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SKIN BEAUTY AND CARE FOR MEN

Dr Michèle VERSCHOORE, Marine VIALLANEIX. L'ORÉAL Research 

 

Human skin care through the centuries

Beauty has always been an integral part of the relationship between men and women. They devote energy and resources to maintaining a beautiful appearance of their face, body and hair for reasons that have varied over the centuries.

The caveman, for example, used to wear animal skins and skin ornaments to seduce women but also to show his belonging to a certain group. The Egyptians used make-up, hair and cared for their bodies in a very advanced way because the improvement of their physical appearance had a spiritual and sacred meaning. In Greek antiquity, men also took great care of their bodies and their health, because their physical appearance and their intellectual qualities were strongly linked.

Later on, other peoples, especially during the Roman Empire or Ancient China, also attached great importance to their appearance, because in their case, having a sculpted and purified body was a representation of their abilities in battle. 

However, from the XVI ème century, The Latin civilizations reject these habits to take care of its body under the pressure of the Church for in counterpart, to support the rise of the spirit. These body treatments are then considered as only feminine and become for some men a taboo subject. It is only in the XIX ème century that the trend is reversing again, men are starting to dye their hair, take care of their beards and assert their bodies. At the end of the XXème In the 19th century, the beauty of the body was totally democratized, and this one joined the health, concerning all the classes of the society. 

Today, access to health and beauty care for men is as important as it is for women, who openly take care of their bodies, skin and hair. A modern virility has been created and men no longer hesitate to use cosmetics and perform cosmetic procedures to beautify their appearance.

Standards vary by culture

In 2021, men's beauty is fully democratized but the criteria of beauty are very different depending on the country and geographical area. In some Asian countries such as South Korea, Japan or China, the market for men's cosmetics is very developed, it is common for them to buy skincare products or even makeup. Europeans have not yet reached this level, but they tend to do so, especially thanks to digital communication. It is possible to say today that we are witnessing a strong movement towards a globalized approach to men's beauty.

The purpose of this article is to inform men of their specific problems, to increase their knowledge of their skin and finally to guide them in the choice of adapted cosmetic care.

 

Why specific care for men?

 

Although men's skin has many characteristics in common with women's skin, it also has its own clinical signs that require different care. These differences are due to genetic inheritance, but also to all the environmental factors to which the body is exposed, i.e. the exposome, which has been proven to have a significant impact on skin aging[1]

The skin is the largest organ of the human body, it is a very complex organ but very important because it is the first barrier separating the body from the outside environment, protecting it from a large number of external aggressions such as pollution, UV rays etc. The skin is composed of three distinct layers: the epidermis, the dermis and the hypodermis. Several aspects of the skin differ depending on the sex of the individual, the skin of men is physiologically different from that of women and this is largely due to the sex hormones of the steroid family, mainly testosterone.

The first difference between the skin of men and women is the thickness, the male skin is thicker, it measures an average of 1.54 mm for 1.36mm in women[2]. The layers of the skin are also not the same thickness, the epidermis of the man, not to mention the stratum corneum which is the most superficial layer is thicker by about 10% than in women, however, with age it balances out, between 20 and 30 years, it measures about 63 µm to reach 34 µm between 70 and 80 years, while in women it varies from 49 µm to 33 µm[3]

Melanin, which is synthesized by the melanocytes in the basal stratum in two forms according to the genetic inheritance: eumelanin (dark brown), and pheomelanin (red-yellow), which can be more or less dark according to the sex of the individual. Indeed, it has been proven that the quantity of melanin is higher in men as well as their vascularization[4].

The skin defenses are not identical between men and women, in fact, the latter have a lower density of desquamating cells and keratinosomes, which means that the thickness of the lamellar layers of the lipid cement is less in men[5]. The barrier function provided by the presence of the stratum corneum of the male skin is less protective due to its thinner lipidic cement which consequently contains less water than in women[6]. The insensible water loss (IWL) is thus more important in men. The dermal-epidermal junction (DEJ), which is the zone that ensures cohesion between the epidermis and the dermis, is thicker in the lamina densa in men than in women[7]. This affects the skin's resistance to the effects of aging.

The male dermis is also thicker than the female dermis, and its collagen density is higher[8], which protects the skin from the signs of aging, but also from mechanical stress on certain areas such as the forehead[9]. Because of the oblique configuration and not perpendicular as in the septaAs collagen fibers enclose the fat globules, the subcutaneous adipose tissue of men is thinner, which means that it is not generally subject to cellulite formation[7]. Sweating is another point that differs between the two sexes, the apocrine glands are less numerous in men but they sweat more overall than women, especially between 15 and 50 years old[11].

Their sweat is also more odorous and more acidic due to the greater presence of lactic acid in male sweat[12]. Androgens are essential to the activity of the sebaceous glands, they are present in large quantities in the male skin and are more numerous and voluminous in certain areas such as the face, scalp or genitals[13]. Men's skin has a higher level of sebum and this, from puberty, it is also generally more oily with more visible pores[14].

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[1] Buendía-Eisman A, Prieto L, Abarquero M, Arias-Santiago S. Study of the Exposome Ageing-related Factors in the Spanish Population. Acta Derm Venereol. 2020 May 28;100(10): adv00153.

[2] Lasagni C, Seidenari S. Echographic assessment of age-dependent variations of skin thickness: A study on 162 subjects. Skin Res Technol. 1995 May;1(2):81-5. 

[3] Cohen-Letessier A., Bombal C., " Dermocosmetology of man. Cosmetology and aesthetic dermatology", art. cit. - Goursac C. de, L'Esthétique au masculin, op. cit.

[4] Cohen-Letessier A., Bombal C., " Dermocosmetology of man. Cosmetology and aesthetic dermatology", art. cit. - Giacomoni P.U., Mammonea T., Teri M., "Gender-linked differences in human skin, J. Derm. Sci. ; 2009, 55, p. 144-149.

[5] Martini M.-C., Men's CosmetologyParis, Lavoisier, 2009.

[6] Mizukoshi K., Akamatsu H., "The investigation of the skin charcteristics of males focusing on gender differences, skin perception, and skin care habits", art. cit.

[7] Tidman M. J., Eady R. A. J., "Ultrastructural morphometry of normal human dermal-epidermal junction. The influence of age, sex, and body region on laminar and nonlaminar components", J. invest. Dermatol., 1984, 83, p.448-453

[8] Shuster S, Black MM, McVitie E. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol. 1975 Dec;93(6):639-43.

[9] Diridollou S, Black D, Lagarde JM, Gall Y, Berson M, Vabre V, Patat F, Vaillant L. Sex- and site-dependent variations in the thickness and mechanical properties of human skin in vivo. Int J Cosmet Sci. 2000 Dec;22(6):421-35.

[10] Elsner P. Overview and trends in male grooming. Br J Dermatol. 2012 Mar;166 Suppl 1:2-5. 

[11] Wilke K, Martin A, Terstegen L, Biel SS. A short history of sweat gland biology. Int J Cosmet Sci. 2007 Jun;29(3):169-79.

[12] Martini M.-C, Cosmetology for men, op. cit. - Cohen-Letessier A., Bombal C., "Dermocosmetology of man. Cosmetology and aesthetic dermatology", art. cit.

[13] Martini M.-C., Cosmétologie masculine, op.cit.

[14] Kim BY, Choi JW, Park KC, Youn SW. Sebum, acne, skin elasticity, and gender difference - which is the major influencing factor for facial pores? Skin Res Technol. 2013 Feb;19(1): e45-53.

What about hair?

Hairs and hair are created from hair follicles, which are present on the entire body except for the soles of the feet and the palms of the hands. Between 100,000 and 150,000 of them are implanted on our scalp [15]. These hairs are born in cavities called hair follicles or pilosebaceous follicles because they are always associated with a sebaceous gland. These follicles are different according to the different areas of the body [16]These include: terminal follicles (with a medium-sized sebaceous gland and thick hair, located on the scalp, pubic area and underarms), sebaceous follicles on the face, back, shoulders and chest (with a large sebaceous gland and fine hair) and downy follicles (with a small sebaceous gland and very fine hair, located all over the body) 

Hairs and hairs are very similar in some respects because their hair follicles are identical, but it is possible to differentiate them by the location of their bulb, located for hairs in the reticular dermis and for hairs in the hypodermis. These hair follicles evolve cyclically, following three distinct phases: The anagen phase or growth phase (the period of growth coupled with keratogenic activity), the catagen phase (cessation of cell multiplication) and the telogen phase (formation of a new shaft in the follicle and then fall of the old hair shaft).

In the case of hair, an additional phase is added to this cycle: the latency phase or exogenous phase, found in 80% of hair cycles. These cycles can be impacted by the hormonal system, by age but also by environmental factors. Steroidal hormones, in particular testosterone, influence hair growth, while androgens have a more specific action on the evolution of hair follicles located in the armpits, pubic area and face by promoting their growth. Men have 95% of terminal hair while women have only 35%, which is consistent with the development of their hair system. 

In men, androgens lead to an enlargement of hair follicles in the armpits, pubic area and beard, but they can also lead to the formation of miniaturized hair and a decrease in hair production during the anagen phase, which can lead to androgenic alopecia[17]. Men's skin has particular characteristics specific to women's skin, particularly because of the hormonal influence it is subject to. The studies carried out on its physiology allow us to better understand its needs and to develop adapted products.

[15] Bouillon C., Wilkinson J. (eds), The science of Hair CareBoca Raton: Taylor and Francis, 2005, 2e edition.

[16] Dao H Jr, Kazin RA. "Gender differences in skin: a review of the literature". Gend Med. 2007 Dec;4(4):308-28. - Crickx B., "Understanding the skin", art. cit.

[17] Pelletier G, Ren L. Localization of sex steroid receptors in human skin. Histol Histopathol. 2004 Apr;19(2):629-36. - Cohen-Letessier A., Bombal C., "Dermocosmetology of man. Cosmetology and aesthetic dermatology," art. cit.

What is my skin type?

Taking care of your skin means knowing what type of skin it is and its characteristics in order to choose the right products. Here is a summary of the different types of skin that can be found in men.

Characteristics of the different skin types: 

Problem-free skin or ideal skin: pelastic, homogeneous water, without imperfections or dilated pores, without visible cloudiness.

Mixed skin :  Normal to dry skin on the cheeks and rather oily on the forehead, nose and chin (T-zone of the face). Defined by a microrelief and a secretion of sweat and sebum of normal skin except on the T-zone.

Oily skin or hyperseborrhea :  Skin that has and secretes excess sebum causing a shiny appearance mainly on the T-zone. Defined by a thick, uneven texture and generally dilated pores. Often associated with acne, blackheads, whiteheads and inflammatory lesions but more protected from external aggressions and skin aging. Hyperseborrhea more frequent in men (4 times more than in women). Often accompanied by acne in adolescents (12 to 24 years old), sebum secretion decreases from the age of 35.

Dry skin:  Defined by a lack of lipids and/or water in the surface layer of the skin. Often physiological but can be linked to age, lifestyle, environment, medication... Sometimes extreme and pathological as in some people with eczema. Characterized by a scaly and rough surface with in some cases an irregular desquamation. More sensitive to external aggressions, especially in winter, when temperatures are low and the air is dry, also more sensitive to aging.

 

Sensitive skin:

Having sensitive or irritable skin, on the other hand, can happen to anyone, with any type of skin. Indeed, a sensitized skin can present very different symptoms such as redness, erythema, sensations of tingling, tightness... But there are two main types of sensitive skin:

  • skin sensitive to environmental stimuli such as heat, sun exposure, pollution, seasonal changes, temperature changes or certain topical factors...[18]
  • And very sensitive skin to all factors: whether they are external or internal (stress, diet...).

It is possible to evaluate the skin sensitivity of a person with many sensory tests such as the lactic acid prick test which is very common, the capsaicin test[19]occlusion tests or washout tests[20]. Certain factors increase the sensitivity of the skin, in men, shaving is the main cause. In fact, shaving regularly can promote the formation of follicular micro-infections and permanently sensitize the skin in this area[21].

[18] Ye C, Chen J, Yang S, Yi J, Chen H, Li M, Yin S, Lai W, Zheng Y. Skin sensitivity evaluation: What could impact the assessment results? J Cosmet Dermatol. 2020 May;19(5):1231-1238.

[19] Jourdain R, Bastien P, de Lacharrière O, Rubinstenn G. Detection thresholds of capsaicin: a new test to assess facial skin neurosensitivity. J Cosmet Sci. 2005 May-Jun;56(3):153-66. 

[20] Misery L, Loser K, Ständer S. Sensitive skin. J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:2-8.

[21] Maurer M, Rietzler M, Burghardt R, Siebenhaar F. The male beard hair and facial skin - challenges for shaving. Int J Cosmet Sci. 2016 Jun;38 Suppl 1:3-9.

Now that I know my skin type, I create my routine and choose my products accordingly.

A beauty routine includes the different steps of cleansing (morning and evening) and facial care. This routine is not universal and must be adapted to each person according to the particularities of their skin.

Problem-free skin or 'ideal' skin:

  • Cleanse and moisturize the skin daily, no special maintenance is required

Mixed skin :

  • Use products to regulate the amount of sebum produced but also moisturize to meet the different needs of this type of skin
  • In case of small imperfections, use "combination skin" creams to remove grease from the affected areas.

Oily skin or hyperseborrhea :

  • Clean the skin with a syndet (hypoallergenic product in which soap has been replaced by surfactants), a detergent or a cleansing foam.
  • If necessary, use a mild exfoliating or scrubbing product before shaving. This will remove dead skin and level the skin surface to prevent the razor from creating micro-cuts.
  • Avoid using alkaline soaps to avoid irritating the sebaceous glands, alcohol-based products such as aftershaves.
  • Then moisturize the skin with a light moisturizing gel.
  • Avoid rich creams or products that are too greasy, as this can result in a shiny, unattractive finish.
  • Use products enriched with keratolytic agents such as salicylic acid, lipohydroxy acids (LHA) and glycolic acid in case of acne problems.

Dry skin:

  • Cleanse the skin with a gentle, non-drying product such as a cleansing milk, a superfatted soap, a dermatological bar or a micellar water.
  • Use a non-alkaline foam for shaving.
  • Absolutely avoid using alcohol-based products or products containing perfumes.
  • Protect your skin with a moisturizing day cream with sun filters and use a very nourishing night cream in case of severe dryness.
  • Use products containing petroleum jelly, mineral oils, vegetable waxes and glycerol.

Sensitive skin:

  • It is advisable to clean the face with a dermatological bar or a superfatted soap and to absolutely avoid alcoholic aftershave lotions and replace them with soothing hypoallergenic moisturizing creams.
  • To moisturize the skin, it is recommended to use soothing products that protect and rebuild the skin barrier and to avoid products that can attack the already sensitive skin such as perfumes, dyes and preservatives, but also to exfoliate the skin with products that are too abrasive.
  • Women have been cleansing, protecting and moisturizing their skin every day for a long time, while men are slowly getting used to these new skincare routines to complement their traditional shaving routines.
  • These practices, which are increasingly adopted, help to maintain healthy skin over the long term.

I fight against the signs of aging

Types of aging and the phenomena involved

Both men and women are affected by the signs of aging, but their skin does not react in the same way to aging, and this has been scientifically proven[22]. Skin aging affects all skin functions and therefore has an impact on the overall appearance of the skin.  It is characterized by a progressive weakening of the biochemical and physiological functions of the skin such as elasticity, the protective system...

There are two main types of aging:

Intrinsic aging or chronological aging which affects the entire body, is a slow process that evolves over time. To measure this type of aging, specific areas such as the forearms are analyzed because they are the least exposed to environmental factors such as UV radiation[23]. This aging leads to the formation of fine wrinkles and sagging skin.

Extrinsic aging it is directly linked to environmental factors, mainly to sunlight but also to tobacco[24]It is considered to be a premature aging of the skin and results in the formation of deep wrinkles and an overall loss of skin elasticity. This is considered to be a premature aging of the skin and results in the formation of deep wrinkles and an overall loss of skin elasticity.

Skin aging is a complex phenomenon because many biological mechanisms are involved and act simultaneously.  These include increased genome mutations, accumulation of toxic metabolites, epidermal and dermal changes, increased levels of free radicals and protein glycation. Men's skin does not age at the same rate as women's skin. In fact, it is generally less dry, thinner and more gradual than female skin.

In addition, hormones play an important role in aging, the amount of androgenic hormones in men decreases gradually while the amount of sex hormones in women decreases drastically during menopause. These factors delay the aging process in men compared to women.

What are the signs of age in men?

Signs of age vary in humans depending on many factors such as ethnicity, lifestyle, environment or facial expressions but some of them are common[25]. Horizontal forehead wrinkles and vertical glabellar wrinkles or frown lines are found in the upper part of the face, which is the most marked area. These wrinkles are caused by the contraction of facial muscles when emotions are expressed.

In the eye area, wrinkles called 'crow's feet' form at the outer corners of the eyes gradually, caused by facial expressions and blinking. The bags under the eyes become more pronounced around the age of 45. In the lower part of the face, wrinkles appear as a result of the sagging of the skin muscles and the effect of gravity. The fatty tissue migrates downward, causing the creation of jowls and nasolabial folds. As men age, brown spots gradually appear on their faces, becoming darker and larger. The signs of aging in men include all of these phenomena: fine wrinkles, deep wrinkles, sagging skin and brown spots, but there are solutions to prevent and reduce these signs of aging.

Hyaluronic acid

Naturally present in the skin, it plays an important role in the metabolism of the dermis and also has the particularity of being able to retain up to a thousand times its weight in water, making it essential in the hydration of the skin [26]. It acts on the thinning of the skin directly related to chronological skin aging, studies have proven that hyaluronic acid reduces wrinkles by remodeling tissues[27].

Caffeine

This alkaloid which has the ability to penetrate the skin barrier[28] is widely used, it stimulates certain enzymes such as adenylcyclase, increases skin metabolism and has draining and decongesting properties.

Alpha Hydroxy Acids

AHAs, the best known of which are glycolic acid, lactic acid and mandelic acid, are natural sugar acids that come mostly from plants or fruits. They are used in cosmetics for their exfoliating properties.

Used at low concentrations (4 to 15%), they allow the desquamation of dead cells by acting at their junction zones, they also increase the density of collagen and the dermal thickness[29]. These acids can also be used in higher concentrations (about 30%) to perform deeper and more effective peels, but they can cause irritation in people with sensitive skin[30]. 

Other active ingredients; antioxidants are used in addition to those mentioned above, in order to prevent and repair the skin, they have antiradical or photo protective properties.

Antioxidants are the active ingredients most used to protect cells from free radicals that accelerate skin aging. Vitamin C and vitamin E are the most commonly used.

Vitamin C

Also known as ascorbic acid, vitamin C is the most abundant antioxidant present in the skin. It has many roles including stabilizing certain free radicals, regenerating oxidized vitamin E[31]the synthesis of collagen and elastin and the reduction of melanin production[32].

Vitamin E

This antioxidant is liposoluble and protects cell membranes and lipoproteins from free radical reactions. It has also been proven to reduce the roughness of the skin, the length and depth of fine lines and wrinkles[33].

Other procedures (procedures / peels / injections)

Topical skincare products are not the only ones used by men. In fact, procedures and interventions performed by professionals are becoming more and more popular. Today, men no longer hesitate to consult dermatologists because the solutions offered in the office are effective and require little time on the part of patients.

The most common cosmetic procedures performed on men are: botulinum toxin injections, dermal fillers, chemical peels, microdermabrasion, laser resurfacing, laser hair removal, hair transplants and minimally invasive fat reduction techniques.[34].

Superficial peels

The purpose of these 'soft' peelings is not to erase wrinkles but to reduce the appearance of fine lines. They are performed in a doctor's office. Dermatologists generally ask patients to prepare their skin two weeks beforehand with a mild exfoliating solution at home. Then they use glycolic acid solutions at 30, 50 or 70% or trichloroacetic acid in low concentration and leave it on for a certain time depending on the different skin types. Be careful, after the treatment, the skin is more sensitive, it can peel and become slightly red, it is necessary to protect it from UV rays. These treatments can be repeated monthly for a better result. Men may need more sessions or a greater quantity of peeling agent due to their sebaceous quality of the skin and the density of the hair follicles.[35]

Botulinum toxin A

Commonly known as Botox, it is the most widely performed non-surgical cosmetic procedure in the world[36]. It is recommended for the treatment of the upper part of the face: horizontal forehead wrinkles, glabella wrinkles and crow's feet wrinkles. Specialists inject this neurotoxic protein into the muscle which, by acting on the nerve endings, blocks its contraction. The injection points vary according to the patient, men generally receive larger doses than women because of their greater muscle tone.

Filling products

Also known as 'fillers', fillers such as hyaluronic acid or collagen are used to reduce the appearance of wrinkles by filling in the furrows formed by the gradual slackening of the skin[37]. For men, the most commonly treated area is the nasolabial folds, but fillers are also used in conjunction with botulinum toxin A in the glabella area. These treatments are not permanent, however, and their effects diminish after four to eighteen months. 

Patient satisfaction with hyaluronic acid injections is very high, as demonstrated by a study of 21 patients for the treatment of nasolabial folds[38].

Physical techniques

These physical means of improving the appearance of the face are now widely used by men, because they are fast, effective, discreet and do not require heavy post-treatment care[39].

Lasers have been used to improve the appearance of the skin since the 1980s[40]. It is possible to find different types of lasers;

Ablative lasers, which are generally used to perform resurfacing or regenerating treatments such as CO2 or Er:Yag lasers, which are very effective but also aggressive.

Non-ablative lasers such as Nd:Yag lasers, diode lasers or pulsed light lasers (IPL) are therefore preferred by specialists today because they are less destructive[41]. On the other hand, the safety of their use in people with dark skin has yet to be proven[42].

Photomodulation lasers (PMB) such as LEDs are also used and allow to treat the skin without thermal reaction are very appreciated by patients[43].

As the skin ages, it undergoes clinical and physiological changes that affect the superficial dermis as well as the epidermis. Cosmetic treatments combined with procedures performed in the medical office can preserve the appearance of the skin's surface and reduce the signs of aging.

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[22] Hamer MA, Pardo LM, Jacobs LC, Ikram MA, Laven JS, Kayser M, Hollestein LM, Gunn DA, Nijsten T. Lifestyle and Physiological Factors Associated with Facial Wrinkling in Men and Women. J Invest Dermatol. 2017 Aug;137(8):1692-1699.

[23] Zhang S, Duan E. Fighting against Skin Aging: The Way from Bench to Bedside. Cell Transplant. 2018 May;27(5):729-738.

[24] Kennedy C, Bastiaens MT, Bajdik CD, Willemze R, Westendorp RG, Bouwes Bavinck JN; Leiden Skin Cancer Study. Effect of smoking and sun on the aging skin. J Invest Dermatol. 2003 Apr;120(4):548-54. 

[25] Rossi AM, Eviatar J, Green JB, Anolik R, Eidelman M, Keaney TC, Narurkar V, Jones D, Kolodziejczyk J, Drinkwater A, Gallagher CJ. Signs of Facial Aging in Men in a Diverse, Multinational Study: Timing and Preventive Behaviors. Dermatol Surg. 2017 Nov;43 Suppl 2: S210-S220. 

[26] Laurent TC, Fraser JR. Hyaluronan. FASEB J. 1992 Apr;6(7):2397-404.

[27] Kaya G, Tran C, Sorg O, Hotz R, Grand D, Carraux P, Didierjean L, Stamenkovic I, Saurat JH. Hyaluronate fragments reverse skin atrophy by a CD44-dependent mechanism. PLoS Med. 2006 Dec;3(12):e493. 

[28] Herman A, Herman AP. Caffeine's mechanisms of action and its cosmetic use. Skin Pharmacol Physiol. 2013;26(1):8-14.

[29] Ditre CM, Griffin TD, Murphy GF, Sueki H, Telegan B, Johnson WC, Yu RJ, Van Scott EJ. Effects of alpha-hydroxy acids on photoaged skin: a pilot clinical, histologic, and ultrastructural study. J Am Acad Dermatol. 1996 Feb;34(2 Pt 1):187-95.

[30] Tang SC, Yang JH. Dual Effects of Alpha-Hydroxy Acids on the Skin. Molecules. 2018 Apr 10;23(4):863. 

[31] Chan AC. Partners in defense, vitamin E and vitamin C. Can J Physiol Pharmacol. 1993 Sep;71(9):725-31.

[32] Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999 Oct;125(10):1091-8. 

[33]Junkins-Hopkins JM. Antioxidants and their chemopreventive properties in dermatology. J Am Acad Dermatol. 2010 Apr;62(4):663-5. 

[34] Cohen BE, Bashey S, Wysong A. Literature Review of Cosmetic Procedures in Men: Approaches and Techniques are Gender Specific. Am J Clin Dermatol. 2017 Feb;18(1):87-96.

[35] Reserva J, Champlain A, Soon SL, Tung R. Chemical Peels: Indications and Special Considerations for the Male Patient. Dermatol Surg. 2017 Nov;43 Suppl 2: S163-S173. 

[36] Sundaram H, Signorini M, Liew S, Trindade de Almeida AR, Wu Y, Vieira Braz A, Fagien S, Goodman GJ, Monheit G, Raspaldo H; Global Aesthetics Consensus Group. Global Aesthetics Consensus: Botulinum Toxin Type A-Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg. 2016 Mar;137(3):518e-529e.

[37] Monheit GD, Prather CL. Hyaluronic acid fillers for the male patient. Dermatol Ther. 2007 Nov-Dec;20(6):394-406.

[38] Narins RS, Brandt FS, Dayan SH, Hornfeldt CS. Persistence of nasolabial fold correction with a hyaluronic acid dermal filler with retreatment: results of an 18-month extension study. Dermatol Surg. 2011 May;37(5):644-50. 

[39] Juhász M, Marmur E. Energy-Based Devices in Male Skin Rejuvenation. Dermatol Clin. 2018 Jan;36(1):21-28.

[40] Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524-7. doi: 10.1126/ science.6836297.

[41] Heidari Beigvand H, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Safari S, Rezaei-Tavirani M, Mansouri V, Heidari MH. Assessment of Laser Effects on Skin Rejuvenation. J Lasers Med Sci. 2020 Spring;11(2):212-219.

[42] Kaushik SB, Alexis AF. Nonablative fractional laser resurfacing in skin of color: evidence-based review. J Clin Aesthet Dermatol. 2017;10(6):51-67.

[43] Wunsch A, Matuschka K. A controlled trial to determine the efficacy of red and near-infrared light treatment in patient satisfaction, reduction of fine lines, wrinkles, skin roughness, and intradermal collagen density increase. Photomed Laser Surg. 2014;32(2):93-100.

I protect myself from the sun

The sun and its effects (radiation diagram, risk factors)

The sun's rays are indispensable to us, they allow the Earth to be livable for human beings as well as all other terrestrial species. However, they can also have harmful effects on health and particularly on the skin.

The solar rays do not all reach the surface of the earth, there are five of them and they are defined by their wavelength:

  • Gamma rays and X-rays are both blocked by the ozone layer, X-rays are the most dangerous and energetic rays, their wavelengths are the weakest of the solar spectrum.
  • Ultraviolet rays (100 to 400nm) are the rays that have effects on our skin, they include UVA, UVB and UVC
  • Visible light (400 to 700nm), these rays represent about 40% of the solar radiation that reaches the ground on a clear day[44].
  • Infrared (700 to 2500nm), represent about 50% of the terrestrial radiation and are the cause of thermal effects.

How to differentiate between ultraviolet rays: UVA, UVB and UVC?

UVC (100 to 280nm) are the most energetic rays, they are very dangerous for health even in very low doses but they do not reach us because they are blocked by the ozone layer.

UVA rays (320 to 400nm) are the most penetrating UV rays, part of them are absorbed by the epidermis (20 to 30%) but the rest reach the deep dermis. The quality of the skin is very much affected by these rays because they create an immediate tan but are also responsible for premature aging and can lead to the creation of certain skin cancers.

UVB (290 to 320nm) penetrate the protective layer of the epidermis, they are twice as biologically active as UVA. They are responsible for long-term tanning, sunburn and the majority of skin cancers.[45].

These radiations vary according to many factors; the seasons, the geographical zones, the altitude, the latitude, the thickness of the ozone layer, the time of the day or the nature of the ground which is more or less reflecting.

The harmful consequences of sun exposure

Moderate exposure to the sun initiates tanning in most people, also called delayed pigmentation. It is a self-defense mechanism of the skin, triggered by the aggression of UV radiation, it is characterized by an increase in melanin present in the epidermis. Once this is synthesized, the melanocytes whose dendrites distribute the pigment grains within the epidermis and thus color the skin. However, tanning is not the only effect of exposure to UV rays, and unfortunately there are more negative effects than positive ones. Among them are counted:

  • The actions of UVB and UVA rays on DNA and proteins which are responsible for mutations, cellular dysfunctions and formation of toxic free radicals which can lead to the formation of 'sunburn' cells and in the worst case cancerous cells.
  • Sunburns are immediate inflammatory reactions caused by unprotected exposure. In most cases, they result in a reddening of the skin or the formation of an erythema, but can sometimes cause extreme pain, burning of the skin and blistering and scarring. The severity of these symptoms depends on the dose of radiation received and the person's phototype.
  • Skin aging, which is mainly caused by overexposure to the sun. It is manifested by the formation of age spots, sun spots or lentigines, the appearance of superficial wrinkles in addition to expression lines, a loss of elasticity and overall skin dryness.
  • Immunosuppression is a phenomenon of alteration of skin immunity involving UVA and UVB rays. The rays target the Langerhans cells, antigen-presenting cells, which leads to an altered immune response.[46].
  • The most serious and common form of skin cancer in adults is melanoma. This aggressive form of skin cancer occurs when UV-altered DNA damage triggers genetic mutations that cause skin cells to multiply rapidly and develop into malignant tumors. It should be noted that young women are globally more affected than men by melanoma but the incidence rate reverses around the age of 40, probably due to a lack of skin examination.[47].
  • Photosensitivity and photoallergy which are manifested by an increase in skin reactivity to UV. This sensitization is mainly caused by UVA rays and can cause skin eruptions (polymorphic sunburn) and itching upon exposure to the sun. Taking certain photosensitizing drugs can also cause allergic reactions in the form of sunburn. In this case, it is important to protect yourself quickly from UV rays.
  • The worsening of acne caused by the thickening of the stratum corneum and the blockage of sebum excretion due to UV exposure. Contrary to popular belief, the sun only improves acne temporarily thanks to the bacteriostatic actions of UVB rays and the unification of the complexion due to tanning.

However, not all individuals are equal when faced with the effects of the sun. Indeed, the biological response mechanisms are different depending on the type of skin and particularly on the pigmentation that constitutes the skin's color.

This is due to the presence of eumelanin synthesized by dark skin which acts as a solar filter by absorbing UVB rays. At the same time, pheomelanin, synthesized mainly by light or red skins, does not protect the skin from the sun. These pigments are synthesized in varying quantities depending on the individual and largely define their sensitivity to the sun and therefore their phototype. These phototypes are classified from the lightest to the darkest according to the Fitzpatrick classification and indicate the sensitivity to sunburn as well as the ability to tan.

[44] S.C. Bhatia, Solar radiations, Advanced Renewable Energy Systems, Woodhead Publishing India, 2014, pages 32-67

[45] Battie C, Verschoore M. Cutaneous solar ultraviolet exposure and clinical aspects of photodamage. Indian J Dermatol Venereol Leprol. 2012 Jun;78 Suppl 1: S9-S14. 

[46] Seité S, Zucchi H, Moyal D, Tison S, Compan D, Christiaens F, Gueniche A, Fourtanier A. Alterations in human epidermal Langerhans cells by ultraviolet radiation: quantitative and morphological study. Br J Dermatol. 2003 Feb;148(2):291-9.

[47] Raimondi S, Suppa M, Gandini S. Melanoma Epidemiology and Sun Exposure. Acta Derm Venereol. 2020 Jun 3;100(11): adv00136. 

Fitzpatrick's classification is not the only way to determine your phototype. Indeed, there are other more objective classifications, in particular the classification of skin colors according to the ITA (Individual typological angle), based on two colorimetric values; a component of luminosity of the skin (luminance) L* and a component of color of the skin b*, it makes it possible to better represent the diversity of colors of skin

Classification of dark skin colors on ITA measurement.

Exposure to the sun is therefore the source of many more or less serious harmful effects. It is essential to protect the skin from UV rays, particularly for people with fair skin but also for those with darker skin types, who are not immune to DNA damage.[48].

Photoprotection

Men are more affected by sunburn overall than women because women are more likely to protect themselves from UV rays[49] and apply sun protection[50].

It is therefore important for men to protect their skin effectively, especially the uncovered areas such as the face, back and hands, which are among the most exposed areas and therefore prone to the formation of brown spots, sunburn, premature aging and cancer. The best protection is not to expose yourself to the sun and to protect your body as much as possible with clothes, hats, etc. If this is not possible, it is strongly advised to apply sunscreen regularly and in sufficient quantity. Moreover, the quality of sunscreen products is excellent today and products are available for all skin types.

There are many types of solar products that can be marketed in different galenic forms such as creams, oils, sprays, sticks ... These allow to protect the skin from UV rays because solar filters are included in the composition of their formulas.

Sunscreens are separated into two categories:

Mineral or inorganic filters: are fine mineral particles that remain on the surface of the skin, deflect and diffuse part of the UV rays and absorb the rest, transforming them into heat that is then released from the skin. These filters are widely used in creams for children and sensitive skin because they are not very irritating, but they are not recommended for people with matte skin because they leave white marks when applied. The most common mineral filters are titanium dioxide and zinc oxide.[51].

Organic filters: absorb UV rays, transform them into heat and release this heat from the skin. These filters are used in the majority of suncare products because they are easy to apply and are very effective, even in small quantities.

Most sunscreen products combine several filters in their formula to filter out a maximum of UV rays. They can also combine organic and mineral filters in order to obtain products that are less irritating and allow to filter a larger part of the solar spectrum, including UVA and UVB.

[48] Del Bino S, Sok J, Bernerd F. Assessment of ultraviolet-radiation-induced DNA damage within melanocytes in skin of different constitutive pigmentation. Br J Dermatol. 2013 May;168(5):1120-3.

[49] Pinault L, Fioletov V. Sun exposure, sun protection and sunburn among Canadian adults. Health Rep. 2017 May 17;28(5):12-19.

[50] Roberts CA, Goldstein EK, Goldstein BG, Jarman KL, Paci K, Goldstein AO. Men's Attitudes and Behaviors About Skincare and Sunscreen Use Behaviors. J Drugs Dermatol. 2021 Jan 1;20(1):88-93.

[51] Schneider SL, Lim HW. A review of inorganic UV filters zinc oxide and titanium dioxide. Photodermatol Photoimmunol Photomed. 2019 Nov;35(6):442-446. 

The SPF (Sun Protection Factor) is an important element to take into account when selecting a sun cream since it provides information on the sun protection factor and therefore on the effectiveness of the product in protecting the individual from sunburn. This generally varies from 6 (low protection) to 50+ (high protection) but it is possible to find suncare products with SPF 100+ which are even more effective[1]The effectiveness of these SPFs is highly regulated and determined by methods of the international standard ISO[2] required in France and Europe to determine the protection against UVB. Is the UVA protection indicated directly on the packaging by a UVA logo. It is important to adopt the right gestures and to understand the needs of your skin to protect it accordingly. It is also important to note that the skin, and especially the skin of the face, is not a flat surface, so it is necessary to apply a sufficient quantity to cover it completely. In addition, for increased effectiveness, it is recommended to reapply a layer every two hours or after each swim or sweaty episode.

 

[52] Al-Jamal, Mohammed & Griffith, James & Lim, Henry. (2014). Photoprotection in ethnic skin. Dermatologica Sinica. 32. 10.1016 and Rai R, Shanmuga SC, Srinivas C. Update on photoprotection. Indian J Dermatol. 2012;57(5):335-342.

[53] Williams JD, Maitra P, Atillasoy E, Wu MM, Farberg AS, Rigel DS. SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual use: Results of a randomized, double-blind, split-face, natural sunlight exposure clinical trial. J Am Acad Dermatol. 2018 May;78(5):902-910.e2. 

[54] https://www.iso.org/obp/ui/#iso:std:iso:24444:ed-2:v1:en