Elderly Skin Conditions series – Elderly Skin, How does Skin Age?

This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

How does Skin Age?
It is obvious that our skin ages as we age – even if we don’t look into the mirror or care to look at our own skin, the number of anti-ageing, whitening and anti-wrinkle products remind us that our skin grow old. Aging can be intrinsic (i.e. genetics) and extrinsic, with the main factor being sun exposure, although lifestyle (smoking, alcohol, obesity, diet, exercise) and pollution also play a role.

We have covered skin functions in this blog, so below explains how our skin age and loses its ability to perform its functions.

Differences in Elderly Skin

1. Thinner skin that appears more transparent, due to loss of epidermis (surface layer of skin)
2. Decreasing and increasingly fragmented collagen, thus less supple skin
3. Wrinkles, from sagging of elastic fibres and more reasons here
4. More fragile skin due to flattening of skin cells, prone to blisters, burns and tears
5. Loss of elasticity (from less fibroblasts), thus ‘loose’ skin
6. Fewer Langerhans cells, which are immune cells of skin
7. Reduced lipids within skin
8. Reduced sebum (oil) production, leading to dry/itchy skin
9. Reduced cutaneous blood flow
10. Reduced sweat glands, from shrinkage of eccrine glands
11. Reduced pigment cells
12. Photaging, due to sun exposure
13. Lower cell replacement
14. Less acidic pH of epidermis
15. Thinner blood vessel walls at the dermis, thus easier to bruise

Skin Function Loss for Elderly

With the above skin changes, there is associated loss of skin function:

• Weakening of the skin barrier function, more permeable to irritants
• Less able to regulate temperature, due to loss in fats and sweat glands
• Less able to protect against sun
• Less able to retain water in skin (stratum corneum)
• Less able to repair the skin and heal wound, aggravated by health conditions that reduce healing such as diabetes
• More susceptible to infection (from fewer AND less responsive Langerhans cells)
• More susceptible to injury due to reduced ability to sense pressure and temperature, and thinner blood vessel walls

With the skin changes in elderly, there are numerous skin conditions that affect them. Most of the skin disorders have signs of skin inflammation and itch (pruritus). General itch without an underlying skin disorder is very common and mainly due to the breakdown of skin barrier, thus normally tolerated soaps and detergents start to trigger rash and itch (i.e. increasing risk of contact dermatitis). Atopic dermatitis is also common because of increased penetration of allergens via the defective skin barrier. As eczema, contact dermatitis and itch has been discussed in this blog (type into search box for all related posts), this series won’t cover these skin conditions despite being very common in elderly (as well as kids!).

For this series, I’m covering 3 skin disorders which are common and that I see in elderly around me (aka Singapore). These are Statis Dermatitis (affecting varicose vein area), Incontinence Associated Dermatitis (from exposure to urine or stools) and Asteatotic eczema (cracked skin). Older people may also have health conditions where either the condition itself predisposes them to skin disorders (atherosclerosis, diabetes, HIV, congestive heart failure) or the medication might. For instance, non-enzymatic metabolites, diuretics and calcium blockers affect the skin. So take time to Google, research and ask the doctor for elderly in your family about potential side effects of the medication they are taking. Elderly who are immobile (i.e. always on the chair or bed) or live in homes are also at higher risk of skin disorders.

Catch up next week on Statis Dermatitis and meanwhile, drop me a comment if you have a condition for elderly skin that you’d like me to look into!