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Skin changes are be among the most visible signs of aging. Evidence of increasing age include wrinkles and sagging skin. Graying of the hair is another obvious sign of aging.

Your skin does many things. It protects you from the environment, helps regulate your body temperature, helps with fluid and electrolyte balance, and provides receptors for sensations such as touch, pain, and pressure.

Although skin has many layers, it can be roughly divided into 3 main portions. The outer portion (epidermis) contains skin cells, pigment, and proteins. The middle portion (dermis) contains blood vessels, nerves, hair follicles, and oil glands; it provides nutrition to the epidermis. The portion under the dermis (the subcutaneous layer) contains sweat glands, some of the hair follicles, blood vessels, and fat. Each layer also contains connective tissue, with collagen fibers to give support and elastin fibers to provide flexibility and strength.

Skin changes are related to environmental factors, genetic makeup, nutrition and other factors. The greatest single factor, though, is sun exposure. This can be seen by comparing areas of your body that have regular sun exposure with areas that are protected from sunlight. Natural pigments seem to provide some protection against sun-induced skin damage. Blue-eyed, fair-skinned people show more aging skin changes that people with darker, more heavily pigmented skin.

With aging, the outer skin layer (epidermis) thins even though the number of cell layers remains unchanged. The number of pigment-containing cells (melanocytes) decreases, but the remaining melanocytes increase in size. Aging skin thus appears thinner, more pale, and translucent. Large pigmented spots (called age spots, liver spots, or lentigos) may appear in sun exposed areas.

Changes in the connective tissue reduce the skin's strength and elasticity. This is known as elastosis and is especially pronounced in sun-exposed areas (solar elastosis). Elastosis produces the leathery, weather-beaten appearance common to farmers, sailors, and others who spend a large portion of their life outdoors.

The blood vessels of the middle layer (dermis) become more fragile, which in turn leads to bruising, bleeding under the skin (purpura), cherry angiomas, and similar conditions.

Sebaceous glands produce less oil. Men experience a minimal decrease, usually after 80 years old. Women gradually produce less oil beginning after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness.

The subcutaneous fat layer, which provides insulation and padding, thins. This increases your risk of skin injury and reduces your ability to maintain body temperature. Some medications are absorbed by the fat layer, and loss of this layer changes the way that these medications work. As you age, you have less "natural insulation" and in cold weather, hypothermia can result.

The sweat glands produce less sweat. This makes it harder to keep cool, and you become at increased risk for becoming overheated or developing heat stroke.

Growths such as skin tags, warts, and other blemishes are more common in older people.

As you age, you are at increased risk for skin injury. Your skin is thinner, more fragile, and the protective subcutaneous fat layer is lost. In addition, your ability to sense touch, pressure, vibration, heat, and cold may be reduced. Thus, your aging skin becomes injured readily.

Rubbing or pulling on the skin can cause skin tears. Fragile blood vessels are easily broken. Bruises, flat collections of blood (purpura), and raised collections of blood (hematomas) form after even a minor injury. This is most easily seen on the outside surface of the forearms, but can occur anywhere on the body. Skin changes and loss of subcutaneous fat, combined with a tendency to be less active, contribute to pressure ulcers.

Aging skin repairs itself more slowly than younger skin. Wound healing may be up to 4 times slower. This contributes to pressure ulcers and infections. Diabetes mellitus, blood vessel changes, lowered immunity and similar factors also affect healing.


Skin disorders are so common among older people that it is often difficult to tell normal changes from those related to a disorder. More than 90% of all older people have some type of skin disorder.

Skin disorders can be caused by many diseases including diabetes, liver disease, heart disease, and blood vessel diseases such as arteriosclerosis. Stress, reactions to medications, obesity, and nutritional deficiencies can be other causes. Climate, exposures to industrial and household chemicals, indoor heating, clothing, allergies to plants and other allergies, and many other common exposures can also cause skin changes.

The major cause of skin changes is sunlight. It has been directly linked to elastosis (loss of elasticity), keratoacanthomas (non-cancerous skin growths), thickening of the skin, pigment changes such as liver spots, and other conditions. Sunlight has also been directly linked to skin cancers, including basal cell epithelioma, squamous cell cancer, and malignant melanoma.

Because most skin changes are related to sun exposure, prevention is a lifelong process. Prevent sunburn if at all possible. Use a good quality sunscreen when outdoors, even in the winter. Wear protective clothing and hats as necessary.

Good nutrition and adequate fluids are also helpful. Dehydration increases the risk of skin injury. Sometimes, minor nutritional deficiencies can cause rashes, skin lesions, and other skin changes even if no other symptoms are present.
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