Aging and damaged skin
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Take a careful history and assess patients with skin changes due to aging, ultraviolet exposure or therapeutic radiation for risk of loss of skin integrity and/or barrier function. | Level of Evidence Not Assessed |
| 2 | Monitor precancerous skin changes regularly to allow early diagnosis and treatment of skin cancer. | Level of Evidence Not Assessed |
| Address Patient-centered Concerns | ||
|---|---|---|
| 3 | Provide information and advice on prevention and treatment options. | Level of Evidence Not Assessed |
| Provide Local Care | ||
|---|---|---|
| 4 | Develop and implement an individualized treatment plan in patients with skin trauma, infection or radiation effects to promote healing. | Level of Evidence Not Assessed |
| 5 | Develop and implement an individualized care plan to maintain skin integrity in patients with compromised skin. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 6 | Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information. | Level of Evidence Not Assessed |
Background
Age alters skin integrity. The epidermis, dermis and subcutaneous layers gradually thin, and elastin, collagen, and subcutaneous fat decrease. These changes make the skin more susceptible to mechanical trauma, moisture loss, and infection. Physiologic functions, such as injury response, healing, thermoregulaion, barrier function, immune function, sensory perception, and vascular responsiveness are also affected. Among elderly patients, environmental and physical factors can affect skin integrity, especially if the skin is dry, frail, or overhydrated, or if the individual’s health is compromised.Significant exposure to ultraviolet light, due to many years of sun exposure, causes numerous skin changes:
• Premature aging of the skin
• Thinning of the skin with fine wrinkles and skin tears
• Blood vessel changes resulting in easy bruising, especially on the arms, and
• Telangiectasia become more prominent, especially on the face
• Skin pigment changes, including solar lentigos
• Pigmented nevi, commonly called moles
• Precancerous red, scaly lesions, especially on the face, ears and the back of the hands (actinic keratoses), or on the lip (actinic cheilitis).
Exposure to therapeutic radiation produces localized skin damage. The effects of radiation therapy depend on the area and tissue volume treated, the type of radiation and the schedule, the total dose administered, individual skin characteristics, age, health status, and comorbid conditions. Skin folds, skin over bony prominences, facial skin, and surgical wounds tend to be more sensitive.
Effects of radiation may be seen during treatment or may not occur until months or years later. The earliest change is usually erythema, which may occur after a few weeks of treatment, followed by pruritus and moist or dry desquamation. Moisturizing lotion may be useful for pruritus associated with dry desquamation. Zinc oxide, hydrocolloid, or wet astringent dressings may help to manage moist desquamation. These areas usually heal within a few weeks of completion of radiotherapy. Irradiated areas may remain more sensitive to temperature, more susceptible to sunburn, and dryer than non-irradiated skin. Delayed radiation effects include skin atrophy; altered pigmentation; loss of hair, sweat glands and sebaceous glands; increased fragility and decreased capacity for repair; ulceration and necrosis; lymphedema due to lymphatic fibrosis; and increased risk of non-melanoma skin cancer.
Maintenance of skin integrity in individuals with fragile and/or damaged skin relies on avoidance of adhesives, harsh soaps, perfumes, powders, and deodorants; prevention of trauma from friction, such as rubbing the skin dry, shaving, and wearing tight clothing; protection from temperature changes and sun exposure; and maintenance of appropriate levels of hydration.
References
| Essential Publications |
|---|
| 1 | Skin Integrity |
Quality Indicator
|
Type: Narrative Review |
| Sibbald RG, Campbell K, Coutts P, Queen D. Intact Skin – An Integrity not to be lost. Ostomy Wound Continence 2003;49(6):27-41 | |||
| This comprehensive article outlines the skin integrity issues and suggests products that might be used for prevention and treatment. | |||
| 2 | Photo-Aging |
Quality Indicator
|
Type: Case-control study (2 groups) |
| Lee JH, Roh MR, Lee KH. Effects of infrared radiation on skin photo-aging and pigmentation. Yonsei Med J. 2006 Aug 31;47(4):485-90. | |||
| This publication is useful because it demonstrates that infrared radiation is beneficial in the treatment of photo-aged skin. This suggests that it can be safely and effectively used in clinical practice as a potential treatment strategy, | |||
| 3 | Actinic Keratosis |
Quality Indicator
|
Type: Narrative Review |
| Schwartz RA Bridges TM Butani AK Ehrlich A. Actinic keratosis: an occupational and environmental disorder. [Review] [79 refs] [Journal Article. Review] Journal of the European Academy of Dermatology & Venereology. 22(5):606-15, 2008 May. | |||
| This publication is relevant because it provides a summary on all of the necessary information relating to actinic keratosis, including history, prevalence, detection methods and treatment strategies, It is useful to clinicians or researchers attempting to obtain information on actinic keratosis from one source. | |||