LEARN MORE ABOUT MATURE SKIN As we grow older, so does our skin. Our skin is the largest organ in the body. It is the organ which endures the maximal abuse from external factors like sunlight, winds, soaps, cosmetics and pollution. The ageing skin is drier, more wrinkled, irritable, has poor healing capacity and has more spots and growths. These changes may be purely cosmetic (eg, liver spots and skin tags) or sinister (pre-cancerous and cancerous moles and growths). Some of these changes can be ignored, while others may cause itching and discomfort. Irrespective of the cause or nature of these changes, most of them can now be remedied through one or many of the various therapies available today. Dry Skin As we age our skin loses tissue, becomes thinner, loses more moisture and becomes dry and flaky. This becomes worse in winters and by excessive use of soap. Dry skin is itchy and prone to cracks, fissures and injuries. Use liquid soaps for bathing, add emollient oils to your bath water, and moisturize your skin 2-3 times a day with a petrolatum based cream. Wrinkles These are caused by an interplay between gravity, repetitive use of facial muscles, sun damage, thinning of skin and loss of skin fat. Changes include lines, folds, frowns, wrinkles, sagging and hollows. The changes are more dramatic over the face, as the face is constantly exposed and unprotected. Proper use of a sunscreen (with SPF 15 and above) along with use of retinol-based anti-ageing night creams (starting at a younger age) can help in slowing down age-related skin changes. There are various treatment options available for the treatment of lines and wrinkles, eg. chemical peels, microdermabrasion, botox, fillers, laser skin tightening and surgical facelifts. Discuss your options with your dermatologist. Itchy skin This is a very common complaint among the elderly. This could be due to dry skin, internal diseases ( mostly kidney or liver- related ), allergies, stress- induced, medication- induced, or due to asteatotic eczema ('pavement- crack' appearance of the shins ). Bed sores Commonly seen on the shoulders or buttocks of elderly and bed-ridden patients. These should be attended to immediately as they are a major source of infection, which can turn fatal. They are treated with antiseptics, surgical debridement (for bigger sores) and nutritional support. The caregiver must be educated on caring for such patients. Intertrigo Moist, red, foul-smelling maceration of the skin folds among the elderly, the obese, the bed-ridden, diabetics and/or adult diaper- wearers. It can also be seen around the private parts of older patients who have problems with urinary and fecal incontinence. Keeping the folds clean and dry is the main rule for prevention. Skin growths Skin Tags- harmless skin growths on the neck and/or underarms. Removed easily and painlessly using snip excision or carbon dioxide laser. Cherry Angiomas harmless, small, bright red raised bumps created by small blood vessels which 'pop-out' into the skin. Seen mostly over the trunk. Easily eliminated with carbon dioxide laser. Dermatosis Papulosa Nigra- These appear as smaller, 'stuck- on', mole-like lesions on the cheeks and neck folds of darker races like Indians and Negros. They can run in families, and are more common in the middle- aged. Removed painlessly with carbon dioxide laser. Heals without scarring. Actinic Keratoses- Red or brown scaly spots seen on sun- exposed areas of fair skinned patients. These are pre-cancerous lesions. Can be treated completely and successfully if detected early. Seborrheic Keratoses- Brown or black raised wart-like growths, mostly over the face, scalp and legs of the elderly. These never turn into cancer. Basal cell carcinoma- The most common skin cancer. Presents as painless, superficial ulcers or nodules. Usually appears over the scalp, face, nose or chest. When treated early, they have a 95% cure rate. Early lesions can be treated by a dermatologist through non-surgical means. Melanoma- Less common but more serious form of skin cancer. Appears as black or dark brown mole-like growths with irregular borders and variable colors. Any change in an existing mole or a rapid appearance of a new mole could be sign of melanoma. Such a mole should be examined immediately and surgically excised. Melanoma can spread to other organs and can be fatal. Liver spots Blotchy, flat brown areas of pigmentation, mostly on the face and hands. They are harmless and can be remedied using laser skin resurfacing. Idiopathic Guttate Hypomelanosis Harmless 'porcelain-chip' like white spots, seen mostly on the limbs of the middle- aged and elderly. These do not require any treatment. Telangiectasis ('Broken capillaries') Dilated and broken facial blood vessels. May be related to sun damage. Respond to laser therapy. Rosacea Common skin condition that causes redness and swelling on the face. Can lead to swelling and disfiguration of the nose. Responds to antibiotic creams and Isotretinoin. Varicose veins and Spider veins These are enlarged veins that appear blue and bulging. Seen on the legs and thighs of the elderly. It is seldom harmless. It causes pain, swelling, itching and skin discoloration. Patient must avoid standing for prolonged periods, must keep feet elevated while sitting or lying down, and wear supportive stockings or elastic bandages. Severe cases are treated with sclerotherapy or surgery. Bruises Easy bruising is common among the elderly, as their skin is thinner and damaged after several years of exposure to the sun. Vitamin C deficiency is another important cause. Care for hands and feet The older a person gets, the more prone the hands and feet become to problems. Corns, calluses, warts, dry skin, fungal infections, ingrown toenails, blisters and other deformities are common. Proper care of your hands and feet, including daily self- inspections and regular checkups by a doctor, can alleviate most of these problems. The feet are also a g