Skin as We Age: What is Normal and Abnormal?

There are two things that happen to skin as we age. One is the normal changes that aging produces called “chronological aging” (just as other organs in our body are altered by age) and the other is the result of exposure to the sun called “photoaging.” Both fall into normal processing since, as we get older, we accumulate more sun exposure as we experience more time on earth.

Normal Skin Changes of Age

Age causes our skin to become thinner, drier, less resilient, less efficient in heat exchange, and discolored. Wrinkles are a result of the change in the matrix of the collagen in the skin and are a normal response to both chronological and photoaging. The skin keeps its barrier protection intact, but when injured with a cut or bruise does not heal as quickly. Photoaging tends to produce similar changes to the skin as chronological aging, but if one has more sun exposure then the normal aging of the skin is accelerated – meaning the more sun exposure the more advanced the skin aging process. Both are cumulative processes so the longer we live and the more we are in the sun, the more age-related changes we can expect in our skin.

The color changes along with the formation of wrinkles are the most prominent and observable changes to the skin. The varieties of mottled pigmentation from age and sun exposure include actinic lentigines or “age spots” and the skin condition called seborrheic keratosis. The actinic lentigines are harmless and do not become cancerous. The lesions of seborrheic keratosis are not harbingers of cancer but are sometimes difficult to distinguish from skin cancers.

Because of skin changes that occur with aging, the older we are the less we are able to perspire through the skin. This diminution of our ability to cool off in hot weather as efficiently as when we were young renders us more vulnerable to heat effects. This is why the older we are the more careful we must be in conditions of high heat and humidity.

Man's arm that has been exposed to sun much of his life 
Right arm of 76 y.o. male exposed to sun much of his life. Note wrinkles and thin, dry appearance of skin with several "age spots".

Skin Cancer and Its Prevention – The Latest Information

Skin cancer is diagnosed in almost 9,500  people in the U.S. every day - making it easily the most common form of cancer. There are two types of skin cancer because the cancers derive from either melanocytes or epidermal cells.The non-melanoma cancers represent 95% of skin cancers, but it is melanoma that is considered the more invasive and fatal type.Each year in the U.S. nearly 200,000 new cases of melanoma are detected, half of them of the invasive variety. Excision of the entire cancer can be done in many cases but in advanced disease, hypnotherapy and targeted drug therapy are used. Radiation can also be used.

The predominant types of epidermal cell cancers are basal cell and squamous cell. Basal cell is the more common of these two cancers. The usual treatment for non-melanoma cancer is simple excision or Mohs microsurgery (where repeated excisions are done until microscopic examination shows a clear, safe margin.) The American Academy of Dermatology (AAD) reports that three million Americans have non-melanoma cancers and that women and older people are experiencing a higher incidence than men and younger Americans.Melanoma affects more women earlier in life than men but by age 80 the incidence of melanoma in men is three times higher than in women.

Prevention

The cause of the majority of cancers is the environment and what is meant by the environment is exposure to ultraviolet (UV) radiation – from the sun or tanning booths. Since it has been established that the root cause of skin cancer, both melanoma and non-melanoma types, is exposure to ultraviolet light, then the prevention strategy is to avoid exposure to it.

Limiting exposure to UV light is not that straight-forward. The data seem to show that the most important time when limited exposure is most helpful in preventing skin cancer later in life is up to adolescence. If you experienced five or more blistering sunburns between ages 15 and 20, your risk of non-melanoma cancer is increased 68% and of melanoma 80%! Unfortunately, it is a well known scientific fact that we cannot relive our first 20 years.Thu s those of us in our older years can only remind all parents of young children to keep them covered and lathered up with sunscreen.

Specific Recommendations

There is good scientific evidence that, as we age, we should be mindful of exposure to the sun and do everything possible to avoid the root cause of skin cancer – namely, prevent unnecessary exposure to UV light. There are three major strategies to achieve this goal: 1) avoid sun between 10 a.m. and 2 p.m.; 2) cover the body with long pants, long sleeves, and hat when out in the sun at all times; and 3) use sunscreen equal to or greater than 30 SPF.

Understandably, it may be impossible – even undesirable – never to be out in the sun during the peak sun hours mentioned above. After all, exercise during that time often requires sun exposure and exercise has enormous health benefits that could trump the UV exposure. Nevertheless, it is best to plan as much as possible to limit time out in the sun between 10 a.m. and 2 p.m.

If one is going to be out at any time remember to stay in the shade if possible and the more covered one is with protective clothing the better. Also remember that sand, water, and even snow are highly reflective and any skin not covered in these settings is being exposed to the reflected UV rays as well as those from above. Be mindful of this when sitting under an umbrella on the beach. Likewise, UV light penetrates clouds and thus UV exposure and sun damage are occurring even on a cloudy day.

Finally, the last line of protection and actually the least effective is the use of sunscreen.

Sunscreen

All sunscreens are not alike and the most important thing for you to decide is which one you like and will use as directed. The Sun Protection Factor (SPF) number on sunscreen is a measure of how much UVB protection the chemical produces. All the SPF number really means is that the higher the number the more protection, but the thing to really pay attention to is in the sunscreen label. The better sunscreen products will state in the Directions portion of the label when the sunscreen should be reapplied. Reapplication of sunscreen should be as recommended by the manufacturer, and always after swimming or significant perspiration as when playing a sport.

Broad spectrum sunscreens will afford more protection against UV. It is best to use a broad spectrum sunscreen to protect the skin from wrinkling and developing aging spots.

Water resistant means that the sunscreen is protective up to 40 minutes while swimming or sweating. Very water resistant means the protection lasts up to 80 minutes. These descriptions will be on the label of the sunscreen.

The sunscreens use chemicals to cause the protection. There are two classes of chemical protection, organic and inorganic. The organic compounds absorb the UV light and actually create slight heat in doing so. Inorganic compounds use elements like titanium or zinc to reflect the UV light and these tend to be less irritating to the skin.

Finally, sunscreens come as creams, lotions, and sprays.Many burn when in the eye. There is no best form of application or type of preparation. What counts most is that all areas of the exposed skin are covered no matter with what the form of protection. Ears and hands are sometimes shortchanged when sunscreens are applied. It is crucially important that all exposed skin - no matter where - be evenly and well covered when the sunscreen is applied 10 to 15 minutes before going out into the sun.

The Bottom Line

Like the rest of our body, skin will change as we age. Exposure to UV light of the sun hastens normal skin changes and causes cancer.It is up to each of us to protect ourselves from the harmful effects of the sun’s UV light when outdoors. Protect the vulnerable skin by seeking shade, covering skin with clothing, and using a broad spectrum sunscreen that is equal to or greater than 30 SPF as directed on the label. This ounce of protection will avoid a pound of cure at the dermatologic surgeon’s office.