Published in Gulf Times on July 7, 2002

Taking cover is not enough

LENA LIEW talks to some local experts on skincare and learns more than she bargained for
Heads turn as she steps out into the summer sun. Dressed in a figure-hugging sleeveless tank top matched with enticingly short shorts, she strolls carelessly swinging her conspicuously bare arms. As if under a spell, the construction workers nearby stop work, tools in hands frozen midair. Male pedestrians and motorists stop in their tracks to ogle. The air rapidly gets thick with anticipation.

The woman is in danger ... but not from the men around her. She will regret walking down that street dressed as she is ... when she has to spend a fortune on sometimes painful cosmetic treatments to undo the sun damage to her skin. Or when a dermatologist tells her that she has skin cancer. Yes, the danger literally is skin-deep ... though it may well extend beyond that if left unchecked.

Philips performing a 'facial' on a client.

According to Professor Mostafa Mokhtar Kamel, head of Dermatology at Hamad Medical Corporation (HMC), the most common sun-related skin disorders in Qatar are photosensitive rashes, premature aging, pimples and acne, inflammation (redness, soreness and swelling) of the skin and lesions. In some cases, actinic chelitis, actinic keratosis or psoriasis is triggered or worsened with sun exposure.

Premature aging refers to the appearance of wrinkles, crow's feet arounds the outer corners of the eyes, pigmentation (i.e. age-spots, freckles), rough leathery complexion, thinning or thickening of the skin, loss of the skin's firmness, uneven colouration and/or texture, and, more seriously, broken capillaries and hyper-pigmentation.

Actinic keratosis refers to the appearance of pre-cancerous crusts which begin as rough-textured reddish bumps on the skins. Actinic chelitis refers to a pre-cancerous thickening whitish discolouration around the border of the lips. Psoriasis is a skin disease that results in rough, red and scaly skin that peels off in patches.

For Sheela Philips of the Doha Beauty Centre, the most common sun-related cases that she treats are acne (which produces pimples), pigmentation, blackheads and whiteheads. The problem begins with internal factors like hormonal imbalances which are triggered by the onset of puberty or pregnancy, or stress, Philips said.

"Acne is cause mainly by an overproduction of hormones during puberty or pregnancy or when a person is under stress. The hormonal imbalance in turn stimulate the secretion of sebum from the sebaceous glands, which causes pimples (infection of the pores), blackheads and whiteheads (when the pores get clogged with sebum). Blackheads are the result of trapped sebum on the surface of the skin getting oxidised due to exposure to atmospheric pollution. Whiteheads are trapped sebum that remain inside closed pores and don't get oxidised."

The resulting blemishes sometimes disappear on their own, but often, due to exposure to the sun, they become permanent. Or cancerous. Likewise, pigmentation such as freckles, brown sunspot or freckles, is a result of an overproduction of melanin accelerated by sun exposure.

Aside from facials, which cost between QR80 and QR250 depending on what is required, the most common treatments available in Doha are skin 'lightening', hydrating and laser treatment for removing pigmentation and wrinkles. According to a British-trained beauty therapist who declined to be named, 'bleaching' treatments advertised are not quite what they claim to be because the complexion does not actually turn white after treatment; just visibly lighter.

Drastic results cannot be expected immediately. Depending on the extent of sun damage, a course of treatment at the salon, supplemented by the prescribed home treatment, may take up to three months before results are seen. In some cases, individuals react adversely to the products used, even though the treatment comes with a good track record.

Laser treatment can sometimes cause pigmentation to worsen or spread (hyper-pigmentation) when performed on darker complexions, the British-trained beauty therapist cautioned. This is because the greater concentration of melanin in the surrounding skin tissues tend to absorb the laser energy more, and thus 'burn' further. After all, laser is a fine ray of light energy so concentrated that it cuts or vapourises the target. Since the sale of laser machines is not regulated, and beauticians do not need to be specifically licensed, some botched jobs have been reported in Doha in the past.

Home remedies - like honey, vinegar, lemon, eggs or other natural preparations - may work for some but not for others. In some instances, home remedies handled with dirty hands, utensils or vessels cause new problems or present ones to worsen instead.

Creams and lotions off the supermarket shelves may be economical, but don't expect much because they cannot possibly contain the same quality or concentration of active ingredients as salon products.

For example, as much as vitamin E creams and lotions are touted as skincare, "vitamin E does not protect the skin. It just makes your skin feel nice and soft", said Professor Mostafa of HMC dismissively. He explains that although vitamin E is known to hydrate the skin and promote healing, in most cases, the vitamin E molecules are too large to penetrate the skin tissues. Also, although vitamin E helps the healing of scars, sunburn or stretch marks, it cannot undo pigmentation.

"Diagnosis by a qualified beauty therapist is very important because the extent of a problem, or combination of problems, differs from individual to individual," said Philips. Stressing a holistic philosophy to health and skincare, Philips stressed that most skin disorders stem from internal factors like poor liver function, vitamin deficiency, poor nutrition, heart problems, hypertension, stress, overconsumption of tea, coffee or colas, aside from hormone imbalance resulting from the removal of uterus, consumption of oral contraceptive pills, frequent pregnancies, and thyroid problems.

Don't forget to drink plenty of water and fruit juice everyday, Philips advised. And never get too lazy to cleanse, tone and moisturise your face at least twice a day.

"Indeed, it is more important to eat fresh greens and fruits rich with anti-oxidants, beta cerotene and vitamin C," Professor Mostafa said, citing vitamin A, C, E and selenium tablets, carrots, tomatoes, capsicum, grapefruit, and oranges as examples. "If you find grapefruit juice too ascerbic, then add an equal part of honey to the drink. That way you benefit also from the healthful immunity-building properties of honey," he added.

After all, sun exposure compromises the body's immune system and therefore the skin's natural defences against the elements. When our immune system is suppressed, our response to immunisation is impaired, and our skin becomes more sensitive to the sun and other substances. That in turn means we are more likely to develop problems when exposed to the sun or to allergens which cause allergic reactions.

"Never, never go outdoors without sun protection. Use at least SPF20. And avoid going out in the sun. The sun ray's are strongest from 10am to 3pm," Professor Mostafa stressed. And don't forget to monitor your skin for abnormal changes, which could be a sign of skin cancer.

Do thick or dark coloured clothes help to protect the skin from the sun?

The answer is a resounding "no" from all the experts. Dark colours absorb the sun's rays and heat, they say. "And unless it's special fabric which scientists are still researching, thicker clothes offer no protection against the sun's harmful rays," says Professor Mostafa. Opt for light-coloured fabric instead. And wear white or pastel-coloured clothing during the summer to reflect the sunrays when outdoors. This advise is especially pertinent to the majority of Muslim women here who are almost always seen clad from top to toe in black abayas.

Often forgotten under the cover of abayas, sunglasses are also a must for the protection of the eyes. Regular sun exposure can cause cataracts - 'clouding' of the lens of the eye - which leads to blindness if left untreated.

Damage from sun exposure is so gradual that one may not notice it until it is too late. As the woman described in the beginning of this article will discover one fine day, the high price of overexposure. It's better to be safe than sorry.