Anti-aging Treating the Neck

When thinking about skin care, the face is generally the first area of concern that comes to mind. However, there are other parts of the body that can provide telling signs of age after going years without proper protection and skin care. Two areas that are often neglected in this way are the neck and décolleté. It is important to distinguish the ways in which the skin on the neck and chest vary from that of the face; to identify the ingredients that target this important, yet commonly neglected area; and to learn how to guide your clients toward optimal outcomes.

Physiological differences

To the naked eye, the skin on the neck and décolleté does not appear much different from that of the face, but it is quite different. Facial skin has a higher number of sebaceous glands that provide natural lubrication and protection. With fewer sebaceous glands on the neck and chest, there are reduced moisture levels, as well as a tendency toward dryness and dehydration. The skin on the neck and chest is thinner with less adipose tissue—the fat layer that supports the dermis—and more vascularity, or blood vessels.

The calcium distribution gradient in the epidermis is not maintained as the skin ages, resulting in the loss of keratinocyte function and a thinning dermis. Although this affects all skin, the already-thinner skin on the neck and chest are quick to develop the sagging, crêpe-like appearance, as well as an increase in chest-area wrinkles. This unfortunate combination of thinner skin, increased vascularity, and loss of calcium and dehydration can greatly impact the appearance of the neck and décolleté, resulting in an increase of lines and wrinkles, a red and blotchy appearance, and increased hyperpig­mentation.

The consequences

Clients who routinely see a skin care professional are educated about the importance of applying daily care products and sunscreen to their faces; however, they often make the all-too-common mistake of not applying that same protection to the neck and chest. These areas are exposed to ultraviolet (UV) rays almost as consistently as the face; however, without protection from UV rays and other environmental offenders, they can become telling signs of a client’s age. Many daily practices involve being outdoors, and even short periods of time outside lead to skin degradation, because this exposure is cumulative. For example, driving a car is a common practice that routinely exposes the neck and chest to direct sunlight for extended periods of time, and UVA rays are powerful enough to penetrate glass. The importance of daily, broad-spectrum protection on all exposed areas cannot be overstated.

The extracellular matrix (ECM) is a highly complex and important cutaneous support structure that works to keep the skin full, taut and youthful. When exposed to UV radiation and the resultant oxygen radicals, ECM structural components become disorganized and cross-linked, disrupting the structure’s ability to keep the skin firm, resulting in the formation of fine lines and wrinkles. UV radiation also contributes to an increase in melanocytic activity and an abnormal dilation of the blood vessels, leading to uneven pigment, increased erythema and telangie­ctasias. The thinness of the skin on the neck and the chest makes these UV-driven conditions more apparent than when they occur on the face.

Matrix metallop­roteinases (MMPs) are enzymes responsible for the breakdown of the skin’s support system, and are necessary for the elimination of old and unusable protein fragments within the skin. MMPs are upregulated by UV exposure, accelerating the breakdown of necessary proteins. Clients using daily care products and receiving regular professional facial treatments will notice that treated skin becomes healthier, more hydrated and more even in tone. However, if the neck and chest are neglected, the contrast in visible aging can be dramatic.

Presentations

The presentations of aging skin may include sagging, laxity, fine lines and wrinkles, thinning of the skin, dehydration, hyperpig­mentation and telangie­ctasias. These affect all exposed areas of the skin, yet there are some conditions that are exclusive to the neck and décolleté. One is referred to as “necklace” wrinkles—wrinkles that appear as horizontal lines across the neck and occur due to sun exposure, ECM breakdown, gravity and loss of elasticity.

Poikiloderma of Civatte (PC) is another condition found only on the neck and chest. It is a benign condition that develops predominantly in women, and presents on the upper chest and sides of the neck, but does not affect the throat. This condition is a complex combination of hyperpig­mentation and dilation of blood vessels, leaving a mottled appearance to the skin. PC is thought to be caused by accumulated UV exposure, exacerbated by photosen­sitizing ingredients in cosmetics and perfumes, although hormones may also play a part in this condition. It tends to be more prevalent in fair-skinned individuals, but anyone may be affected. Additionally, increased hyperpig­mentation and dilated blood vessels from overexposure to UV rays are typical.

The development of deep vertical lines on the chest occur throughout time and are common in clients who prefer to sleep on their sides, compressing the skin between the breasts. This condition can be treated with topicals to strengthen collagen, yet it cannot be kept from worsening without the client altering her sleep position. Skin that appears transparent begins to increase as the skin on the neck thins and becomes more lax due to a decrease in collagen and elastin production within the dermis

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Solutions and ingredients

It is never too late for clients to begin caring for their skin. Science in skin care has advanced tremendously, and there are now ingredients available that have shown excellent results in treating the common presentations of aging skin on the neck and décolleté.

Increasing firmness and elasticity. The delicate skin on the neck and chest are best served by products that are specifically formulated for these delicate areas. A novel ingredient containing calcium hydroxym­ethionine and 3-aminopropane sulfonic acid has been tested specifically for its efficacy on the vulnerable tissues of the neck. This ingredient targets the sagging, crêpe-like appearance common in aging skin on the neck, and has been shown to increase firmness and elasticity, improving the overall tone and texture of the skin in this area.

Ingredients, such as palmitoyl tripeptide-38, a next-generation messenger peptide, promotes the synthesis of matrix proteins—specifically collagen, fibronectin, hyaluronic acid and laminin-5. This peptide also stimulates the production of heat shock protein 47 (HSP47), a “chaperone protein” functioning as support for maturing collagen and other matrix components to ensure they reach maturation. HSP47 ensures that the synthesis of these six major components of the ECM reach maturity and work to their highest potential.

Palmitoyl tripeptide-5 encourages skin strengthening by supporting the production of collagen, while secale cereale (rye) seed extract stimulates the synthesis of stress fibers, which reduces laxity.

Retinol is one of the most highly studied ingredients in the industry and provides a host of benefits for the skin, such as collagen and elastin stimulation, and a suppression of MMP enzymes, as well as the melanogenesis process. It is an antioxidant and it speeds up cell turnover, a process that slows with age, leading to a dull complexion.

Addressing hyperpig­mentation and redness. As mentioned previously, the presence of hyperpig­mentation and redness is of concern to those treating the neck and chest. There are advanced corrective topicals containing ingredients specifically formulated to address these concerns. Hydroquinone, licorice root extract, and kojic and lactic acids are effective melanogenesis-inhibitors that are well tolerated by most clients and provide dramatic results. Bisabolol, brown and red algae, and caper bud extract aid in the reduction of distended or otherwise weakened capillaries by minimizing inflammation and strengthening the capillary wall. These ingredients work to directly suppress the inflammatory pathway and greatly reduce chronic redness.

Another critical ingredient for reducing hyperpig­mentation and redness is niacinamide. This B vitamin plays a role in multiple biochemical reactions within the skin. In addition to assisting in clearing hyperpig­mentation and diffusing redness, niacinamide has the ability to reduce the Maillard reaction that leads to yellowing of the skin with age.

Additional treatments to consider

As it applies to any skin condition on the face, treating the skin of the neck and chest with regular superficial chemical peels is key to optimal outcomes. Blended peels are particularly helpful for treating these areas, because they typically contain combinations of lower percentages of several peeling agents, making them gentle, yet tremendously effective. Due to the sensitive nature of this skin and because it is thinner, fewer layers of peel solution are usually recommended to avoid undue inflammation and potential post-inflammatory hyperpig­mentation (PIH) or other negative outcomes. Peels will accelerate the process to achieve youthful, healthy and strong skin on the neck and décolleté.

Before using the ingredients mentioned in this article, it is critical to ensure that clients follow a regimen using a broad-spectrum sun protection product with SPF 30 each day. It is a well-documented fact that sun avoidance and protection is the best, most effective strategy for fighting age-related skin breakdown on any exposed area. Applying products formulated with ingredients designed to treat the neck and chest specifically, combined with time-tested ingredients to target other common presentations in this area, will drastically improve the overall appearance of the neck and chest.

GENERAL REFERENCES

JE Murphy-Ulrich, M Poczatek, Activation of latent TGF-ß by thrombos­pondin-1: mechanisms and physiology, Cytokine & Growth Factor Reviews 11 1–2 59–69 (2000)

MA Farage, KW Miller, et. al., Textbook of Aging Skin, Springer (2010)

J Varga J, J Rosenbloom, et al., Transforming growth factor beta (TGF beta)
causes a persistent increase in steady-state amounts of type I and type III collagen and fibronectin mRNAs in normal human dermal fibroblasts, Biochemical Journal 247 597–604 (1987)

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