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Aging changes in skin

Wrinkles - aging changes; Thinning of skin

Aging changes in the skin are a group of common conditions and developments that occur as people grow older.

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Skin changes are among the most visible signs of aging. Evidence of increasing age includes wrinkles and sagging skin. Whitening or graying of the hair is another obvious sign of aging.

Your skin does many things. It:

Contains nerve receptors that allow you to feel touch, pain, and pressure
Helps control fluid and electrolyte balance
Helps control your body temperature
Protects you from the environment

Although skin has many layers, it can generally be divided into three main parts:

The outer part (epidermis) contains skin cells, pigment, and proteins.
The middle part (dermis) contains skin cells, blood vessels, nerves, hair follicles, and oil glands. The dermis provides nutrients to the epidermis.
The inner layer under the dermis (the subcutaneous layer) contains sweat glands, some 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. You can see this 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 than people with darker, more heavily pigmented skin.

AGING CHANGES

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. The remaining melanocytes increase in size. Aging skin looks thinner, paler, and clear (translucent). Pigmented spots including age spots or "liver spots" may appear in sun-exposed areas. The medical term for these areas is lentigos.

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

The blood vessels of the dermis become more fragile. This leads to bruising, bleeding under the skin (often called senile purpura), and cherry angiomas.

Sebaceous glands produce less oil as you age. Men experience a minimal decrease, most often after the age of 80. 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 thins so it has less insulation and padding. This increases your risk of skin injury and reduces your ability to maintain body temperature. Because you have less natural insulation, you can get hypothermia in cold weather.

Some medicines are absorbed by the fat layer. Shrinkage of this layer may change the way that these medicines work.

The sweat glands produce less sweat. This makes it harder to keep cool. Your risk for overheating or developing heat stroke increases.

Growths such as skin tags, warts, brown rough patches (seborrheic keratoses), and other blemishes are more common in older people. Also common are pinkish rough patches (actinic keratosis) which have a small chance of becoming a skin cancer. Skin cancers are also common and usually located in sun-exposed areas.

EFFECT OF CHANGES

As you age, you are at increased risk for skin injury. Your skin is thinner, more fragile, and you lose some of the protective fat layer. You also may be less able to sense touch, pressure, vibration, heat, and cold.

Rubbing or pulling on the skin can cause skin tears. Fragile blood vessels can break easily. Bruises, flat collections of blood (purpura), and raised collections of blood (hematomas) may form after even a minor injury.

Pressure ulcers can be caused by skin changes, loss of the fat layer, reduced activity, poor nutrition, and illnesses. Sores are most easily seen on the outside surface of the forearms, but they can occur anywhere on the body.

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, blood vessel changes, lowered immunity, and other factors also affect healing.

COMMON PROBLEMS

Skin disorders are so common among older people that it is often hard 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 conditions, including:

Blood vessel diseases, such as atherosclerosis
Diabetes
Heart disease
Liver disease
Nutritional deficiencies
Obesity
Reactions to medicines
Stress

Other causes of skin changes:

Allergies to plants and other substances
Climate
Clothing
Exposures to industrial and household chemicals
Indoor heating

Sunlight can cause:

Loss of elasticity (elastosis)
Noncancerous skin growths (keratoacanthomas)
Pigment changes such as liver spots
Thickening of the skin

Sun exposure has also been directly linked to skin cancers, including basal cell cancer, squamous cell carcinoma, and melanoma.

PREVENTION

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 a hat when needed.

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 you have no other symptoms.

Keep skin moist with lotions and other moisturizers. . Do not use soaps that are strongly detergent (drying) or heavily perfumed. Bath oils are not recommended because they can cause you to slip and fall. Moist skin is more comfortable and will heal more quickly.

References

Standring S. Skin and its appendages. In: Standring S, ed. Gray's Anatomy. 42nd ed. Philadelphia, PA: Elsevier; 2021:chap 7.

Tobin DJ, Veysey EC, Finlay AY. Aging and the skin. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 25.

Walston JD. Common clinical sequelae of aging. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Review Date: 7/21/2022

Reviewed By: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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