Skin

The challenge of the clinical look of the aging skin is to separate the normal changes of age. This must take into account external damage from sunlight and changes due to internal disorders.

Among common conditions that can confuse is chronic vitamin deficiency, found mainly in older persons living on their own. This may be a pellagra type of condition due to vitamin B deficiency. In this, the exposed skin, particularly of the arms, turns a dusky shade and is somewhat dry and scaly. Those prone to diet deficiency can also get scurvy due to vitamin C deficiency. Again, the skin is dry and scaly, but there are also horny spines at the openings of the hair follicles. Overall protein deficiency in the diet manifests as wasting which appears as enhanced aging.

Cachexia is the term used for progressive wasting due to an unrecognized malignancy. It is often misinterpreted as premature and undue aging. Generalized itching without apparent cause may signify an underlying malignancy. Since there are a number of other causes for this miserable affliction, skilled medical help is required for full investigation.

Dryness of the skin of older people (xerosis) can cause fissures and develop into a persistent, uncomfortable, and disabling eczema (dermatitis). A common cause is excessive showering or bathing in the winter months. Whereas younger persons can bathe daily throughout the year, this is too drying for most older skins. So-called winter eczema in the northern climates can occur. It is usually first seen on the shins, where the skin surface looks somewhat like cracked pavement. Scratch marks and pinpoint oozing are present. At that stage it can rapidly spread to the arms and over the trunk. Medical assistance is necessary.

Those who have a disposition to atopy may suddenly be troubled by extensive atopic eczema after not having had trouble for many years, or, indeed, ever. The term atopy is used for a hereditary hypersensitivity such as asthma, eczema, hay fever, or hives. Those who are subject may have had one, some, or all of these conditions earlier in their life, then experience it or them again in older age.

An altered immune response may allow the parasitic infection scabies, due to the scabies mite, to become very extensive in the skin. It is commonly called Norwegian scabies. This causes much scaling. Each scale contains numerous mites, and thus is highly infectious. If the affected person is in an institution, a very wide outbreak of the condition may result. It will cease only when the asymptomatic carrier is identified.

In all, the common complaints of older people about their skin are related to its normal anatomic and physiological changes. Pride and self-esteem depend so much on appearance that any concern of older people about their skin should be attended in a respectful and noncondescending manner.