What is normal?Suggestions for skin careCommon skin conditions
What is normal?
This period can see changes occurring in the skin of both men and women: many men will experience some degree of male pattern hair loss from the scalp, while more hair may be noticed in the nostrils and ears.
For women, skin changes are frequently seen around the time of menopause, which for most women occurs in the early 50s.
These changes result from reduced levels of female hormones (such as oestrogen), and often include skin dryness, flushing, increased wrinkling and less commonly, thickening of the skin on the palms and soles.
Additionally, some post-menopausal women may notice increased body and facial hair (hirsutism), while a proportion may also experience hair loss from the scalp.
People will often notice the development of multiple brown, warty lesions (seborrhoeic keratoses) in this age group, which are related to factors including cumulative sun exposure, ageing and genetic susceptibility. They may be unsightly but are harmless. By the age of 60, it is estimated that people will have received 73% of their lifetime sun exposure.
Suggestions for skin care
As people in this age range are at increased risk of dry skin, it may be beneficial to apply a moisturiser each day to the body after a shower. Additionally, using a soap substitute, which is less irritating than soap, may be helpful. These measures can be particularly important for post-menopausal women, who are even more prone to dry skin.
Protection from the sun is as important as ever, especially if premature ageing of the skin is to be avoided.
Common Skin Conditions
Although more obvious in the elderly, it is not uncommon to see the first signs of sun damage in this age group. These include increased wrinkling and skin discolouration. Red scaly “sunspots” (actinic keratoses) may occur on heavily sun-exposed areas such as the backs of hands or nose. These have a low risk of evolving into skin cancer, but are definitely related to sun damage.
This age group also has an increased risk of skin cancer compared to younger adults.
The term 'alopecia' refers to hair loss. While we all lose hair everyday (losing 50-100 hairs per day is considered normal), some adults will develop disorders of hair loss, such as alopecia areata, or female and male pattern hair loss (androgenetic alopecia)
If you experience sudden or significant hair loss or hair thinning, then you should see a dermatologist for a specialist medical diagnosis and advice.
Middle-aged females in particular may notice that their face appears persistently red and flushed, regardless of their activity level. This condition is known as rosacea, and is more common in fair-skinned people. It may also be associated with pimples and, less commonly, eye irritation. The skin may feel sensitive and easily irritated by cosmetics. It may be exacerbated in those experiencing post-menopausal flushing.
Seborrhoeic dermatitis may also affect adults in this age group and has a significantly different appearance to that in babies. It presents as dandruff (scaling on the scalp) but may also cause a scaly, red rash typically affecting the forehead and chest.
As we get older our skin, like the rest of our body, our skin also ages and its appearance changes.
The biggest contributor to skin ageing is sun exposure. The ultraviolet radiation of the sun interacts with our skin (particularly the dermis, the underneath layer of the skin) and causes damage. This is known as photoageing. Prevention is better than cure when it comes to the ageing of our skin, which is where sunscreen and protective hats and clothing are important. Dermatologists are able to advise on which of the thousands of skin care products available will have various effects on your skin. Some of the treatments that they might recommend include:
- topical creams and lotions
- injections to reduce lines, wrinkles and expression lines
- use of Intense pulsed light therapy (IPL) or lasers
- cosmetic surgery.
Skin cancer commonly occurs within this age group. In fact, at least 2 in 3 Australians will be diagnosed with skin cancer by the age of 70. Skin cancers will usually present as a spot, freckle or mole that is visibly different to the skin surrounding it. It is often a new spot but skin cancer can also be present in a pre-existing spot that has changed colour, size or shape.
It is important that you see a dermatologist if you have any marks or spots on your skin that are:
- changing shape
- bleeding or itching.
There are several different types of skin cancer, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. As these conditions can be life-threatening if left untreated, early detection is very important. If you notice any skin changes, see your doctor.
Basal cell carcinoma (BCC)
This is the most common form of skin cancer and is caused by exposure to the sun over many years. This condition typically presents as a sore which does not heal. Alternatively, it may be a sore that bleeds, then heals completely, but then recurs. These often occur on areas that get a lot of sun exposure, such as the head and neck, but may occur anywhere on the body. Some people who experience multiple BCCs on the body may have inherited a genetic susceptibility to develop these. BCCs may have a 'pearly' edge, and are typically slow growing.
Squamous cell carcinoma (SCC)
This is particularly associated with cumulative sun exposure. A SCC often presents as a rapidly growing skin-coloured scaly lump that is firm to touch, and typically tender. As mentioned, actinic (solar) keratoses are red, scaly spots that are common on sun exposed areas in the elderly. Although not yet cancerous, these can develop into SCCs.
While BCCs and SCCs are more commonly associated with lots of sun exposure over time, melanomas are thought to be related to genetic factors, numbers of moles and a history of sunburns. They are the most dangerous type of skin cancer and can have a number of different appearances but are often dark and irregularly coloured. Most importantly, they change relatively quickly, over weeks but sometimes even days.
Occupational Contact Dermatitis
In Australia, the majority of people in this age group are actively engaged in working. Occupational contact dermatitis commonly presents as hand dermatitis (rash on the hands). Depending on the nature of your workplace setting, occupational contact dermatitis may be due to irritant contact dermatitis or allergic contact dermatitis. While irritant contact dermatitis is most common, there are also many potential causes of allergic contact dermatitis.
Allergic contact dermatitis is a delayed hypersensitivity reaction, so people do not get itchy rashes straight away after contacting a chemical that causes allergy (allergen) - it can take hours or even a day or two. Important occupational allergens include chromate in cement and leather, hairdressing chemicals such as hair dye and bleach, and rubber chemicals in certain gloves. It is said that 4000 chemicals (of a total of 100,000) can cause allergic contact dermatitis. The most common cause of non-occupational contact dermatitis is nickel from cheap jewellery. Other important allergens include fragrances and preservatives in skin care products.
Psoriasis is another skin condition frequently seen in older adults. It is characterised by red patches with a white, scaly surface, and can sometimes resemble eczema. These patches are of varying size and often affect the scalp, although people often present with more generalised psoriasis affecting much of the body. It tends to have a symmetrical distribution (i.e. occurs on both sides of the body)
There are many different prescription treatments available, including topical treatments (creams and ointments), tablets and UV light phototherapy. The field of psoriasis has recently been completely reinvigorated by the use of a new class of treatments, the 'biologics', which can be extremely effective in severe disease.
Eczema is also a common condition in this age group, as it is for all ages. A discoid (nummular) pattern may be seen, which can either involve “dry” (crusty, cracked) or “wet” (oozing, blistering) oval-shaped patches. These can be various shades of pink, red or brown, and may be very itchy.