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 heal…given 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
 7 Signs of Aging
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
Structural Changes in Older Skin
Change in structure Consequence
• Epidermal turnover • Thinner skin
slows
• Less effective • More prone to
barrier function infection/dryness
• Less flexible and • More prone to
tough collagen wrinkles and
sheering
• Less melanin • More prone to sun
damage
 Structural Changes in Older Skin
• Fewer sweat glands • Less effective
temperature control
• Less sebum • Increased skin
production 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
• Bullae…flexural 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