16 July 2012

Ageing of the skin

Ageing is an inevitable part of life. According to the law of nature, everybody will age, but some quicker than others.


Ageing is a continuous dynamic chronological process. A person starts ageing from the time that he pops out of the womb. The baby’s age is recorded in days, then months, then years and in no time by the number of decades. Later in life, age is celebrated by various precious medal jubilees.  Ageing is an inevitable part of life. According to the law of nature, everybody will age, but some quicker than others.  The movie “The curious case of Benjamin Button” is partially correct, as conditions exist where one can age very quickly, however the reverse part is not possible. The condition that can make a ten year old child look like a sixty year old with very rapid ageing is called Progeria.

A person will age naturally as determined by his genes. Every time the cells in our skin replicates, certain DNA chromosomes become slightly shorter and this leads to us becoming older. However, there are many external factors that add to this process, making our skin look like that of a geriatric at a faster pace. These extrinsic factors include, UV radiation, temperature variation (global warming), wind, humidity, chemical pollutants and irritants, poor nutrition,physical and mental stress, excessive use of untested abrasive compounds on the face and poor social habits like smoking. Factors such as smoking are important both from the view of premature ageing, as well as its therapy.

The older skin is characterised by the following: dryness, loss of elasticity, deeper expression lines, wrinkles, irregular pigmentation as well as decreased healing from bruises.  Associated with old age, there is a list of other unwelcomed skin disorders that are listed in the table.


Pruritus and asteototic eczema

Itching due the dryness and very dry skin on the anterior lower leg

Emollients, Steroid creams and oral antihistamines


Dark and pale spots- colour of skin is not uniform

Sunscreens, hydroquinone, retinoids, skin peels

                         Idiopathic guttate hypomelanosis

Small whitish dots on anterior leg or arms

Better left untreated

Acrochordons, dermatosis papulosa nigra

Small hanging fleshy things, that commonly appear on the neck, axillae or areas of friction

Can be treated by cautery, laser or cryotherapy

Seborrhoeic keratoses

Warty, greasy growths on the face, arms and trunk

Can be left untreated, laser, cautery, shave excision

Cherry angiomas

Small cherry-coloured spots, mainly on the trunk

Can be left untreated, cauterised or lasered

Sebaceous hyperplasia

Pimples on the face, that stay unchanged with time

Retinoids, cautery, laser and dermabrasion. Can also be excised

Cutaneous pre-malignancies and malignancies

Can look warty, dark, ulcerated and can be painful

Needs to be treated appropriately by Dermatologist

Senile purpuras

Bleeding under the skin, looking like big bruises, mainly on the arms. There is on a background of sun-damage

Vitamin K creams

Solar lentigines

Brown patches on sun exposed areas

Skin peels, cryotherapy and medical therapy



For most people, wrinkles are the earliest and cosmetically most undesirable problem, which at times can be used as an indicator that one should start planning their pension policy in readiness for retirement.  These wrinkles can appear in stages, getting deeper with time. Glyphic wrinkles are only accentuated normal skin creases, which are normal in young individuals with increased sun exposure. Thereafter linear furrows start appearing as long grooves, which are straight or curvy on the forehead. One can also encounter wrinkles that radiate as crow’s feet from the lateral side of the eyes.  They can also extend as creases from the nose to the corner of the mouth.  Finally, crinkles are very fine criss-cross wrinkles that occur even in the sun-protected areas of most elderly persons. Wrinkles are also classified as being static, when they follow facial expressions. They are regarded as dynamic, when they follow ageing and physical tension.

When a patient presents to a dermatologist, he can be classified on the basis of examination of wrinkles.  The table below gives a brief summary:


Type I

Age between 18-30

Early sun damage

Very  little pigment changes

No keratoses

No wrinkles

Type II

Patient in forth decade

Moderate sun damage can be noted

Keratoses can be felt as rough spots

Crow’s feet and parallel smile lines visible

Wrinkles in motion

Type III

Age 50 or older

Significant amount of sun damage

Obvious changes of thickness of the skin, with visible capillaries and mottled pigmentation

Sebaceous hyperplasia

Wrinkles at rest

Type IV

Above 60 yrs olds

Severe sun damage

Yellow-grey skin

Prior skin malignancies

Deep wrinkles


Although several treatments are available for skin rejuvenation, prevention where possible is still the most important factor.  The rejuvenation programme consists of the use of the following modalities alone or in combination. The choice of therapies to be instituted depends on the age of the patient, skin conditions, skill of the skin specialist, financial consideration and most importantly the expectation and desire of the patient.

  1. Prevention by protecting oneself from the sun. The use of sunscreens, hats, umbrellas and long sleeved shirts, tend to help. The choice of sunscreen is very important and should contain both SPF for UVB and UVA. Unlike what beauticians have been advising patients, a high SPF is better. Beauticians trying to sell sunscreens with low SPF at exorbitant prices have been spreading wrongful myths that high SPFs are detrimental to your skin.   Good habits that help the skin are: Adequate sleep and fluid intake and no smoking. A reduction in alcohol consumption will also help.
  2. Proper nutrition with balanced diet, including all vitamins and antioxidants. Exercise increases blood flow and nutrition to the skin.
  3. Daily skin care: The use of gentle soaps and proper moisturising of the dull lustreless skin will help in giving the skin a healthy look.
  4. Cosmeceuticals: Alpha hydroxyl acids, retinoids and vitamin C. Retinoids prevent collagen breakdown and improve sun damaged epidermal atrophy, dysplasia, keratosis and dyspigmentation.  Thus it helps reverse sun damage. Vitamin C helps in pigmentary problems, as well as helps in the synthesis of collagen.
  5. Non surgical therapy: Massage, facial masks, sonar, Iontophoresis, micro-current stimulation.
  6. Surgical therapy: Various chemical peels, dermabrasion, lasers, Botulinum toxin, fillers and surgical face lifts. There are many other surgical procedures, all with their pros and cons and the outcome of these procedures depend greatly on patient selection and the expertise of the specialist.

All these modalities can be combined and used to improve the appearance of the person.


In conclusion: One cannot prevent the aging process, however, one should try to age gracefully. Habits can play a big role and a Dermatologist or a Plastic surgeon can make a huge difference. Many simple procedures are available and should be chosen carefully.  Whilst there are many treatment modalities offered by beauticians, procedure like colonic lavage, do not erase years from the skin.



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