Cosmetic problems in the elderly are often ignored. Older people often find it embarrassing to seek help for blemishes, yet are grateful when treatment is offered. It is quite common to hear people say things like, ‘I shouldn’t worry about these little things, the main thing is that I am alive and healthy’.
Facial hairCoarse facial hair is very common in women after menopause. These hairs can be readily removed by electrolysis, plucking or waxing. Hormone treatment is another option for some women.
Seborrhoeic keratosesSeborrhoeic keratoses are large, brown, warty growths which can occur on any part of the body. They are usually hereditary but can also occur in areas of chronic sun exposure. They are benign lesions, but are often unsightly. Treatment with liquid nitrogen, curettage and/or laser will readily remove them with excellent cosmetic results.
Skin tagsSkin tags can occur on the eyelids and around the neck. Occasionally they cause irritation, but are more often a purely cosmetic problem. They can be readily removed under local anesthetic.
Bulbous noses in menRhinophyma is the medical term for the bulbous noses in middle-aged or elderly men. This enlargement of the nose is rarely related to alcohol intake and can be readily treated with a carbon dioxide laser, which produces an excellent cosmetic result.
Make-up for the elderlyAs women get older they may find they can no longer apply make-up effectively. Often their eyesight is poor and their hands are not as steady as they once were. Several studies have shown that older people who are well groomed feel better and healthier than those who neglect their appearance. If you have an elderly relative, helping her with simple grooming can make an enormous difference to her sense of wellbeing.Foundation can be used to even out skin tone, while a white, pearlised undercover can be applied to minimize the appearance of brown blemishes and wrinkles. Light foundations look best, as heavier foundations tend to accentuate wrinkles. Darker shades may help blend in brown blotches, and pinky shades help to freshen up the appearance of sallow skin. Creamy lipsticks should be avoided as they bleed into wrinkle lines; non-creamy lipsticks and lip crayons are better. It is useful to apply foundation and powder to the lips before applying lipstick. This will help stop lipstick from bleeding. Matt eye shadows work better than shiny or frosted ones, as they do not exaggerate creases around the eyes.

Australian consumers spend well over 20 million dollars a year on cosmetics, despite harsh economic times. Cosmetic sales have increased dramatically over the last fifty years through aggressive promotion and marketing, to a point where cosmetic counters can now take up an entire floor of a department store.Because we are a very aesthetically oriented society, looks are of paramount importance. Studies have shown that physical appearance plays an important part in our social interactions, interpersonal relations and job success. In western societies youth is also highly valued, so fear of ageing and loss of attractiveness make us easy prey for those promising simple (but expensive) solutions to ageing.Traditionally, cosmetics were used simply to beautify or decorate the skin. Over recent years, however, cosmetic companies have tapped into (and promoted) our fear of ageing and the cosmetic counters are now stocked high with potions and creams that, the manufacturers would have us believe, will rejuvenate our skin, prevent wrinkles or otherwise modify the ageing process. So many unsubstantiated claims, not surprisingly, have led the Federal Government to legislate against the use of unproven ‘scientific’ claims. Nevertheless, terms such as ‘liposomes’, ‘elastin’ and ‘anti-oxidants’ will no doubt continue to entice people to spend their hard-earned wages on products which may be of no real benefit. The use of pseudo-scientific terminology is confusing and often meaningless to customers, and even the sales staff may be unable to explain what it means. Moreover, nowadays cosmetics can be very expensive. It is not as though we are duped out of only a few dollars. We are also led to believe that the more expensive products are somehow better, and this too can be far from the truth.

Cosmetics have been used for over 4000 years. People have always been conscious of their appearance and have always devised ways to ‘improve’ upon it. Rouge was used as far back as 1500 ВС to colour the lips and cheeks, and the ancient Egyptians used henna for colouring the hair and eye pencils to highlight the eyes. The Greeks preferred blond hair and used saffron to lighten the hair pigment. They also used lanolin as a moisturizer.Around AD 100 the Romans felt that a white complexion was the most beautiful. They took milk baths and used powdered chalk to make the complexion paler. Soon after, lead and arsenic powders were introduced to whiten the skin. These ‘cosmetics’ led to many deaths due to poisoning. During the Elizabethan era white lead powders again became popular and again many deaths occurred in the name of beauty.In 1938 major regulations were brought to bear on the cosmetic industry as a result of multiple adverse reactions. Apart from the fatal lead powders, coal tar dyes, which were used for colouring the hair, caused blindness. Cosmetic authorities deemed that cosmetics were intended to beautify or cleanse the body, but should not alter the biological activity or structure of the skin. The Cosmetic and Toiletries Association took it upon itself to regulate cosmetic products in order to minimize side effects, however, as mentioned, the Federal Government has now passed legislation to regulate unsubstantiated therapeutic claims. Cosmetic companies are now also required to list all the ingredients in their products on the labels.

The large, reputable cosmetic companies test their cosmetics very carefully. It is fair to say that very few side effects occur given the number of cosmetics used by the average person. However, new chemicals are constantly being introduced into cosmetics with uncertain long-term side effects. Cosmetics are not regulated by health authorities and do not have to undergo strict toxicity testing before being released on to the market. Less reputable companies may not have strict quality control, so the ingredients they use may be more suspect.
How are cosmetics tested for safety?Because cosmetic companies have come under increasing pressure not to test their products on animals, many tests are now done on human volunteers. There are four main categories of safety testing which are routinely carried out by the larger manufacturers:- Irritant reactions. The biggest problem with most cosmetics is that they can produce irritation or stinging when applied to the skin. New cosmetics are now routinely tested on human volunteers to check for such reactions. Cosmetics intended for the eye area or for babies must be less irritating than other cosmetics.- Allergic reactions. Because cosmetics contain so many different chemicals, they can easily produce allergic reactions. The average cosmetic contains between ten and twenty chemicals, many of which can cause allergies in certain individuals.The two main causes of allergic reactions are perfumes and preservatives. Most cosmetics contain some sort of perfume in order to mask the smell of the other chemicals. Preservatives are used in all cosmetics to prevent decay.      There is no such thing as a cosmetic which doesn’t contain preservatives.Cosmetics are tested for allergic reactions by repeated patch testing on volunteers. Nonetheless, allergic reactions can still occur in susceptible individuals.- Acne production. Many skin care products contain moisturizers which are likely to cause blackheads, whiteheads and even acne lesions. Testing cosmetics for acne production is very crude. Testing is not performed on the human face but on the human upper back or on a rabbit’s ear. Neither the ear nor the human back is an adequate predictor of acne production on the face.- Bacterial count Preservatives are necessary in a cosmetic to prevent bacterial and fungal growth and to prevent decay. Bacterial counts must be lower in cosmetics for the eye area and in baby cosmetics. Without preservatives bacterial count would be unacceptably high, and so would the risk of serious skin infection.Despite all this rigorous testing, however, the long-term safety of many substances used in cosmetics is not known. Some potentially dangerous ingredients have been incorporated into cosmetic products. A recent example was urocanic acid which was used in some moisturizers. This substance has been linked to the production of skin cancer in animals.
Dermatologically tested cosmeticsThe more reputable cosmetic companies employ dermatologists to test their cosmetics. Cosmetics are tested in different ways, mainly for lack of side effects, especially irritant and allergic reactions. A cosmetic range which has been tested by a dermatologist is more likely to include suitable products for a wide range of skins. However, just because a cosmetic product is dermatologically tested does not mean that it will be suitable for acne skin or that it will prevent or treat wrinkles. Overall, dermatologically tested ranges are more reliable than those which are ‘adequately’ tested, and are labeled as being dermatogically tested.

Because cosmetics are so numerous, and because they can be so expensive, it is important to be able to distinguish between effective and non-effective preparations. Below are listed the main types of skin care products, what they are meant to do and whether or not they work or are necessary.
Cleansers The purpose of cleansers is to remove dirt and make-up from the skin. They do not remove blackheads or whiteheads. There are three types of cleansers available and these are suitable even for the eye area unless they cause stinging.
SoapsIt is often said that soaps should not be used on the face. Although this is true of the older, harsher soaps, milder soaps can be safely used on most skin types. Soaps are very effective for cleaning and degreasing the skin. Some soaps, however, may irritate the skin because they remove its protective fatty layer. Milder soaps are less irritating and can be used daily on the face. Examples include Almay facial soap and Clinique and Neutrogena soaps. Moisturizing soaps, such as Aveenobar and Dove, are also available and are good for those who suffer from dry skin.
Liquid cleansersLiquid cleansers may come as lotions, foams or gels. These also remove the dirt and make-up and function in much the same way as soap. They are very safe to use and are very effective.Some good products are Cetaphil Lotion, Yardley foaming wash, Neutrogena liquid cleanser and Avicide.
Cold creamsCold creams should only be used on very dry skin or for removing very heavy make-up. Although cold creams do remove dirt, they leave a film of cream on the skin. If this is not washed off acne, blackheads and whiteheads will appear after several months. Cold creams should only be used by more mature people and under no circumstances by people with oily skin or acne.

Toners There are basically two types of toners available. The first is an astringent-type toner which is very drying and should only be used on oily skin. It contains alcohol and oil-absorbing chemicals so is unsuitable for people with normal to dry skin.The second type of toner is basically water, which makes the skin feel cooler and fresher.
Facial scrubsThe main purpose of facial scrubs is to exfoliate the skin, making it appear smoother and more polished. Scrubs usually contain beads or granules which act as a mild abrasive. The skin, however, exfoliates itself every fourteen days and does not really require help to remove dead skin cells. In addition, abrasive scrubs can be very irritating to the skin, especially where there is acne. Overall, the benefits of facial scrubs are limited.
Masks There are two main types of masks available. The first is a moisturizing mask which contains many different moisturizers. The mask is left on the skin for about twenty minutes and then rinsed off. This is just another method of applying a moisturizer. Although it can be relaxing to use masks, they do not achieve more than moisturizers and will not prevent wrinkles.The second type of mask is a cleansing or clay mask which can be useful for oily skin. These masks absorb oil, making the skin drier and tighter. However, they can also be very irritating and often cause dermatitis.
T-zone productsThese products are designed mainly for the area around the nose, chin and central forehead where excess oil is produced. They are essentially oil-absorbing products and are useful for people who get an ‘afternoon glow’ on their noses. Examples include Almay Oil Control Lotion and Nutrasorb.

Moisturizers are mixtures of oil and water which trap water within the skin, making it more pliable, looking and feeling less dry, and smoother and softer. This allows make-up to be applied more evenly. Moisturizers can also plump up the skin, making wrinkles less visible. They do not, however, prevent wrinkles, treat wrinkles, or alter the ageing process. They are analogous to hair conditioners. Moisturizers work in three main ways: - Moisturizers can have an occlusive action, whereby the surface of the skin is ‘glued’ down, preventing water evaporation. Heavier moisturizing creams provide a thicker glue, which decreases water loss. Thicker preparations include lanolin, petrolatum, paraffin and mineral oils. These products may block the pores, resulting in blackheads, whiteheads and acne but are useful for older people with very dry skin.- Humectants are substances which draw water from the deeper layers of the skin to the surface. This means that the deeper layers become dehydrated at the expense of the surface. Collagen, elastin, glycerine, propylene, glycol, sorbitol, vitamins A and E and many other proteins act as humectants. However, if the surface of the skin is damaged, all the water escapes and both the top and deeper layers of the skin are left dehydrated.- Liposomes are little capsules which bind to the surface of the skin and release moisture on to the cell membranes. Although this sounds very fancy, it is really just another way of applying a moisturizer.Most moisturizers contain both glue-type substances and humectants. They draw water to the surface of the skin and keep it there, making the skin look plumper and smoother. Super-rich moisturizing creams and night creams contain a higher quantity of glue-like substances, and so trap in water for longer periods of time. On the other hand, they are responsible for many blemishes due to their suffocating effect on the skin. Despite all this, moisturizers do not alter the ageing process, nor do they repair the damage caused by excessive sun exposure.

Because moisturizers make the skin less dry, they are suitable for people with dry or normal skin but not for those with oily skin or acne. It is not necessary to spend a fortune on moisturizing creams. Although cosmetic companies generally test their moisturizers very thoroughly, it is as well to remember that you are subsidizing their advertising, marketing and packaging. Cheaper moisturizers often have similar ingredients and the same effect. It is a good idea to compare ingredients, which must now be listed on all products.Younger people should keep away from heavy, super-rich moisturizers as they will produce pimples. Light, vanishing-type moisturizers are fine but it is better to use a light moisturizer underneath a sunscreen on a daily basis as this will help prevent photoageing. Cosmetic moisturizers alone generally provide little protection from ultraviolet light.For the more mature person, a moisturizer may be necessary because the skin gets drier with age. Heavier moisturizing creams should be kept to a minimum, however, as you would with heavy hair conditioners. It is quite common to see people over fifty with a multitude of whiteheads and blocked pores around their eyes from using heavy moisturizers.If you want to spend a lot of money on moisturizing creams there is no real harm in doing so. You must realize, however, that they are really no better than cheaper products. Examples of good, inexpensive day moisture creams include Neutrogena moisturizer and Simple moisturizer. Good, heavier creams include Candermyl and Nutra-D. Recently, Choice magazine stated that sorbolene cream is the best facial moisturizer. This is not true. Sorbolene cream is rather occlusive for the face and tends to produce acne and blemishes. It is more suitable for the body.

Acne production is the biggest problem associated with moisturizers. As a general rule, the heavier the cream the more likely it is to produce blackheads, whiteheads and other blemishes. People under the age of forty should look for ‘non-comedogenic’ creams.Chemicals which commonly cause major acne include lanolin, mineral oil, paraffin and petrolatum. Other substances which can cause minor acne are butyl stearate, isopropyl isostearate, isopropyl myristate, isopropyl palmitate, myristyl lactate and myristyl myristate. The higher the percentage of these chemicals the more likely it is that blemishes will occur. They tend not to appear immediately but after long-term use.Moisture creams may contain many irritating chemicals. The reputable American cosmetic companies have minimized this by thoroughly testing their products before they are released on the market.Allergic reactions to moisturizers are not uncommon and are usually due to the masking perfumes, preservatives or sunscreens. Preservatives which frequently cause allergic reactions include Dowicill (quanterium 15), Kathon (methyl-chloroisothiozalone), Germall (imidazoyl urea), parabens, and other formaldehyde formations.

Most of the so-called anti-ageing creams available have no proven scientific benefit and are merely expensive variations on standard moisturizing creams. There are only two types of products available which have true anti-ageing qualities, namely sunscreens and Retin-A. Tighter government regulations have meant that cosmetic companies are no longer able to claim that their products are ‘anti-ageing’ unless they can prove this. In order to comply with these restrictions, some cosmetic companies are now incorporating sunscreens into all their products, even night creams. These sunscreens may cause severe contact dermatitis. Consumers are now being asked to spend 50 100 dollars or more for an elegantly packaged sunscreen. Furthermore, the sunscreens added to cosmetic creams are generally ultraviolet B-blocking agents such as cinnamate, which are in fact inferior to the regular broad spectrum SPF 15 sunscreens, especially those containing titanium dioxide.