Elderly Skin Care

8/12/2019 Elderly Skin Care

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Managing elderly skin

Rebecca Penzer

Independent Nurse Consultant

Skin HealthOpal Skin Solutions


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Aims of Presentation

To discuss theageing process

To explore general

care of older skin To examine some

common skin

conditions seen inolder people


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Skin Thickness

Epidermis 35-50micrometres thick

(micrometre is one

thousandth of amillimetre)

On palms and soles

is millimetres thick

Around the eyes 20

micrometres thick


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Our skin

Is the largest organ in the human body

Weighs 2.75-4kg

Waterproof

Washable Eliminates waste

Has incredible capacity to healgiven the rightnutrients

2,500,000 sweat glands approx

3 million cells all shredding constantly


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Functions of the Skin

Barrier function

Immunological surveillance

Regulates body temperature Sensation - nerve endings detect heat,

cold, pain, touch

Plays a role in vitamin D production


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Barrier Function

Physical barrier

Stops water escaping

Keeps out pathogens and allergens

Chemical barrier

Surface of skin acidic

Melanin protects from UV

Immunological barrier

Responds to allergens


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Intrinsic Ageing

Rete pegs flatten

Blood vessels and sweat glands in the

dermis decrease

Hair loses colour

Collagen and elastin decrease

Localised overproduction of melaninIn women changes are accentuated

fol low ing the menopause


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Extrinsic Ageing

Epidermis thickens

Collagen and elastin increase but structure

is disorganised


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A survey of 6000 women from around the worldidentified which signs of aging were most relevant

across geographical and cultural boundaries. While

there were slight variations country by country, women

consistently identified seven relevant signs of aging.1. Fine lines and wrinkles

2. Rough skin texture

3. Uneven skin tone

4. Skin dullness5. Visible pores

6. Blotches and age spots

7. Skin dryness

www.pg.com

7 Signs of Aging


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Structural Changes in Older Skin

Change in structure

Epidermal turnover

slows

Less effectivebarrier function

Less flexible and

tough collagen

Less melanin

Consequence

Thinner skin

More prone toinfection/dryness

More prone to

wrinkles and

sheering

More prone to sun

damage


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Structural Changes in Older Skin

Fewer sweat glands

Less sebum

production

Less effective

temperature control

Increased skin

dryness


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Compromised Barrier Function

External protection becomes less and less

effective with age

Dry skin becomes more of a problem

Skin becomes more sensitive to irritants


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To Promote Skin Health

Use emollient therapy

Soap substitute

Bath oil

Topical moisturiser

Gently dry skin after washing then apply

moisturiser


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How should we apply a

moisturiser?


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General Tips For ApplyingEmollients

Apply an emollient whilst the skin is warm

after bathing

For an all over application apply around 25g

stroke the emollient onto the skin followingthe line of the hair

Apply at least twice daily and more if

possible/necessaryUse an emollient that the patient likes, have

two or three options suitable for different

times of the day


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Keep Skin Preparations Bland

Avoid perfume

Avoid soap

Preferably use ointment rather than creamespecially if the skin is sensitive Ointment is an oil based product

Cream is a mixture of water in oil (i.e. more oil

than water) Lotion is a mixture of oil in water (i.e. more

water than oil)


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Irritant Contact Dermatitis Caused

by Incontinence Remove the irritant i.e. faeces and urine

Ensure good practice frequent pad changes,

correct pad sizes and toileting

Minimise other potential irritants

Keep any product going on the skin as mild as

possible Treat fungal/bacterial rash appropriately

Use emollients/barrier if appropriate


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Intertrigo

Occurs in moist skin folds


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Infected Skin

Promote good skin care including hygiene,

drying flexures and emollients

Promptly treat rash with appropriate anti-

fungal or anti-bacterial (in combination

with topical steroid as appropriate)


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Fungal Infection


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Venous dermatitis


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Treatments

Total emollient therapy

Topical steroid ointment

Compression bandaging if appropriate Dressing wounds


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Discoid Eczema


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Treatment


Topical steroids


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Plaque Psoriasis


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Treatment


Tar based products (e.g. Exorex or

Polytar)

Vitamin D analogues (e.g. Dovonex or

Curatoderm)


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Flexural Psoriasis


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Treatment

Topical steroids


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Bullous Pemphigoid

Chronic autoimmune disease

Cause unknown

Bullaeflexural areas, abdomen, lowerlegs, feet.


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Bullous pemphigus

Autoimmune disease

Antibodies attack proteins which keep

cells bound together

Age 40-60 years

Affects mouth, lips, oesophagus, skin

Bullae then sores


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Bullous Pemphigoid


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Bullous Pemphigoid


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Quality of Life

All these conditions can have significant

impact on QOL

Not necessarily related to disease severity

Work with patients to enhance

concordance

Allow them to chose which emollients suit

them best


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Skin cancers


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Actinic Keratosis


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Squamous cell carcinoma

Prevalence variescountries, races

Cumulative lifetime sunlight exposure

Complicated long standing skin conditionschronic venous ulcers


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Clinical features Irregular warty lesion

Nodule

Thickened area Bleeding lesion/area

Expansive


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Basal cell carcinoma

(Rodent ulcer)

Common

Prevalence age, sunlight exposure

Arise in or adjacent to chronic ulcers


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Clinical features

Expanding translucent nodule

Ulcerated lesion

Pearly edgenot complete

Crusted


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Malignant melanoma

Arises from melanocytes

Incidence increasing

Sun exposure, burning episodes, but canoccur on none sun exposed sites


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Malignant melanoma

Usually pigmented

Atypical moles

Changing mole

Ulcerated lesion


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What To Look For

Asymmetry

Borders are irregular

Colour is uneven

Diameter


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In conclusion

Ageing skin requires extra care

Careful observation is key

Documents

Elderly Skin Care