health&healing

“Our skin does change as we age,” observes Dr. Laura Briley of Southern Dermatology & Skin Cancer Center in Raleigh. “But skin damage owes less to how old we are than to how we have exposed and cared for our skin in our younger years.

“Age certainly plays a role,” she acknowledges, “because skin loses its elasticity over time. So, as we get older, we go from having nice tight skin to skin that starts to sag, wrinkle, or get crepey. And those changes are compounded by long-term exposure to ultraviolet (UV) radiation—sunshine. UV rays destroy collagen and thin the skin, degrading its texture, and further eroding its elasticity. In fact, much of the skin damage that we attribute to aging—severe wrinkling, discoloration, even leathery skin—is the result of chronic sun exposure. And, the more years we have under our belt, the longer we’ve been exposed to UV radiation.”

While we can’t prevent the natural loss of elasticity as we age, says Dr. Briley, we can prevent the damage caused by long-term sun exposure. “I will occasionally meet a 90-year-old who has never been exposed to the sun—just always wore long sleeves and pants. And I’ll think ‘That is the most beautiful skin I’ve ever seen.’ In contrast, the next patient might be a 40-year-old who used a tanning bed—and whose skin looks terrible.

“People who take care of their skin and limit sun exposure will still have a loss of elasticity and thinning of the skin over time,” she says, “but they will have much less damage to their skin. Because sun damage isn’t simply the result of getting old—it’s just that you’ve had more years of being in the sun.”

Skin Problems as We Age

“Most serious skin damage occurs from over-exposure to the sun, which not only harms the skin, but causes skin cancer,” notes Dr. Briley. “And the longer you live, the more sun you’ve had—so sun damaged skin can certainly be considered a health problem of aging.

“However, many things contribute to the skin changes associated with aging, including smoking, diet, and exposure to pollutants. And it is the cumulative impact, over many years, of multiple factors that results in many of the skin problems we treat. So, it’s not surprising that the majority of our patients are older.

“The older you are, the more exposure you’ve had to UV radiation,” notes Dr. Briley. “So our elderly patients will likely have many more cancers and precancers. However, for the majority of older patients, the skin problems that concern them are ones affecting their quality of life—conditions that can be well managed.”

Discoloration, Itching, Hair Loss

Dr. Briley notes that one of the most frequent complaints of her elderly patients is that they itch more. “It’s a common problem,” she says, “resulting from a combination of things. For one thing, skin dries over time—every year skin moisture is lost, and it just becomes itchier. This is often aggravated by medications. Our goal for these patients is to find treatments that provide relief without adding medications that may contribute to the problem. Fortunately, we have many options to choose from and can tailor the treatment to the individual patient.”

Years of sun damage, observes Dr. Briley, “inevitably affect skin tone, resulting in discoloration, including brown spots, uneven skin color, and something called actinic purpura. These are large purple marks on the hands and forearms that look like bruises. They’re not bruises, however—and go away without treatment. Since hands and arms get the most sun exposure, the skin on our forearms and hands thins over time. And, once the skin thins, the connective tissue around the blood vessels in the skin gets thin, resulting in the eruption of these large purple marks. Many patients—especially those who are on blood thinners, which contributes to the problem—are concerned about these apparent ‘bruises,’ and I’m able to reassure them that they’re nothing to worry about and will go away on their own.”

A similarly benign sign of aging, notes Dr. Briley, is hair loss on our bodies. “Nearly everyone has some hair loss with aging,” she says. “And not only does the rate of hair growth slow, but hair strands become smaller and have less pigment.”

Meeting the Challenges of Aging Skin

“For those wanting to maintain healthy skin as they age,” says Dr. Briley, “the best advice I can offer is a single word: sunblock. And I’m advising sunblocks—that include zinc or titanium dioxide—rather than chemical sunscreens.

“Preventing sun damage is the most important thing you can do for overall skin health,” says Dr. Briley. “But I would also advise adding retinoids. We tend to use prescription Retin-A (tretinoin), which I’ll recommend for use on face, neck, and hands. Not only will retinoids help with fine wrinkles and preventing brown spots, but they also help prevent pre-cancers.”

Many options exist for repairing sun-aged skin, notes Dr. Briley. “The Aesthetic Suite at the Skin Renewal Center at Southern Dermatology offers a wide range of non-surgical treatments for restoring skin health—including laser treatments, chemical peels, collagen replacement therapies, and more. “When treating and repairing skin damage for our elderly patients,” she adds, “there are special considerations. For one thing, many older patients have other health issues—and may be taking many other medications—all of which must be taken into account. When, for example, a 90-year-old with psoriasis comes in upset because it’s itching, we’re always going to try treating them with less medication.”