Intrinsic ageing of the skin

The changes in aged, sun-protected skin are more subtle than those of photoageing (p. 107) and consist of laxity, fine wrinkling and benign neoplasms. In addition, androgenetic alopecia (p. 66) and greying of the hair are age related.

Histologically, the epidermis is thinned with the loss of the rete ridge pattern and a reduction in the numbers of melanocytes and Langerhans cells. Individual epidermal cells are smaller. The dermis is thinned due, mainly, to loss of proteoglycans. Functionally, the skin is less elastic and has a reduced tensile strength. Resistance to injury, irritants and infection is reduced, and wound healing is slower.

Some inherited disorders, e.g. pseudoxanthoma elasticum (p. 93), show features of aged skin. The misuse of potent topical steroids induces atrophy and purpura (p. 114), signs also seen in old skin.

Dermatoses in the elderly

Few skin conditions are exclusive to old age, but some are seen more frequently (Table 1).

Table 1 Skin disorders common in the elderly