Mature Skin
Copyrighted Material: Not for Reproduction or Distribution
As we grow older, we see and feel certain changes in our skin, which is the body's largest and most visible organ. The skin becomes drier, more wrinkled, and spots and growths appear. Also, after an injury our skin tends to heal more slowly.
Some of these skin changes are natural, unavoidable, and harmless. Others are itchy or painful, and some changes, such as skin cancers, are serious and require medical attention. Many of these skin problems can be prevented. Whether a danger to health or merely cosmetically unattractive, most of these skin problems can be addressed by therapies that are now available.
Wrinkles
As skin ages, collagen and elastin, fibers that keep the skin firm, weaken. The skin looks loose and lax, becomes thinner and loses fat, so that it looks less plump and smooth. While all these changes are taking place, gravity also is at work, pulling at the skin and causing it to sag.
Can Wrinkles Be Avoided?
The sun is the major cause of unwanted changes in the skin when it comes to aging. How wrinkled your skin becomes depends largely on how much sun you have been exposed to in your lifetime. Cigarette smoking also can contribute to wrinkles. Wrinkles also depend on your parents; the tendency to wrinkle is inherited.
The good news is that many wrinkles can be prevented. Beginning in childhood, to avoid wrinkles caused by the sun:
- Always wear sunscreen with SPF of at least 30.
- Wear a hat with a brim and other protective clothing.
- Don't deliberately sunbathe.
- Try to avoid sun exposure between 10 a.m. and 3 p.m.
Remember that sun exposure as a child or teenager makes a big difference to the appearance of the skin at the age of 30, 40, or 50. If you already have sun-damaged your skin, you will still benefit from sun protection as an adult. It's never too late.
Broken capillaries, or Telangiectasia, are dilated facial blood vessels that may be related to sun damage. They respond to the same treatments as other broken blood vessels (angiomas).
Treatments for Aging Skin
There are some promising treatments for aging skin. Retinoic acid, available as a cream and also used successfully in treating acne, improves the surface texture of the skin, reduces irregular pigmentation, and increases dermal collagen if applied daily for several months. It is currently the only medication approved by the FDA as safe and effective for reversing some of the effects of sun damage. Alpha hydroxy acids also show promise in reversing some of the effects of the sun.
Creases caused by facial expressions such as squinting, frowning, or smiling can be treated by a dermatologist, using what are called injectable soft tissue dermal fillers such as collagen or fat. These dermal fillers are injected into the skin under wrinkles and scars to puff out creases or scars. A naturally produced toxin, botulinum (Botox™), can also be injected to relax the small muscles and thus eliminate fixed expression lines (frown lines). Broken blood vessels accompany these wrinkles and can be treated with lasers or cautery. Fat folds such as those under the chin, around the waist and hips, and on the thighs, can be removed by liposuction under local anesthesia. Liposuction is the removal of fat by suction to eliminate unwanted bulges.
None of these remedies can guarantee the appearance of youthful skin, but they can improve the overall appearance of your skin. Wrinkled skin may be improved by resurfacing with dermatologic surgery, lasers, dermabrasion or chemical peels. Before you undertake any home-treatment or surgery, discuss your options with your dermatologist.
Dry Skin
As we age, our skin becomes drier. This can result in flaky and itchy skin, especially in cold, dry, windy climates. Milder cases of dry skin can be managed with a moisturizer used immediately after bathing, while the skin is still damp. Oils added to the bath water can cause the tub to be dangerously slippery.
Petrolatum, an ingredient in many lotions, creams and ointments, is an excellent moisturizer. Many moisturizers contain chemicals such as urea, alpha hydroxy acids, lactic acid, or ammonium lactate to reduce scaling and help the skin hold water. Some of these chemicals can irritate the skin, however. Your dermatologist can help you decide which is best for you.
Bathing less often and using milder soaps or a soap substitute, or soaking in a tub of warm water without soap can help relieve dry skin. Hot water is more irritating to dry skin than warm water. After bathing and drying off, a moisturizer such as petrolatum or lanolin should be applied immediately to seal in moisture.
If dry skin continues to be a problem, consult your dermatologist. Severe flaky, itchy, and cracked skin may be a sign of a more serious problem.
Skin Lesions
Skin growths and pigment spots become more common as we age. They may range from harmless warts, liver spots, or age spots, to skin cancers that require treatment. Most are caused by years of sun exposure.
Among the most common are red or brown scaly spots called actinic keratoses. If ignored, they may become skin cancers that eventually need to be removed surgically. In the early stages they can be removed by freezing with liquid nitrogen, applying a chemotherapy cream, or by skin resurfacing.
Liver Spots
Squamous cell carcinoma typically develops on the rim of the ear, the face, the lips, or the back of hands. These skin cancers can destroy normal tissue and squamous cell cancers occasionally spread to internal organs. If left untreated, squamous cell carcinomas can be aggressive.
The most common form of skin cancer is a basal cell carcinoma. It usually appears as a small, shiny bump or pinpoint red bleeding area on the head, face, nose, neck, or chest. It's more common in older, fair-skinned people with blond or red hair and blue or green eyes. Untreated, these skin cancers can bleed and crust over. They grow slowly and rarely spread to other parts of the body. When treated early, squamous cell and basal cell skin cancers have a 95 percent cure rate.
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma is a less common but more serious form of skin cancer. This skin cancer usually appears as a dark brown or black mole-like growth with irregular borders and variable colors. Men over the age of 50 are at the highest risk for melanoma, but it can affect anyone of any age. Melanoma is more likely to strike people who had severe childhood sunburns. The most frequent sites for melanoma are the upper back in both men and women, the chest and abdomen in men, and the lower legs of women.
Melanoma
Any change in an existing mole or the rapid appearance of a new mole could be a sign of melanoma and should be examined immediately by a dermatologist. Melanoma can spread to other organs and can be fatal.
Other Growths
Several other skin growths are very common in older individuals. These include:
Age spots or liver spots: These flat, brown areas are called lentigines. They have nothing to do with the liver; they are caused by the sun and usually appear on the face, hands, back, and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial fade creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available.
Seborrheic Keratoses: These brown or black raised spots or wart-like growths look like they were stuck on the skin's surface. They are not cancerous and are very common in older people. If annoying, they can be easily removed by a dermatologist.
Cherry Angiomas: These are harmless, small, bright red, raised bumps created by dilated blood vessels. They occur in more than 85 percent of middle-aged and elderly people, usually on the trunk. Electrocautery, laser surgery, or other surgical therapies remove these spots.
Skin Diseases
Some skin diseases that are more common in older people are shingles (herpes zoster), seborrheic dermatitis, varicose veins, and leg ulcers.
Shingles/Herpes Zoster: Shingles is an infection of a nerve caused by the same virus that causes chicken pox. Early symptoms are localized pain, headache, or fatigue. Shingles can affect people of all ages, but it is more common (and painful) in older adults.
The virus attacks a nerve root and follows the course of that nerve, causing a line of painful blisters on the scalp, face, trunk, or extremities. The disease almost always affects one side of the body only ands lasts for several weeks. Anti-viral medication can reduce the severity of the attack and reduce the chance of lingering pain afterward.
Shingles can become serious and cause complications. A dermatologist should be contacted immediately if shingles is suspected, especially if the condition appears near the eyes, because treatments are most effective if started within three days of onset.
Seborrheic Dermatitis: The signs of seborrheic dermatitis are redness and greasy-looking scales on the skin. Areas of the skin with a high concentration of oil glands, such as the scalp, sides of the nose, eyebrows, eyelids, behind the ears, and the middle of the chest are usually affected. Seborrheic dermatitis occasionally affects other areas such as the navel, breasts, buttocks, and skin folds under the arms.
Seborrheic dermatitis
Seborrheic dermatitis can be successfully treated and may even go away on its own, but it tends to recur. Frequent shampooing and washing are very helpful and your dermatologist may prescribe topical medications, including low-strength cortisone preparations and special shampoos.
Varicose Veins: These are enlarged leg veins that appear blue and bulging. They are common in older individuals. The veins become twisted and swollen when blood returning to the heart against gravity flows back into the veins through a faulty valve. This condition is seldom dangerous. The aching associated with varicose veins can be eased by avoiding standing for long periods, by keeping feet elevated when sitting or lying down, and by wearing support hose or elastic bandages. More severe cases can be treated with surgery or radio-frequency treatments. Sclerotherapy injections or laser therapy may remove smaller varicose veins, also called spider veins.
Varicose veins
Varicose Ulcers: A backflow of blood (reflux) in the veins may lead to sustained high pressure and can cause ulcers, called vericose ulcers. When a crack or cut occurs in the skin of the leg, it may fail to heal because of poor blood flow. The injury can develop into an ulcer or a shallow wound that may contain pus and become infected. The ulcers may last for months or even years. Special dressings and careful management of the wound may speed healing.
Varicose ulcers often develop at the ankles. They may be accompanied by swelling and red, itchy, scaly skin around the ulcer. Another cause of ulcers on the legs is poor blood flow in the arteries. This condition is associated with medical disorders such as arteriosclerosis, hypertension, diabetes, mellitus, and smoking. There are many other causes of ulcers. If you have an ulcer, see your dermatologist.
Bruising (Purpura): Many seniors complain of black and blue marks or bruises, particularly on the arms and legs. These are usually a result of the skin becoming thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. If you put pressure on the area immediately after a bump, sometimes you can prevent the bruise. Bruising sometimes is caused by medications that interfere with blood clotting by certain internal diseases. Bruising in areas always covered by clothing should be evaluated.
Itching: A very common problem with aging skin is itching. Although often associated with dry skin, itching also has other causes. Elderly skin appears to be more sensitive to fabric preservatives, wool, plastics, detergents, bleaches, soaps, and other irritants. Certain days also may make the skin itchy. Identifying and limiting exposure to the cause is important. Prolonged itching may lead to lack of sleep and fatigue. Your dermatologist can often offer some medical remedies for itching if moisturizing alone is ineffective, and he or she can perform tests to detect internal disorders that cause itching.
Although most of the changes we experience in our skin as we age are harmless, there are certain signs of more serious problems that shouldn't be ignored. See your dermatologist if you notice any of the following symptoms or signs:
| Symptom | May Indicate |
|
|
|
|
|
|
|
|
|
|
| Sign | May Need |
|
|
|
|
|
|
To learn more about mature skin, visit AgingSkinNet or call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
1 (888) 462-DERM
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2006 American Academy of Dermatology
Revised 1991, 1993, 1997, 2000
American Academy of Dermatology
930 E. Woodfield Road
P.O. Box 4014
Schaumburg, IL 60168-4014
PAM28 - 5/03
Copyright © American Academy of Dermatology
Not for Reproduction or Distribution
