Skin Care for the Elderly
As we go through life, our bodies are constantly undergoing change at a cellular level. The details of how your skin changes depends on many factors: Genetics, lifestyle, diet, stress, pollution, sun exposure, and numerous other factors. We look at what causes skin changes, and tackle the most commonly seen symptoms in the elderly.
We all feel the effects of aging, but genetics play a huge role in how and when we see the signs of aging. A very recent (and ongoing) study looking at ethnicity, genetics, and aging, has found that some people really are lucky - their appearance can be 10 years younger than their actual age1. As we age, we still retain genes that help to combat damage, but they are expressed more weakly, leading to genetic aging. Gene expressions that help produce antioxidants begin to decline in their 20s. By the 30s, gene expressions related to cell energy decline. By the 50s, expressions of cell junction and barrier function decreases.
When it comes to environmental factors, one stands out from the others: Sun exposure. UV light breaks down elastin, causing the skin to stretch, sag, and wrinkle, develop pigmentation (colored spots), all associated strongly with symptoms of aging. With decades of data, the evidence could not be more clear: Lifestyle matters, and specifically, total sun exposure is a critical determinant in how quickly your skin becomes damaged2. A large part of the damage we see in elderly skin is due to the skin simply being exposed longer to UV light through repeated exposure. Other factors include loss of fatty tissue, stress, exposure to pollution, gravity (over time), daily facial movement.
Common Skin Concerns
Although very few skin conditions are specific to age groups, there certainly are tendencies, with acne and teenagers immediately coming to mind. Generally, as we age, we become prone to more skin conditions. We've looked at the 3 most common skin complaints in the elderly and how best to manage them:
Chronically dry and itchy skin is the most common skin concern among the elderly. Sometimes called senile pruritus, itching is extremely common among patients over the age of 703. Itching is a challenge to address both in terms of diagnosis (it's subjective, and difficult to measure) and the pathophysiology is also poorly understood4. Additionally, as elderly patients are more likely to be using multiple medications, this presents yet another hurdle in pinpointing the possible causes of itching as many medications can have itching and irritation as part of its side-effect profile. Generally, itching in the elderly is considered idiopathic (has no known cause), for this reason.
That said, even if the exact reasons for the itch isn't known, there are several possible factors that are suspected to contribute to itching in the elderly. The sebaceous glands slow with age, producing less natural oil that helps lubricate the skin. Accumulated sun damage over the years can also cause the skin to become drier, contributing to itch. If the itch is acute - quick onset, and likely caused by a particular issue - addressing the issue will generally solve the problem. Sometimes medications like corticosteroids will calm the itchiness down until the problem resolves. When itching is general and chronic, it's often the dryness of the skin that needs to be addressed.
- Moisturizers are medicine (without the unpleasant side-effects) for people with dry skin. Apply them regularly.
- Ointments are best, followed by creams, and lastly lotions. The thicker consistency of ointments may turn you off, but they are the most effective.
- Apply a moisturizer quickly after washing, whether you are bathing, showering, or washing your hands. Ideally you want to moisturize while the skin is mildly damp (pat your skin dry rather than rub).
- Smooth cotton clothes help to reduce itch
- Sun protection is critical; exposure to sunlight damages and dries the skin further making it more likely to itch (not to mention that it is a major factor in skin cancer)
- Cool baths, or applying cold compresses can alleviate itch
Wrinkles are a natural part of aging. The two most important factors that are in play with wrinkle formation are gravity/facial expressions, and sun damage. There are a myriad of other factors that play a role as well, such as genetics, medication, smoking, or sometimes simple dehydration. Often the first noticeable wrinkles form on the upper face, and these wrinkles are primarily the result of overusing facial muscles. Repeated expressions like smiling, frowning, and squinting can cause wrinkling to occur prematurely. With age, the ability of the skin to spring back into its original position is reduced. Eventually, the lines become fixed in place.
Sun damage is the other major factor. Collagen and elastin fibers are key components of the connective tissues to support its structure. UV light breaks down collagen and elastin, resulting in weaker and less flexible skin. A mountain of data show that people with higher exposure to sunlight (typically those working outdoors) suffer from earlier and more severe wrinkles. While we have little control over some factors like genetics or the climate in which we live, we do have control over our lifestyles and a large part of the environmental factors like sun exposure. Some studies show that these controllable factors account for more than 80% of the damage5.
- Protect your skin against sun damage is critical, regardless of age.
- Sunscreens are the most convenient and practical way to reduce sun damage.
- Other common sense precautions like avoiding direct exposure when the sun is high, and wearing wide-brimmed hats and sunglasses can also help.
- Soft procedures like Botox or injectable fillers are extremely effective at reducing or removing wrinkles, but the effects are temporary, lasting from 3 to 12 months.
- Cosmetic surgery is another option for an intervention that is longer lasting. Surgery addresses deeper changes like facial structure and fat placements that underlie the changes in the outer skin and can make the face appear up to 10 years younger in some cases.
- It's important to acknowledge, however, that aging is an ongoing progress, and no intervention will stop the underlying process itself.
3: Skin Cancer/Actinic Keratosis
Skin cancer is a serious issue in the elderly. While sun protection education efforts have been increasing, it hasn't yet translated to a major change in lifestyle6 and efforts to minimize sun damage. Skin cancer risk is not linear; as we age, our risk of developing a skin cancer increases rapidly. More than 50% of skin cancer related death occur in people over the age of 657.
The main and obvious point is that seniors have lived longer, and hence have sustained the most sun exposure over time. Lifetime exposure of UVA and UVB light accumulates, and while we can never know exactly at what point "the straw will break the camel's back," but minimizing sun exposure is a no brainer when it comes to skin cancer prevention. The other factors is that with age, our natural ability to fight cancer (and other damage) decreases. The skin physically becomes thinner, our immune system weakens, our cells recover less efficiently, and thus together, the risk of developing skin cancer increases rapidly.
- Sun protection is critical, certainly for reducing skin cancer risks, but also for reducing other skin problems like dryness, itching, hyperpigmentation, and wrinkles
- As our skin thins and our immune system weaken with age, sun protection becomes even more important
- Skin cancer should not be taken lightly. Skin cancer is the most common form of cancer by far and many forms can be deadly if left untreated. Even Basal Cell Carcinoma will disfigure you and continue to damage surrounding skin if not removed.
- The good news is that skin cancers are visible, unlike many cancers so being diligent will help you identify them. Over 95% of skin cancers, if detected and treated early, can be cured.
Cleansing: Surfactants in cleansers can disrupt proteins and lipids in the stratum corneum (the uppermost layer of the skin); as rosacea patients already have a weakened barrier function and are more susceptible to irritants, mild cleansing is important. pH levels and the type of surfactant used are important considerations for rosacea patients.
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1http://www.dermletter.com/skin-care-science/ethnicity-skin-aging-genetics.html In “exceptional agers” the gene expressions that provide protection from the environment like DNA repair/replication, response to oxidative stress, chromatin remodeling, do not degrade as quickly with age and are expressed fully until much later in life.
4This field is still very undeveloped, along with our understanding of pain. Nonetheless we are making big strides in both the science of itch and pain. https://www.youtube.com/watch?v=i9pPYNMTxTo&t=23s
6Under prevention: Sun protection - the regular use of sunscreens has been stable despite more education about sun damage. https://progressreport.cancer.gov/sites/default/files/archive/report2009.pdf