The topic of aging skin is usually addressed only when someone is trying to sell you something. Talk of the natural changes that occur in our largest organ often get drowned out in this age of Botox and lasers. As we age, we see and feel certain changes in our skin. The skin becomes drier, wrinkled, also spots and warty growths appear. People use terms like “liver spots” and “barnacles” to describe them. Skin bruises easily and heals much slower than in younger years. These changes are a normal part of aging.
As our skin ages, changes are inevitable. They can cause distress in even the most healthy adults. Most of these changes are inescapable and unwelcome but harmless. Unfortunately some can be itchy or painful, even cancerous and require medical attention. Many of these skin problems can be prevented. Many cannot. Hopefully this article will help you make sense of what you observe happening with your skin. It is however no substitution for the trained eye of a dermatologist.
“I just barely bump myself and I get these!” one of my favorite elderly patients gasped in frustration as she showed me her bruised arms. Quarter sized purple and red bruise were scattered over her hands and forearms. “It looks like my husband beats me!” she joked. Purpura, or bruise, is the name given to the appearance of blood that has leaked out of damaged vessels into the skin. As we age our skin grows thinner and more fragile from years of sun damage. The underlying fatty layers and collagen that normally cushion and protect the blood vessels also will decrease; making the shallow vessels in your skin more prone to injury. As my patient experienced, even the slightest little bump against your skin can cause massive bruising. Often the visible appearance of the bruise is out of proportion to the injury, or the injury is simply not remembered because it was so minor. Medications like aspirin or blood thinners can make this worse. I’ve heard vitamin C and Co enzyme Q10 recommended over the years but have yet to really observe it working for anyone. Although it can be alarming, skin bruising is a normal part of the way our skin ages and does not specifically indicate any other medical condition.
“Doctor, I just itch all the time and my skin is dry.” This gets said at least daily in my office. As we age, our skin becomes drier. This can result in flaky and itchy skin, especially in cold, dry, windy climates. The skin does not hold in moisture as well as it once did. Elderly patients often are not as active as they had been previously. But many still bath as frequently as when they were active. Bathing daily is not absolutely necessary if you are not soiled in sweat or filth. I often have people just use a gentle, non fragranced soap on only their armpits, buttocks and genitals in the shower. To put a cleanser on larger areas like your arms and back often causes them to dry out easily and itch. With the loss of the fatty layer we discussed earlier, people get cold more easily and crank up the heater in the wintertime. Since this is such a dry climate that only exacerbates the issue for them.
Just like an untended garden sprouting weeds, our skin grows all sorts of harmless but unsightly lumps and bumps. Small red dots on the skin are called angiomas and are a result of a superficial blood vessel in the skin that does not know to stop growing. They cause people some concern but are also part of the aging process. 85% of them occur on the torso. Your dermatologist can easily treat these if they bother you. Flat brown or fawn colored spots are usually harmless but should be checked before you embark upon any treatment for them. The medical term for these is lentigo, but they are referred to as “liver spots” by most people. Fortunately, they have nothing to do with the health of your liver; but are a result of sun damage (which tends to be a reoccurring theme in dermatology).
Perhaps the growths that cause people the most concern are seborrheic keratosis. A similar sounding entity call actinic keratosis is pre-cancerous unfortunately. Often people will just say “I had a keratosis” and not know if it was pre-cancereous or not. The seborrheic keratosis can be a variety of colors from flesh-colored to brown to black. Most of them tend to be raised and crusty, resembling a giant wart. Men love to absentmindedly pick at them while watching the ballgame on TV. Women usually cringe at their appearance. These seborrheic keratosis may look dangerous but there is no reason to be alarmed most of the time. They do serve a useful purpose in the world however; they get people in the door of their dermatologist’s office. While people’s attention is focused on the big, ugly, warty, black lesion, they may be ignoring the tiny little melanoma next to it that escapes their notice. Seborrheic keratosis know no boundaries and can occur anywhere on the body, including the face and scalp.
It is sometimes hard to ascertain if a spot is cancerous or not. A simple biopsy is often needed to delineate between what bugs you and what can kill you. Every dermatologist who has been practicing long enough has a horror story of a spot that looked 100% benign but came back a cancer. The skin is sneaky and cancer can be a great mimicker of benign spots. So while these harmless skin growths discussed here are a natural part of the aging process, so is cancer. Skin cancer almost seems like a rite of passage now it so common. A yearly skin exam by a dermatologist and high index of suspicion on your part will go a long way to catching cancers early and ease your mind.