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Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998. Updated December 2015.
Ageing skin describes the changes in the appearance and characteristics of the skin that occur as people get older. Ageing changes are particularly pronounced on the face and hands.
Skin appears prematurely aged in people that are chronically exposed to sunlight, a process known as sun damage or photoageing. People with marked signs of photoageing:
Premature ageing of the skin also affects tobacco smokers and those chronically exposed to other environmental pollutants.
Intrinsic ageing of the skin is inevitable, and is genetically predetermined. It occurs because of accumulation of reactive oxygen species, biological aging of cells, and reduced cellular supply of nutrients and oxygen.
In women, loss of oestrogen levels at menopause contribute to premature aging, as compared with similarly aged men.
Photoageing is due to damage caused by solar radiation. Cell damage occurs because of the formation of reactive oxygen species.
Smoking exposes the skin to several damaging factors.
Immune dysfunction also affects skin ageing. Examples include:
In those genetically predisposed, ageing skin develops:
Photoageing results in:
Compared to non-smokers of the same age, long-term smokers have:
Ageing skin is prone to keratinocytic skin cancer and some types of melanoma. The most common form of skin cancer is basal cell carcinoma. However, excessively photoaged skin is at increased risk of intraepidermal carcinoma, squamous cell carcinoma, lentiginous forms of melanoma, and rare forms of skin cancer such as merkel cell carcinoma.
The features of ageing skin are diagnosed clinically. Lesions suspicious of skin cancer may be growing lumps or sores that fail to heal. They often undergo diagnostic biopsy before or as part of treatment.
Glogau classified the degree of sun damage by its clinical signs.
Type I, mild, "no wrinkles"
Type II, moderate, "wrinkles in motion"
Type III, advanced, "wrinkles at rest"
Type IV, severe, "only wrinkles."
Moisturisers will help improve dry and flaky skin.
Alpha-hydroxy acids, vitamin C, lipoic acid, soy isoflavones or retinoid creams applied regularly long term reduce dryness. They may also reduce the number of fine wrinkles and even out pigmentation. Many other products are under investigation but their benefits are unclear.
Procedures that aim to rejuvenate photoaged skin include:
Intrinsic ageing is inevitable. In perimenopausal women, systemic hormone replacement may delay skin thinning; the skin is less dry, with fewer wrinkles, and wound healing is faster than prior to treatment. Replacement is less effective at improving skin ageing in the postmenopausal decades. The effects of topical oestrogens, phyto-oestrogens and progestins are under investigation.
Protection from solar UV is essential at all ages.
Do not smoke and where possible, avoid exposure to pollutants. Take plenty of exercise—active people appear younger than inactive people. Eat fruit and vegetables daily to provide natural antioxidants.
Many oral supplements with antioxidant and anti-inflammatory properties have been advocated to retard skin ageing and to improve skin health. They include carotenoids, polyphenols, chlorophyll, aloe vera, vitamins B, C and E, red ginseng, squalene, and omega-3 fatty acids. Their role is unclear.
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