Aging & the Skin

Reviewed By: Kimberly Bazar, M.D., AAD Aging has many effects on a person’s skin, from wrinkles and sags to increased risk of certain skin conditions, such as skin cancer. As people age, their skin begins to change due to environmental factors, genetic makeup, nutrition and other factors. Covering the entire outside of the body, the skin is the body’s largest organ and consists of three layers: the epidermis (composed of skin cells, pigment and protein), the dermis (composed of blood vessels, nerves, hair follicles and oil glands) and the subcutaneous tissue (composed of sweat glands, hair follicles, blood vessels and fat). Each layer also contains connective tissue, collagen fibers for support and elastin fibers to provide flexibility. Hair and nails are modified versions of skin. Hair maintains warmth in the body by preserving heat. Hair located around the eyes and in the nose and ears protects these areas from small particles such as dust. It also cushions the body against injury. Nails sprout from deep folds in the fingers and toes. They provide protection and support for the sensitive fingertips and toes. The skin serves many roles in an individual's body. It protects a person from the environment, helps maintain fluid and electrolyte balance and provides receptors that help the body feel sensations such as pain, vibration and pressure. It grows faster than any other organ in the body, and people continuously renew their skin throughout their lifetime. From the moment a person is born, the skin begins a process of constant change. A baby’s skin tends to be soft and smooth and has a thicker layer of fat and thinner layer of keratin, a protein that is the chief component of hair and nails. As a person enters the young adult years, the skin becomes stronger and suppler. As people age, many changes affect their skin. The outer skin layers (dermis and epidermis) begin to thin and the number of cells containing pigment (melanocytes) begins to decrease, even as the remaining melanocytes increase in size. Connective tissue begins to change, reducing the skin’s strength and elasticity (elastosis) and causing it to take on a leathery appearance. The skin also dries out and begins to lose underlying fat (except in the abdomen and thighs), and fine wrinkles increasingly appear. Causes of aging-related skin changes Sun exposure (photodamage) is the chief source of aging-related skin damage, including blotchy pigmentation, wrinkling and scaling. The more skin is exposed to the sun without protection, the greater the likelihood of developing signs of aging. A person’s skin type plays a significant role in how damage manifests. For example, people with blue eyes and light skin are much more likely to show aging skin changes than those with darker eyes and skin. In addition, skin becomes even more vulnerable to sun damage as it ages and the number of cells containing pigment (melanocytes) begins to decrease. Because older people have a reduced inflammatory response, they are less likely to develop sunburn than younger people. However, this lack of sunburn masks the fact that older people with fewer melanocytes are actually more likely to suffer significant ultraviolet radiation damage than younger people. Long-term exposure to the sun has been linked to many aging-related skin changes, including loss of elasticity (elastosis), skin growths (keratoacanthomas), thinning of the skin, pigment changes (such as age spots), actinic keratosis (precancerous skin changes) and skin cancers. People who spend a lot of time outdoors may develop solar elastosis due to sun exposure, which causes the leathery appearance to become even more pronounced. Other environmental factors that may contribute to skin damage include climate, exposure to chemicals and allergies. Genetics also play a role in the development of aging-related skin changes. A person's tendency to develop wrinkles, for instance, may be inherited from their parents. Additional aging-related changes that impact the appearance of the skin include: Weakening of blood vessels in the skin’s middle layer (dermis). As these vessels become more fragile, bruising, bleeding under the skin (purpura) and cherry angiomas (small red spots on the skin) may occur. Thinning of the subcutaneous fat layer. This layer of skin provides insulation and padding and absorbs some medications. As the subcutaneous layer thins, a person becomes more susceptible to skin injury and medications may work differently in the person’s system. The subcutaneous fat layer also helps the body to maintain proper body temperature. The thinning of this layer leaves the body with less natural insulation, increasing the risk of hypothermia during exposure to cold. Decreased sweat glands. Both the sweat glands and blood vessels in the skin begin to decrease. This makes it more difficult for patients to keep cool, putting them at increased risk for overheating or suffering heat stroke. Drying out of the skin. This condition – known as xerosis – occurs in a majority of older people and may result in itchiness (pruritus) and a roughness to the skin’s texture. It is particularly likely during the winter. The exact cause of this drying out is unknown, although a reduction of oil production from the sebaceous glands may be at least partially responsible. Women produce less oil after menopause, which causes dry skin and itchiness. Men experience a lesser decrease, usually after age 80. As people age, they also become more vulnerable to diseases and disorders that may cause skin conditions. Diseases that can impact the skin include diabetes, liver disease, heart disease and arteriosclerosis (a blood vessel disease). Shingles (a viral infection caused by the same virus that causes chickenpox) is also more common and painful in people older than 50, although it can occur in people of any age. Other factors that may impact the skin include stress, medication reactions, obesity and lack of adequate nutrition. Symptoms of aging-related skin changes As the skin begins to slowly deteriorate during the aging process, a number of symptoms may appear. The skin often appears thinner, paler and more translucent. People may look increasingly gaunt, with hollowed cheeks and eye sockets. “Laugh lines” may appear around the mouth, and crow’s feet may appear around the eyes. Sleep lines – which are temporary marks on the face that appear after sleeping on a pillow all night – may become etched into the face. As gravity takes its toll on the skin, the eyelids begin to fall, jowls form, the nose tip droops downward, the upper lip recedes while the lower lip protrudes and the ears grow longer. The skin dries out and begins to lose elasticity. Areas that are exposed to sun may develop into brown patches known as age spots or liver spots. These most often appear on the face, hands, arms, back and feet of people with fair skin. Skin is more vulnerable to injury as the subcutaneous fat layer breaks down and a person’s sense of touch becomes reduced (due to a decrease in the number of nerve endings in the skin). Simple rubbing or pulling of the skin can result in tearing of the skin and blood vessels are more easily broken. Even minor injuries can result in bruises, flat collections of blood (purpuras) or raised collections of blood (hematomas). Such injuries most frequently appear on the outside of the forearms. Not only is aging skin more susceptible to injury, but it also heals more slowly. The slow healing process may result in ulcers or skin infections. In addition, the aging process makes people more susceptible to growths such as warts, skin tags (small, fleshy, noncancerous skin growths attached to a stem-like base), seborrheic keratoses (benign, gray/brown rough-surfaced growths) and cherry angiomas (benign skin growths that appear as small, smooth, cherry-red bumps). Generally, skin disorders are more common in older people. Aging also increases the presence of spider veins, blood vessels located just beneath the skin surface that grow larger and appear red or blue when they weaken and become clogged. They most often appear in “sunburst” patterns on the face and legs, but can affect other areas of the body. Finally, aging impacts other types of skin such as hair and nails. Hair begins to go gray as hair follicles produce less of the pigment (melanin) that gives hair its color. This occurs first on the scalp and then on other areas of the body. Over time, gray hair eventually turns white. People may also experience hair loss on the scalp or grow unwanted hair in other regions. Nails may grow slower and become dull, brittle, yellowed and opaque. Toenails may become hard and thick over time. Prevention of age-related skin changes It is impossible to prevent all of the changes that occur to the skin as a person ages. However, older individuals can take steps to slow the pace of these changes, or to treat symptoms that result from these changes. Tips include: Avoid sun exposure. Sun damage (photodamage) is the leading cause of wear and tear to the skin ranging from wrinkles to skin cancer. For this reason, people should always wear sunscreen with a sun protection factor (SPF) of 15 or higher when outdoors, even during the winter. Protective clothing, such as wide brimmed hats, long-sleeved shirts and long pants can also help protect the body from the harmful effects of the sun. If possible, avoid exposure to the sun during the peak sun hours of 10 a.m. to 4 p.m. Avoiding sun exposure is especially important for those living in warmer climates – with every four degrees of closeness to the equator, the incidence of skin cancer doubles. Use moisturizers and emollients. Simple, inexpensive versions of these products can be effective in restoring moisture to dry skin. Moisturizers that contain lactic acid or urea may be more effective in relieving the severe dryness associated with aging skin. These products are intended to alleviate the actual cause of dryness rather than to just treat the symptoms. Maintain a healthy diet and consume adequate fluids. Poor nutrition increases the risk of skin rashes, lesions and other skin changes. Foods that are recommended for good skin health include fruits, vegetables, whole grains and “good” fat, such as that found in vegetable oil, fish and nuts. Foods containing sugar, cholesterol, and sodium should be avoided or consumed in moderation. Dehydration increases the risk of injury to skin tissues. Consuming a minimum of eight 8-ounce servings of water throughout the day can help prevent the body from dehydrating. Talk with a physician about additional medications or treatments. The effects of skin damage can often be treated, slowed or prevented through the use of certain medications (such as tretinoin or alpha hydroxy acids) or procedures (such as cryotherapy, chemical peels, microdermabrasion, Botox, facial skin rejuvenation, soft tissue augmentation, laser resurfacing and blepharoplasty).