Managing elderly skin

Rebecca Penzer
Independent Nurse Consultant
Skin Health
Opal Skin Solutions
Aims of Presentation
To discuss the
ageing process
To explore general
care of older skin
To examine some
common skin
conditions seen in
older people
Skin Thickness
Epidermis 35-50
micrometres thick
(micrometre is one
thousandth of a
millimetre)
On palms and soles
is millimetres thick
Around the eyes 20
micrometres thick
Our skin
Is the largest organ in the human body
Weighs 2.75-4kg
Waterproof
Washable
Eliminates waste
Has incredible capacity to healgiven the right
nutrients
2,500,000 sweat glands approx
3 million cells all shredding constantly
Functions of the Skin
Barrier function
Immunological surveillance
Regulates body temperature
Sensation - nerve endings detect heat,
cold, pain, touch
Plays a role in vitamin D production
Barrier Function
Physical barrier
Stops water escaping
Keeps out pathogens and allergens
Chemical barrier
Surface of skin acidic
Melanin protects from UV
Immunological barrier
Responds to allergens
Intrinsic Ageing
Rete pegs flatten
Blood vessels and sweat glands in the
dermis decrease
Hair loses colour
Collagen and elastin decrease
Localised overproduction of melanin
In women changes are accentuated
following the menopause

Extrinsic Ageing
Epidermis thickens
Collagen and elastin increase but structure
is disorganised
A survey of 6000 women from around the world
identified which signs of aging were most relevant
across geographical and cultural boundaries. While
there were slight variations country by country, women
consistently identified seven relevant signs of aging.
1. Fine lines and wrinkles
2. Rough skin texture
3. Uneven skin tone
4. Skin dullness
5. Visible pores
6. Blotches and age spots
7. Skin dryness
www.pg.com
7 Signs of Aging
Structural Changes in Older Skin
Change in structure
Epidermal turnover
slows
Less effective
barrier function
Less flexible and
tough collagen

Less melanin

Consequence
Thinner skin

More prone to
infection/dryness
More prone to
wrinkles and
sheering
More prone to sun
damage
Structural Changes in Older Skin
Fewer sweat glands

Less sebum
production
Less effective
temperature control
Increased skin
dryness
Compromised Barrier Function
External protection becomes less and less
effective with age
Dry skin becomes more of a problem
Skin becomes more sensitive to irritants
To Promote Skin Health
Use emollient therapy
Soap substitute
Bath oil
Topical moisturiser
Gently dry skin after washing then apply
moisturiser
How should we apply a
moisturiser?
General Tips For Applying
Emollients
Apply an emollient whilst the skin is warm
after bathing
For an all over application apply around 25g
stroke the emollient onto the skin following
the line of the hair
Apply at least twice daily and more if
possible/necessary
Use an emollient that the patient likes, have
two or three options suitable for different
times of the day

Keep Skin Preparations Bland
Avoid perfume
Avoid soap
Preferably use ointment rather than cream
especially if the skin is sensitive
Ointment is an oil based product
Cream is a mixture of water in oil (i.e. more oil
than water)
Lotion is a mixture of oil in water (i.e. more
water than oil)
Irritant Contact Dermatitis Caused
by Incontinence
Remove the irritant i.e. faeces and urine
Ensure good practice frequent pad changes,
correct pad sizes and toileting
Minimise other potential irritants
Keep any product going on the skin as mild as
possible
Treat fungal/bacterial rash appropriately
Use emollients/barrier if appropriate
Intertrigo
Occurs in moist skin folds
Infected Skin
Promote good skin care including hygiene,
drying flexures and emollients
Promptly treat rash with appropriate anti-
fungal or anti-bacterial (in combination
with topical steroid as appropriate)
Fungal Infection
Venous dermatitis
Treatments
Total emollient therapy
Topical steroid ointment
Compression bandaging if appropriate
Dressing wounds
Discoid Eczema
Treatment
Total emollient therapy
Topical steroids
Plaque Psoriasis
Treatment
Total emollient therapy
Tar based products (e.g. Exorex or
Polytar)
Vitamin D analogues (e.g. Dovonex or
Curatoderm)

Flexural Psoriasis
Treatment
Topical steroids
Bullous Pemphigoid
Chronic autoimmune disease
Cause unknown
Bullaeflexural areas, abdomen, lower
legs, feet.
Bullous pemphigus
Autoimmune disease
Antibodies attack proteins which keep
cells bound together
Age 40-60 years
Affects mouth, lips, oesophagus, skin
Bullae then sores
Bullous Pemphigoid
Bullous Pemphigoid
Treatment
High dose topical steroids
Lancing and dressing blisters
Bland emollient (e.g. 50/50 white soft
paraffin/liquid paraffin)
Possibly oral immunosuppression
including steroids
Quality of Life
All these conditions can have significant
impact on QOL
Not necessarily related to disease severity
Work with patients to enhance
concordance
Allow them to chose which emollients suit
them best
Skin cancers
Actinic Keratosis
Squamous cell carcinoma
Prevalence varies countries, races
Cumulative lifetime sunlight exposure
Complicated long standing skin conditions
chronic venous ulcers
Clinical features
Irregular warty lesion
Nodule
Thickened area
Bleeding lesion/area
Expansive

Basal cell carcinoma
(Rodent ulcer)
Common
Prevalence age, sunlight exposure
Arise in or adjacent to chronic ulcers

Clinical features
Expanding translucent nodule
Ulcerated lesion
Pearly edge not complete
Crusted
Malignant melanoma
Arises from melanocytes
Incidence increasing
Sun exposure, burning episodes, but can
occur on none sun exposed sites


Malignant melanoma
Usually pigmented
Atypical moles
Changing mole
Ulcerated lesion
What To Look For
Asymmetry
Borders are irregular
Colour is uneven
Diameter
In conclusion
Ageing skin requires extra care
Careful observation is key