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“A good leg will fall; a straight back will stoop;
a black beard will turn white; a curled pate will grow bald;
a fair face will wither;. . . .”
–Shakespeare: Henry V, Act V, scene ii, 168
n increasing proportion of our population is living longer, and as we mature the consequences of time begin to show. The skin, hair and nails undergo characteristic changes with advancing age, dermatologic complaints increase steadily, and most people in their fifties and sixties have multiple skin problems, many of which are chronic.
There are two types of aging skin: one is a result of chronological, intrinsic aging – changes that occur in sun-protected skin; the other is a manifestation of chronic, sun-exposed skin – photoaging. One we can do little about (“the ineluctable modality of the visible”); the other we can prevent.
People of color – black and brown peoples – have stronger skins as a result of the protective melanin content of their pigment cells. If an African-American person has never been chronically exposed to the sun, and has never smoked, he or she will never exhibit a wrinkle! Even until the age of 80. Contrariwise, fair-haired, fair-skinned, blue-eyed Celtic women will wrinkle in their 40s even with only moderate exposures to the sun.
The integument of the darker-skinned individual will age much more slowly than his or her Caucasian neighbor. The skin of the darker, southern Mediterranean and Arab people will age slower than the Scandinavian and fair-skinned northern European peoples.
The importance of appearance in older people can alter their outlook, influence their self-perception, and affect their interpersonal relationships. Certain components of the normal skin aging are operating throughout life and, as yet, we have been unable to slow these changes. A significant degree of skin aging, however, is the end result of cumulative damage due to sun exposure.
It has recently been shown that it might be possible to reverse some of these degenerative processes. Experimental studies have indicated that the application of topical retinoic acid might result in eliminating some of the fine lines and wrinkles that have been caused by overexposure to the sun.
Dermatologists and plastic surgeons have been using injectable collagen implants – a simple, in-office procedure whereby the physician injects a modified bovine collagen into the upper layers of the dermis – to reduce these cosmetically-unacceptable facial lines. Especially amenable to this type of therapy are the wrinkles of the forehead, the folds at the sides of the nose, and the area between the eyebrows. Unfortunately, the effect of this procedure is not permanent and injections must be repeated anywhere from six months to two years later. This, nonetheless, offers a satisfactory spot treatment to specific areas of the face in those otherwise unwilling or unable to undergo more aggressive surgical operations. Some of the very latest treatment remedies include a variety of laser procedures.
Aging skin undergoes alterations in structure and function that significantly modify its appearance, and while these problems are often medically insignificant and are not life threatening, they are of profound cosmetic concern and detract from the quality of life for many older people.
Loss of elasticity, reduction in fat and moisture, changes in the supporting bone structure and muscles, wrinkles and increased dryness of the skin, changes in coloration, loss of scalp hair and growth of facial hair, and the emergence of skin growths are but a few of the many changes that eventuate with advancing years.
Structural Changes In the Aging Skin
The normal, “young” epidermis – the upper layer of the skin – furnishes a hardy, flexible barrier that prevents excessive water loss and provides protection from an assortment of environmental insults.
In the aging skin, certain changes in the epidermis occur. Some of these are:
The function of the dermis – the lower layer of the skin – is to provide a tough matrix to support the many structures – blood vessels, nerves, appendages – that are embedded in it. Comprised chiefly of collagen and elastic fibers – the components that give the skin its texture and suppleness – the dermis decreases in thickness and density after the age of twenty, more so in females whose dermis is thinner than that of males. In the aging dermis, the following occurs:
Collagen.
The total amount of this component of the dermis decreases steadily throughout adult life. In addition, the collagen becomes frayed at the edges and there is alteration and thickening of the collagen fibers. Aggravated by sun exposure, these changes result in:
Elastic Fibers.
As the elastin network ages, the elastic fibers thicken and degenerate, resulting in:
In addition, there is a decrease in the surface temperature of the skin. This produces skin that is pale in appearance. The small blood vessels around the appendages – sweat glands, oil glands, and hair follicles – also diminish in density resulting in decreased sweating, decreased oiliness, and thinning of the hair.
Care For the Aging Skin
What can we do to lessen the effects of the aging skin? Can we turn back the proverbial epidermal clock? Here are a few things to consider:
PHOTOAGING
A few notes on photoaging:
Photoaging is the combined effect of chronological aging and long-term sun damage on exposed parts of the body. In fair-skinned people with extensive sun exposure, photoaging may begin as early as the 30s and become more pronounced in the 40s and 50s.
Features of photoaging include any or all of the following:
Retin-A and some of the newer retinoids and alpha-hydroxy acids work on some people to lessen these wrinkles. There is an over-the-counter product – Kinerase (in a cream and lotion) – that many women patients seem to like.
For more information on some of the other procedures that are used to reduce or eradicate the signs of aging skin, consult your dermatologist.
To prevent many of the signs of aging, stay out of the sun!
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For further information about aging skin, log on to: www.aad.org 1-888-462-DERM x22 |
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