There are two contributing factors when we talk about ageing skin.
- Intrinsic ageing – this is genetically determined meaning it’s what happens as we naturally age. We don’t have control over this.
- Extrinsic ageing – this type of ageing is due to internal and external influences such as UV exposure, air pollution, stress, smoking, sleep and medication. The good news is that we do have control over this.
In a nutshell, the ageing process of the skin is genetically determined but is largely influenced by environmental factors so we in fact can play a big role in how well our skin ages. For most of us only about 10-15% of our ageing is influenced by genetics which means that 85-90% is extrinsic ageing and controllable. Lifestyle choices greatly affect not only the appearance of the skin but the function of it as well as these factors can lead to the skin weakening which can lead to skin tears, potential difficulties in wound healing and then possible lengthy stays in hospital.
What we must keep in mind is the skin ageing process does not begin from the age of 70 but in fact the protective skin qualities begin to decline much earlier…as early as 50 years old!
What does this mean? Preventive skin care intervention must be introduced at an earlier age to not only enhance the protective qualities of the skin but also maintain its integrity along with protecting our skin from the extrinsic factors such as UV exposure.
There is a greater awareness of how the health care system is being impacted due to our ageing population and this in turn has increased the degree of research into understanding how not only ageing can affect the skin but the changes that can be expected to be seen.
This research has led to the coining of a new term – Dermatoporosis.
This is described as a loss of function that ultimately leads to a breakdown in the protective mechanisms of the skin. As individuals age, skin cells are also biologically ageing.
There are a number of age-related skin changes of which l will highlight a couple. We see an increase in moisture loss and susceptibility to microbial invasion due to a breakdown in barrier function. This increase in moisture loss can make the skin appear flaky, rough, dry and dehydrated. Collagen and elastin fibres are reduced decreasing skin strength and potentially slower wound remodelling.
Furthermore, the sensation of touch is decreasing, which reduces or alters sensation leading to an increased risk of pressure damage. I have only touched on some of the changes that take place and much of this is natural ageing however as mentioned earlier, extrinsic factors can also influence and perhaps make matters worse.
Image: Dermatoporosis with multiple lesions, old & recent (lesions begin to form as a result of skin breakdown and due to poor wound healing, new lesions form before old lesions have had a chance to heal completely)
So as we age the skin changes but what does this mean if the skin is injured?
When one is injured, the wound healing process kicks in. This is a physiological process whereby an elaborate sequence of events occurs with the aim to end with a successful closure and bring back function to the tissues that were damaged.
The typical stages of wound healing are inflammation, proliferation and maturation/remodelling. These stages do not follow a specific timeline of days as the stages do overlap but these stages ideally are a progression of wound healing in a normal, orderly and co-ordinated sequence of events.
However, for this to happen effectively, there needs to be a sufficient supply of oxygen, nutrients, hormones and the necessary cells required for this process. The wound healing process can be delayed significantly due to many factors that are either intrinsic or extrinsic factors.
FACTORS AFFECTING HEALING
- Intrinsic Factors such as an individual’s health status. The general health & wellbeing of a person can influence their ability to heal normally. The nutritional status is also important and in fact malnutrition is common amongst the elderly population. For example, a diet low in protein can lead to the epidermis thinning, reduce epidermal cell proliferation and decrease skin hydration.
- Extrinsic Factors include lifestyle choices such as smoking can decrease skin strength due to impaired connective tissue remodelling and also slow down the regeneration of the epidermis. Mechanical stress such as scratching one’s skin due to the skin being dry and itchy or friction against bedsheets can create wounds. The simple removal of a wound dressing can affect the integrity of the epidermis and lead to trans-epidermal water loss.
And of course, Skin Health. A common feature in older skins is dry skin. When there is a loss of water from the epidermis, the skin is more likely to crack and lead to itching and bleeding. When skin is excessively dry it can often become scaly or cracked, frequently seen on the legs of older people.
Potentially, all wounds if not managed, can become chronic wounds. An example is a skin tear which can be caused by mechanical stress. A skin tear is an acute wound that has a high probability of becoming a chronic wound if not managed properly.
Image: Skin Tear
Image: Chronic Wound
With all this be seeing said, in Part 3 of Ageing Skin: The Changes, Challenges & Management we will discuss Why Skin Care Matters…
This blog post is written by Dora Erdossy, Dermal Educator & Dermal Clinician. With over 25 years’ experience in the Skin Care Industry, Dora Erdossy has worked as a Dermal Clinician and Educator for some of the industry’s largest brands across Australia, USA and Europe. Dora’s passion for education saw her become an educator for dermalogica and The International Dermal Institute in 2001 where she taught in Australia, Vietnam, Fiji and New Zealand. In 2005, Dora moved to the United States where for the next 3 years, she championed the role of Senior Educator at dermalogica’s Los Angeles HQ.⠀