Doctor Q&A

What does Your Skin tell you about Your Health?

This is a much-awaited series, where I get to work with Dr Verallo-Rowell again (we last worked on Sensitive Skin Product Series in 2012). Dr Verallo-Rowell is a dermatologist, dermatopathologist and dermatology/laser surgeon, founder of VMV Hypoallergenics, and is also an author, esteemed researcher and speaker. 

Skin Health Connection Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics

This series is exciting because ever since Laura (Dr Verallo-Rowell’s daughter, CEO of VMV Hypoallergenics) told me during our meeting in Singapore that her mom identified underlying health problems after seeing the skin of her friends, I started to scrutinize everyone’s skin! I became interested in the relationship between skin and health, and discovered through Laura that her mom is very passionate about improving skin and health and also have a nutritionist in her dermatology practice.

So for this series, we are discovering skin, health and health issues that can be identified by changes in skin. Of course, these are not meant to be medical diagnosis and it is always good to look in the mirror and say, ‘Yay! I’m glowing and healthy!’

Understanding Skin and Health – Skin Color

The skin is the largest organ of our body, and has the largest surface area. It consists of 3 layers – the epidermis, the dermis and the hypodermis. The epidermis protects the skin from penetration of foreign matter and also prevents water loss. It has keratinocytes, melanocytes and Langerhans cells. One way to describe skin is its color, for which the melanocytes are responsible for.

How Skin Color Changes during Suntan

MarcieMom: Dr Verallo-Rowell, does a person’s skin stay the same color? For instance:

Sun Tan/ Sun Burn – which layer of skin is affected and how does the skin reverse to its original color?

Dr Verallo-Rowell: Yes. A person’s original, also called constitutive color – under normal/healthy conditions – essentially remains the same throughout one’s life. This is best illustrated by the Fitzpatrick Skin Phototypes I to VI ( from I with very fair, blond or red hair, light colored eyes , often with freckles, thru III with light brown colored skin to VI with black skin). Following a sun tan or sun burn the melanosomes or pre-formed melanin in the epidermis darkens so an immediate pigment darkening occurs – immediately. The radiation reaches the melanocytes in the basal cell layer and stimulates them to form more melanosome which rapidly become melanin granules to contribute to the delayed skin darkening called the tan which in Phototypes I may not happen at all, II, appears and lasts a week, V appears and lasts for 6 months or longer. Once the pigment generated by that sun tan/burn clears up, the color of the skin goes right back to its original – constitutive color.  The tan by the way is called skin’s facultative coloring.

How Skin Changes with Age

From birth to death – does the skin color (assuming good health) stay the same or does the skin color change from an infant to a child, and when entering into old age?

Dr Verallo-Rowell: Even with good health the skin color undergoes natural changes from aging (time on earth) and photoaging ( with the addition of sun/light exposure). Of these two types of aging, photoaging is the one that changes the skin color more.  Notice: the buttocks skin color which most closely resembles the original color throughout life.  Note also the outer arms compared with the inner, the V of the chest up to the neck though sparing the under the chin area which is not exposed to sun/light. Those exposed areas tend to freckle and discolor ( dark and white discolorations) from photoaging effects.

Skin Color as a Reflection of Health Issues

The one some experienced as an infant will be jaundice. Jaundice is the yellow color skin, caused by an accumulation of bilirubin in the newborn’s blood due to the liver not removing it. You may also have heard of babies turning orange after eating too many carrots. This is known as carotenemia due to excess beta-carotene that cannot be processed by the thyroid (hypothyroidism). The skin can also turn blue, a condition called cyanosis, due to lack of oxygen in the blood.

Do the above conditions change the melanocytes of the skin or affect other parts of the skin cells or affect the blood which can be ‘seen through’ the skin? 

Dr Verallo-Rowell: NO. The bilirubin accumulates in the baby who you cited above – whose liver may not be mature enough to remove it. The yellow colored hydrophilic pigment in a sense stains the epidermis and/or its presence in the upper dermis is seen through the epidermis, but it does not affect the melanocytes. Neither does the carotenoids which are lipophilic become prominent in the lipid compartments of the stratum corneum the top most layer of the skin. Melanocytes are unaffected unless for some reason an inflammatory reaction occurs in which case a post-inflammatory hyperpigmentation may occur to temporarily darken the skin from melanocytes reacting to the inflammation.

Pale Skin vs Fair Skin

We know some people like it tanned, but there are others who like it fair. I’ve seen skinny ladies with pale skin, and it doesn’t look healthy to me. There is this condition known as anemia, which is due to iron deficiency for elderly or people without a healthy diet.

How can, say, a lady who is trying for weight loss, be able to spot if it has ‘gone too far’ from observing her skin? Does the same happen for a child (who may for various health reasons not eat well)?

Dr Verallo-Rowell: In ladies (and gentlemen too) who aspire and become successful at losing weight without taking care that they reduce calories but continue to have enough vitamins, minerals and other essential nutrients – iron may become deficient so anemia which gives a pale unhealthy white color develops. Children with poor appetites who likewise lack the above nutritional components also can become pale white from the anemia. Anemia means lowered number of red blood cells hence the pallor.

Thank you Dr Verallo Rowell, I learnt much from your reply! For one, I’ll note my own skin color too as I’m losing weight (and lost quite a fair bit through exercise!)

Your sharing will help others!