What medical condition results in skin that is thinner and more fragile with impaired healing?

Americans spend billions of dollars each year on skin care products that promise to erase wrinkles, lighten age spots, and eliminate itching, flaking, or redness. But the simplest and cheapest way to keep your skin healthy and young looking is to stay out of the sun.

Sunlight is a major cause of the skin changes we think of as aging — changes such as wrinkles, dryness, and age spots. Your skin does change with age. For example, you sweat less, leading to increased dryness. As your skin ages, it becomes thinner and loses fat, so it looks less plump and smooth. Underlying structures — veins and bones in particular — become more prominent. Your skin can take longer to heal when injured.

You can delay these changes by staying out of the sun. Although nothing can completely undo sun damage, the skin sometimes can repair itself. So, it’s never too late to protect yourself from the harmful effects of the sun.

Skin changes that come with age

• Roughness of the skin.
• Development of skin lesions, such as benign tumors.
• Slack skin. The loss of the elastic tissue (elastin and collagen) in the skin with age causes the skin to become slack and hang loosely.
• The skin becomes more transparent as we age. This is caused by thinning of the epidermis (surface layer of the skin).
• Skin becomes more fragile as we age. Increased skin fragility is caused by flattening of the area where the epidermis and dermis (layer of skin under the epidermis) come together.
• Easy bruising of the skin as we age caused by thinner blood vessel walls.

Age spots

Age spots, or “liver spots” as they’re often called, have nothing to do with the liver. Rather, these flat, brown spots are caused by years of sun exposure. They are bigger than freckles and appear in fair-skinned people on sun-exposed areas such as the face, hands, arms, back, and feet. The medical name for them is solar lentigo. They may be accompanied by wrinkling, dryness, thinning of the skin, and rough spots.

A number of treatments are available, including skin-lightening, or “fade” creams; cryotherapy (freezing); and laser therapy. Tretinoin cream is approved for reducing the appearance of darkened spots. A sunscreen or sun block should be used to prevent further damage.

Shingles

Shingles is an outbreak of a rash or blisters on the skin that may cause severe pain. Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After an attack of chickenpox, the virus lies silent in the nerve tissue. Years later, the virus can reappear in the form of shingles. Although it is most common in people over age 50, anyone who has had chickenpox can develop shingles. It also is common in people with weakened immune systems due to HIV infection, chemotherapy or radiation treatment, transplant operations, and stress.

Early signs of shingles include burning or shooting pain and tingling or itching, generally on one side of the body or face. A rash appears as a band or patch of raised dots on the side of the trunk or face. The rash develops into small, fluid-filled blisters, which begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to intense pain. Most people with shingles have only one bout with the disease in their lifetime. However, those with impaired immune systems — for example, people with AIDS or cancer — may suffer repeated episodes.

If you suspect you have shingles, see a doctor right away. The severity and duration of an attack of shingles can be reduced significantly by immediate treatment with antiviral drugs. These drugs also may help prevent the painful aftereffects of shingles known as postherpetic neuralgia. The National Institute of Allergy and Infectious Diseases currently is testing a shingles vaccine at the National Institutes of Health in Bethesda , Maryland . The vaccine they are testing is similar to the one used to immunize against chickenpox. After the shot, some people have had some discomfort around the area of the injection. In addition, a few people have had a low-grade fever. For more information about this study, call 1-800-411-1222.

Bruising

Many older people notice an increased number of bruises, especially on their arms and legs. The skin becomes thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. The skin bruises and tears more easily and takes longer to heal.

Sometimes bruising is caused by medications or illness. If bruising occurs in areas always covered by clothing, see a doctor.

Keep your skin healthy

The best way to keep your skin healthy is to avoid sun exposure.

• Stay out of the sun. Avoid the sun between 10 a.m. and 3 p.m. This is when the sun’s UV rays are strongest. Don’t be fooled by cloudy skies. Harmful rays pass through clouds. UV radiation also can pass through water, so don’t assume you’re safe if you’re in the water and feeling cool.
• Use sunscreen. Sunscreens are rated in strength according to a sun protection factor (SPF), which ranges from 2 to 30 or higher. A higher number means longer protection. Buy products with an SPF number of 15 or higher. Also look for products whose label says: broad spectrum (meaning they protect against both types of harmful sun rays — UVA and UVB) and water resistant (meaning they stay on your skin longer, even if you get wet or sweat a lot). Remember to reapply the lotion as needed.
• Wear protective clothing. A hat with a wide brim shades your neck, ears, eyes, and head. Look for sunglasses with a label saying the glasses block 99 to 100 percent of the sun’s rays. Wear loose, lightweight, long-sleeved shirts and long pants or long skirts when in the sun.
• Avoid artificial tanning. Don’t use sunlamps and tanning beds, as well as tanning pills and tanning makeup. Tanning pills have a color additive that turns your skin orange after you take them. The FDA has approved this color additive for coloring foods but not for tanning the skin. The large amount of color additive in tanning pills may be harmful. Tanning make-up products are not suntan lotions and will not protect your skin from the sun.
• Check your skin often. Look for changes in the size, shape, color, or feel of birthmarks, moles, and spots. If you find any changes that worry you, see a doctor. The American Academy of Dermatology suggests that older, fair-skinned people have a yearly skin check by a doctor as part of a regular physical exam.

If life is about change, skin is proof. Our skin is at the mercy of the many forces we exert on it: sun, harsh weather, and our own bad habits. But we can take steps to help our skin stay supple and fresh-looking.

For a variety of reasons, our skin changes as we age. How your skin ages will depend on a variety of factors: your lifestyle, diet, heredity, and other personal habits. For instance, are you a smoker or did you ever smoke? Smoking can produce free radicals, which are once-healthy oxygen molecules that are now overactive and unstable.

There are other reasons, too. Primary factors contributing to these skin changes over time include normal aging, exposure to the sun (photoaging), and loss of subcutaneous support (fatty tissue between your skin and muscle). Other factors that contribute to aging of the skin including stress level, gravity, daily facial movement, obesity, and even sleep position.

Subcutaneous (below the skin) skin changes associated with aging

• Loss of fat below the skin in the cheeks, temples, chin, nose and eye area may result in loosening skin, sunken eyes, and a "skeletal" appearance.
• Bone loss, mostly around the mouth and chin, may become evident after age 60 and cause puckering of the skin around the mouth.
• Cartilage loss in the nose causes drooping of the nasal tip and accentuation of the bony structures in the nose.

Other skin changes

Gravity, facial movement and sleep position are the secondary factors that contribute to changes in the skin. When the skin loses its elasticity, gravity causes drooping of the eyebrows and eyelids, looseness and fullness under the cheeks and jaw (jowls and "double chin"), and longer ear lobes.

Facial movement lines become more visible after the skin starts losing its elasticity (usually as people reach their 30's and 40's). Lines may appear horizontally on the forehead, vertically on the skin above the root of the nose (glabella), or as small curved lines on the temples, upper cheeks and around the mouth.

Sleep creases result from the way the head is positioned on the pillow and may become more visible after the skin starts losing its elasticity. Sleep creases are commonly located on the side of the forehead, starting above the eyebrows to the hairline near the temples, as well as on the middle of the cheeks. Changing sleep position may improve these sleep creases or prevent them from becoming worse.

Smoking

People who smoke tend to have more wrinkles than nonsmokers of the same age, complexion, and history of sun exposure. The reason for this difference is unclear. It may be because smoking interferes with normal blood flow in the skin.

Dry skin and itching

Dry skin is common in later life. About 85 percent of older people develop "winter itch," because overheated indoor air is dry. The loss of sweat and oil glands as we age may also worsen dry skin. Anything that further dries the skin (such as overuse of soaps, antiperspirants, perfumes, or hot baths) will make the problem worse.

I have heard a lot in the news about antioxidants and free radicals. What are they and how do they affect my skin’s health?

Aside from one’s genetics and the skin sagging that naturally occurs with age, much of what is considered skin aging is really a result of exposure to pollutants and sunlight over time. Skin exposed to sun and toxins is damaged by unstable chemicals called free radicals. Antioxidants come to the rescue of skin ravaged by free radicals. Vitamins A, C, and E; green tea extract; and beta-carotene are antioxidants used in cosmetic products that are putting up a fight against wrinkle-causing free radicals.

It is believed that antioxidants stop potential damage before it occurs by interacting with free radicals as they penetrate through skin layers. Their role is prevention rather than repair of skin damage. Free radicals attack the lipids in skin which normally provide protection against moisture loss. Skin appears to age prematurely because of the resulting dryness and loss of elasticity. Antioxidants neutralize free radicals before they can break down lipids, and help protect skin from environmental agents, such as sun exposure, pollution and stress. Skin stays naturally hydrated and smooth with topical use of antioxidant-containing products.

Exfoliating and Peeling – Does your skin know the difference?

These two words may be cause for confusion. Exfoliation and peel are both processes for the removal of skin cells responsible for wrinkling. However, both have unique advantages and different results on skin. To understand the differences between these two antiwrinkle techniques, it is helpful to know how skin is structured.

Basically, skin is composed of two primary layers - the outer epidermis and the underlying dermis - each of which is made up of secondary layers. The layers of the dermis are a thriving network of connective fibers, blood vessels, proteins, fat cells, oil and sweat glands, and nerve endings that give skin its elasticity, strength, and sensory qualities. The epidermis is a layered series of skin cells that push their way to the top in a natural process known as desquamation. As dead skin cells reach the outermost layer of the epidermis, they shed naturally.

Shedding of the epidermis can be helped along by exfoliating or by peeling. The difference is in how deep the layers of skin cells are removed. Exfoliation can be done at home using products such as low-strength alpha-hydroxy acids (AHAs) that cause the topmost skin cells to slough off. Peels remove deeper layers of skin and are applied in a dermatology office. Peels may be performed using AHA applications, but these are in much higher strengths than what is used at home. Often an in-office application of a glycolic acid peel is followed up with daily exfoliation at home to continue the effects of the peel.

Daily exfoliating at home is a simple and convenient way to remove the buildup of dead skin cells that lead to fine wrinkling on the face. An in-office peel is appropriate for diminishing more noticeable skin wrinkles. Both processes give skin a refreshing glow that looks healthy on any face.

Does what I eat affect the health of my skin?

Skin is the largest organ of the body. And being so outwardly visible, skin is usually an accurate reflection of what goes on inside. Yes, the types and amounts of food you eat, ultimately show on your face.

For good skin tone and texture, it is important to follow a balanced diet. Here are some good nutrition practices that can help you maintain or improve your skin’s health.

Limit fat intake, especially saturated fats. This heart health habit helps keep the blood pumping efficiently to the skin where essential nutrients are delivered.

Eat up to ten nutrient-rich fruits and vegetables per day to provide non-fat, low calorie energy, plus essential vitamins, including the wrinkle fighting antioxidants vitamins C and E. Add fiber through whole-grain foods, starches, fruits, and vegetables to regulate the digestive system for efficient distribution of nutrients to your skin and all other organs. Avoid excessive salt to ward off hypertension and the resulting stress on the heart and circulatory system which, in turn, can diminish the blood supply to the skin. Drink the equivalent of eight glasses of water daily (juices, milk, fruit, and vegetables supply much of this amount) to cleanse away toxins, and maximize the efficiency of body functions, including skin hydration. Moderate the intake of alcohol, coffee, tea and cola to prevent an unnecessary loss of water caused by the diuretic effect of theses fluids. Adequate hydration helps prevent skin dryness, flaking and scaling.

Where can I find more Information?

For more information, contact:

National Institute of Arthritis and Musculoskeletal and Skin Diseases Clearinghouse
301.495.4484

• http://www.niams.nih.gov

National Cancer Institute
1.800.4.CANCER (1.800.422.6237)

• www.nci.nih.gov

Food and Drug Administration
1.888.463.6332

• www.fda.gov

The American Academy of Dermatology
1.888.462.3376

• www.aad.org

National Institute on Aging (NIA) Information Center
1.800.222.2225 or 1.800.222.2225(TTY).

• www.nih.gov

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