Population Ageing Skin Prevention Smoking Common Issues
It’s always important to get your skin checked for any irregularities. As we get older our skin, like the rest of our body, goes through a series of changes.
There is variety of factors that contribute to the level and speed our skin will age. These include:
- skin type - whether we have fair or dark skin
- sun exposure - particularly where we have lived most of our life and how much UV damage we have experienced
- outdoor work or hobbies
- genetic background
- lifestyle, particularly smoking
- nutrition and general health.
Skin changes as we age, due to a number of reasons:
- Intrinsic ageing: the inevitable changes caused by the passing of time as we age.
- Photoageing: caused by the effects of the sun over time, 90% of visible signs of ageing in Australians is caused by chronic sun exposure.
- Influences: the nature of our lifestyle, smoking and genetic characteristics also play a part in these changes.
An Ageing Population
The median age of the Australian population has increased by four years over the last two decades, from 33.4 years in 1994 to 37.3 years in 2014.
Between now and 2050 the number of older people (65 to 84) is expected to more than double and the number of very old people (85 and older) is expected to more than quadruple.
The proportion of people aged 65 years or over is also projected to increase from 13% in 2010 to 23% by 2050.
This population ageing is projected to have several implications for Australia*.
Skin healthcare is one crucial area that will have to evolve to the demands of our ageing population.
What happens to my skin as I get older?
We all know that as we grow older wrinkles and other signs of aging begin to appear on our skin. Did you know your skin has many functions and they decline with age? Skin ageing is not just about the skin’s changing appearance on the outside.
Some of the functions of your skin that decline with age include:
- barrier function
- cell replacement
- DNA repair
- epidermal hydration
- immune responsiveness
- mechanical protection
- sebum production
- sensory perception
- sweat production
- vitamin D production
- wound healing
The biggest contributor to skin ageing is sun exposure. The ultraviolet radiation of the sun interacts with our skin (particularly the dermis, the underneath layer of the skin) and causes damage. This is known as photoageing.
Photoageing is often evident on our hands, the part of our body most often exposed to sunlight without protection.
Looking at the skin on the inside of the upper arm shows us what our skin would be like if we were not exposed to the sun.
During photoageing our skin layers are affected differently by different wavelengths of UV light.
The upper layer (epidermis)
During photoageing the epidermis thins, pales and becomes more translucent due to short wavelength UV radiation (UVB). Changes in the epidermis lead to the development of both pre-cancerous and cancerous skin lesions.
The underneath layer (dermis)
The dermis is particularly susceptible to damage from longer wavelength UV radiation (UVA) which damages the support structures of the skin, particularly collagen and elastin. In addition blood vessels are damaged causing easy bruising.
Wrinkles and sun spots are the two types of photoageing we are most familiar with, and spend a lot of money trying to avoid, but there are many different signs of photoageing that appear on our skin as we get older. These include:
- dryness (roughness) – roughness caused by a lack of moisture in the skin
- actinic keratosis - a rough, scaly patch on your skin that develops from years of exposure to the sun. Actinic keratosis is most commonly found on your face, lips, and ears, back of your hands, forearms, scalp or neck.
- irregular pigmnentation - freckling, lentigines (small brown patches of skin)
- wrinkling - fine surface lines, deep furrows
- elastosis - a condition in which skin appears yellow and thickened as a result of sun damage.
- telangiectasia - a condition in which there are visible small linear red blood vessels (broken capillaries)
- venous lake - a small blood vessel (vein) in the skin, which over time has become enlarged
- purpura - reddish-purple spots, which look like bruises, caused by blood vessels bursting and blood pooling under the skin
- inelasticity - skin elasticity is the skin’s ability to stretch and then go back to normal once the need to stretch is gone. Reduced skin elasticity is a fact of ageing for most people.
Many of these signs of aging will occur in all of us over time but you can slow them down by protecting your skin from the sun.
Learn more about sunscreen
Prevention is better than cure when it comes to the ageing of our skin.
How can I prevent skin ageing?
It’s the billion dollar question. The truth is, we cannot completely prevent signs of age from appearing on our skin. Fortunately, there are a few steps we can take to prevent premature skin ageing.
- Always apply sunscreen when the UV Index is above 3. In order to be effective, sunscreen must be broad-spectrum (protect against both UVA and UVB) and must be reapplied every two to four hours. Broad-spectrum sunscreens are better at protecting against DNA damage and photocarcinogenesis, and in delaying skin cancer development compared with non-broad-spectrum sunscreens. You should use a sunscreen that is SPF 50+.
- Avoid or minimise your time in the sun - between 10am-3pm from September to April when the UV levels are generally high. Please note: If you live in northern Australia (QLD, NT and WA) you should avoid exposure to the sun between 10am-3pm throughout the entire year.
- Wear a protective broad-brimmed or legionnaire-style hat, shirt made from high UPF material with a collar and long sleeves, and long pants or skirt.
- Seek shade when outdoors when the UV Index is above 3.
- Do not start smoking or, if you do smoke, try to give it up.
Prevention of skin ageing
- Primary means and routine skin care for prevention of photoageing should include sunscreen and physical protection such as hat and clothing.
- Minimise your time in the sun between 10 and 2 (or 11 and 3 in daylight savings). Ultraviolet light is strongest during these times.
- Sunscreen should be broad spectrum providing both UVB and UVA protection, as shown on the packaging label.
- Broad-spectrum sunscreens are better at protecting against damage to the skin, and in delaying skin cancer development compared with non-broad-spectrum sunscreens.
- Not smoking or quitting now will help you age more gracefully.
- Seek shade when outdoors in strong sunlight.
Sunscreen & UV Index
When should sunscreen be worn?
- People are advised to protect their skin when the UV index is 3 or more.
- In Melbourne, the UV index usually hits 3, on or about September 1, between 12 and 1pm.
- The duration that the UV index is 3 or more is called the "UV Alert". This is the time that you need to protect your skin.
- Many people do not realise that the UV intensity is related to the date, not the temperature.
- Theoretically, the UV Index is highest when the sun is closest to us, that is at the time of the summer solstice, on December 21.
- In southern Australia, many people get sunburnt in springtime, when the weather is cool, but UV levels are moderately high.
- It is important to understand the UV alert. There is an iPhone app available free from Sunsmart.
Smoking and skin ageing
Like sun exposure, smoking cigarettes is another preventable cause of skin ageing.
- Cigarette smoking makes photoageing worse, particularly in women.
- There is a direct relationship between the number of pack-years smoked and the severity of wrinkling, greyish discoloration, acne-like changes (comedones), and drooping of the face.
- Smokers display poor wound healing capacity and have an increased risk of skin cancers
Learn more about the impact of smoking
Common Skin Issues in Old Age
Aged skin is vulnerable to developing many different skin problems. Of particular concern is skin cancer, with the elderly being at increased risk, resulting from cumulative sun exposure from a lifetime in the sun.
In addition, other factors may also contribute to this increased risk such as decreased DNA repair capacity of aged skin, as well as a degree of immunosuppression also related to sun exposure.
There are several different types of skin cancer, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. As these conditions can be life-threatening if left untreated, early detection is very important. If you notice any skin changes, see your doctor.