole mapping devices, many of which incorporate AI, enhance the screening process significantly. These systems can compare new images with millions of reference images worldwide, analyzing each lesion for potential risk. AI can categorize moles as low, medium or high risk, enabling dermatologists to focus on lesions that require further evaluation. Total body scans allow side-by-side comparisons during follow-up visits, highlighting subtle changes or new lesions that might be missed by the naked eye.

The benefits of this technology are profound. Early detection of melanoma in the “in situ” phase, when a lesion is less than 0.8 millimeters thick, allows for a simple wide local excision, usually without the need for lymph node assessment. This significantly improves prognosis and reduces the risk of complications. In contrast, melanomas thicker than one millimeter require more extensive evaluation and treatment, highlighting the critical importance of regular screenings and baseline assessments.

Screening is tailored to the individual, taking into account genetic background, skin type, sun exposure history and family history of skin cancer. For example, a fair-skinned individual with high sun exposure and a family history of melanoma may require screenings every six months, while someone with lower risk may only need annual assessments.

Dr. van der Westhuizen emphasizes that every individual should undergo at least one comprehensive skin screening, regardless of perceived risk. The initial visit establishes a baseline, allowing dermatologists to identify existing lesions and determine appropriate follow-up intervals. This proactive approach helps catch potentially dangerous lesions early and provides reassurance for patients with benign findings.

Importantly, skin screening is a non-invasive, painless procedure. During the examination, dermatologists may take photographs, identify benign lesions and perform small biopsies if necessary. The combination of technological innovation and expert clinical assessment ensures that patients leave the consultation with a clear understanding of their skin health and a personalized follow-up plan.

How to Maintain Healthy Skin: Sun Protection and Anti-Aging Strategies

Once your skin has been screened and any concerning lesions addressed, the next step is proactive skin care. The goal is not just prevention of disease but maintaining healthy, resilient skin well into later life.

1. Sun Protection: The Most Effective Anti-Aging Tool

The most cost-effective and impactful strategy for slowing photoaging and preventing skin cancer is sun protection. Key practices include:

• Avoiding direct sun during peak hours.

• Taking walks early in the morning or late in the afternoon.

• Using broad-spectrum sunscreens with SPF 30–50 that protect against both UVA and UVB rays.

• Wearing protective clothing and hats.

• Ensuring children are educated about sun safety from an early age.

Sunscreen remains the cornerstone of skin health. While debates about chemical absorption and environmental impact persist, current evidence suggests that the benefits far outweigh the risks. Most particles sit on the skin’s surface to block or reflect UV rays, and typical use is far below any toxic levels. For those concerned with cosmetic acceptability, sunscreens now come in formulations that minimize white casts and blend well on darker skin tones. Powder or touch-up formulations are available for daily use over makeup, while oral supplements may provide adjunct protection during intense sun exposure, but are never a replacement for topical protection.

2. Retinoids: The Multi-Tasking Anti-Aging Ingredient

For adults in their 30s and 40s, retinoids are highly recommended. Whether over-the-counter retinol or prescription-strength tretinoin, retinoids:

• Reduce fine lines and wrinkles.

• Promote collagen synthesis and improve skin texture.

• Regulate sebum production and help with acne.

• Address pigmentation issues.

Starting with lower concentrations and gradually increasing as tolerance improves is key to minimizing irritation. Even using a retinoid every second or third night provides measurable benefits over time.

3. Age-Specific Skin Care for Teens and Young Adults

Early intervention is crucial for teenagers with acne. Topical retinoids can prevent inflammatory damage and scarring, while oral retinoids are reserved for more severe cases. For younger teens without significant acne, a simple routine of cleansing, moisturizing and sunscreen is sufficient. Over-treatment, often influenced by social media trends, can unnecessarily irritate the skin.

4. Additional Preventive Measures

Beyond topical care, oral supplements like nicotinamide (500 mg twice daily) can help reduce inflammation and prevent precancerous lesions, particularly for high-risk patients. However, these are complementary measures and do not replace sun protection or routine skin care.

5. Choosing the Right Sunscreen

The best sunscreen is the one you will actually apply consistently. Key features include:

• Broad-spectrum UVA and UVB coverage.

• Inclusion of long UVA and visible light protection for pigmentation-prone skin.

• Pleasant texture and easy application.

• Adaptability for use over makeup or during outdoor activities.

Vitamin D, Skin Health and Additional Skincare Tips

While strong sun protection is essential, there’s a natural concern about vitamin D. Many people assume that living in sunny regions guarantees sufficient vitamin D, but lifestyle factors often lead to deficiency. Screening in dermatology practices frequently reveals low vitamin D levels, often in the high teens or low 20s, which is suboptimal for overall health.

• Moderate sun exposure: Early morning or late afternoon sun, even with short sleeves, can provide a healthy dose without increasing risk of skin damage.

• Darker skin types: People with more melanin are naturally more protected from UV rays, which means they may also be at higher risk of vitamin D deficiency despite living in sunny climates.

• Testing and supplementation: Testing vitamin D levels and supplementing when necessary is a practical solution. Oral supplements are effective, but the best vitamin D is made by the skin itself through safe sun exposure.

  
  

Additional Skincare Ingredients and Treatments

1. Vitamin C:

   • Topical vitamin C is highly effective for brightening, improving skin texture, and providing antioxidant protection against UV damage.

   • Oral vitamin C has limited direct effect on the skin.

     
     

2. Pigmentation Treatments:

   • Ingredients like niacinamide and tranexamic acid can help with pigmentation concerns but should be used under professional guidance.

     
     

3. Alpha Hydroxy Acids (AHAs):

   • Chemical exfoliants such as glycolic and lactic acid improve skin texture, address fine bumps like keratosis pilaris, and provide gentle exfoliation without harsh scrubbing.

   • Recommended concentrations for at-home use are 5–10% to minimize irritation.

     
     

4. Collagen Supplements:

   • Oral collagen supplements have limited evidence supporting skin benefits. The body breaks down ingested collagen into amino acids, which are then used throughout the body, not specifically rebuilt in the skin.

   • Proven methods to boost collagen include retinoids, microneedling, lasers, and other dermatological treatments.

     
     

5. Nutrition Foundations:

   • A balanced diet providing adequate protein, vitamin C, iron, and other building blocks supports natural collagen production and overall skin health.

     
     

Finding a Dermatologist

• Local search: Google Maps, word-of-mouth referrals, and online directories are reliable ways to find a dermatologist.

• Online consults: Platforms like Dr. Derma and private Zoom or WhatsApp consultations allow patients in remote areas to access specialist care.

• Skin check approach: Modern dermatology focuses on both skin cancer screening and comprehensive skin health. Patients are encouraged to bring their skincare products to review routines, tweak regimens, and ensure optimal sun protection.

  
  

Practical Takeaways

• Social media can be a useful tool to find dermatology content and professionals. Instagram offers polished, prepared content, while TikTok provides informal, accessible educational clips.

• The combination of consistent sun protection, targeted skincare (like retinoids and vitamin C), age-appropriate routines, and professional guidance offers the most effective approach to long-term skin health.

In Conclusion

Taking care of your skin is a lifelong investment. Start with regular screenings to catch problems early, prioritize sun protection as the foundation of your routine, and layer on age-appropriate active ingredients like retinoids, vitamin C, and AHAs. Don’t forget nutrition and vitamin D for internal support, and seek guidance from a trusted dermatologist to tailor a plan to your skin’s needs. With consistent care and smart choices, you can keep your skin healthy, radiant and resilient at any age.

If you would like to get in touch with Dr. van der Westhuizen, you can contact her through the following website: 🔗 www.drbarbaraderm.co.za

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