Your skin changes as you age. You might notice wrinkles, age spots and dryness. Your skin also becomes thinner and loses fat, making it less plump and smooth. It might take longer to heal, too.

Sunlight is a major cause of skin aging. You can protect yourself by staying out of the sun when it is strongest, using sunscreen with an SPF of 15 or higher, wearing protective clothing, and avoiding sunlamps and tanning beds. Cigarette smoking also contributes to wrinkles. The wrinkling increases with the amount of cigarettes and number of years a person has smoked.

Many products claim to revitalize aging skin or reduce wrinkles, but the Food and Drug Administration has approved only a few for sun-damaged or aging skin. Various treatments soothe dry skin and reduce the appearance of age spots.

Your skin changes with age. It becomes thinner, loses fat, and no longer looks as plump and smooth as it once did. Your veins and bones can be seen more easily. Scratches, cuts, or bumps can take longer to heal. Years of sun tanning or being out in the sunlight for a long time may lead to wrinkles, dryness, age spots, and even cancer. But, there are things you can do to protect your skin and to make it feel and look better.

Cynthia's Story

Cynthia had always been proud of her skin, especially her summer tan. But, as years went by, she saw her skin getting more fine lines and wrinkles. Cynthia began to worry about what other skin problems she might have. What are those brown spots on her hands and arms?

All systems in the body accumulate subtle and some not-so-subtle changes as a person ages. Among these changes are reductions in cell division, metabolic activity, blood circulation, hormonal levels, and muscle strength. In the skin, these changes are reflected in decreased mitosis in the stratum basale, leading to a thinner epidermis. The dermis, which is responsible for the elasticity and resilience of the skin, exhibits a reduced ability to regenerate, which leads to slower wound healing. The hypodermis, with its fat stores, loses structure due to the reduction and redistribution of fat, which in turn contributes to the thinning and sagging of skin.

The accessory structures also have lowered activity, generating thinner hair and nails, and reduced amounts of sebum and sweat. A reduced sweating ability can cause some elderly to be intolerant to extreme heat. Other cells in the skin, such as melanocytes and dendritic cells, also become less active, leading to a paler skin tone and lowered immunity. Wrinkling of the skin occurs due to breakdown of its structure, which results from decreased collagen and elastin production in the dermis, weakening of muscles lying under the skin, and the inability of the skin to retain adequate moisture.

Many anti-aging products can be found in stores today. In general, these products try to rehydrate the skin and thereby fill out the wrinkles, and some stimulate skin growth using hormones and growth factors. Additionally, invasive techniques include collagen injections to plump the tissue and injections of BOTOX^® (the name brand of the botulinum neurotoxin) that paralyze the muscles that crease the skin and cause wrinkling.

According to poet Ralph Waldo Emerson, “The surest poison is time.” In fact, biology confirms that many functions of the body decline with age. All the cells, tissues, and organs are affected by senescence, with noticeable variability between individuals owing to different genetic makeup and lifestyles. The outward signs of aging are easily recognizable. The skin and other tissues become thinner and drier, reducing their elasticity, contributing to wrinkles and high blood pressure. Hair turns gray because follicles produce less melanin, the brown pigment of hair and the iris of the eye. The face looks flabby because elastic and collagen fibers decrease in connective tissue and muscle tone is lost. Glasses and hearing aids may become parts of life as the senses slowly deteriorate, all due to reduced elasticity. Overall height decreases as the bones lose calcium and other minerals. With age, fluid decreases in the fibrous cartilage disks intercalated between the vertebrae in the spine. Joints lose cartilage and stiffen. Many tissues, including those in muscles, lose mass through a process called atrophy. Lumps and rigidity become more widespread. As a consequence, the passageways, blood vessels, and airways become more rigid. The brain and spinal cord lose mass. Nerves do not transmit impulses with the same speed and frequency as in the past. Some loss of thought clarity and memory can accompany aging. More severe problems are not necessarily associated with the aging process and may be symptoms of underlying illness.

As exterior signs of aging increase, so do the interior signs, which are not as noticeable. The incidence of heart diseases, respiratory syndromes, and type 2 diabetes increases with age, though these are not necessarily age-dependent effects. Wound healing is slower in the elderly, accompanied by a higher frequency of infection as the capacity of the immune system to fend off pathogen declines.

Aging is also apparent at the cellular level because all cells experience changes with aging. Telomeres, regions of the chromosomes necessary for cell division, shorten each time cells divide. As they do, cells are less able to divide and regenerate. Because of alterations in cell membranes, transport of oxygen and nutrients into the cell and removal of carbon dioxide and waste products from the cell are not as efficient in the elderly. Cells may begin to function abnormally, which may lead to diseases associated with aging, including arthritis, memory issues, and some cancers.

The progressive impact of aging on the body varies considerably among individuals, but Studies indicate, however, that exercise and healthy lifestyle choices can slow down the deterioration of the body that comes with old age.

Tissues of all types are vulnerable to injury and, inevitably, aging. In the former case, understanding how tissues respond to damage can guide strategies to aid repair. In the latter case, understanding the impact of aging can help in the search for ways to diminish its effects.

Tissue Injury and Repair

Inflammation is the standard, initial response of the body to injury. Whether biological, chemical, physical, or radiation burns, all injuries lead to the same sequence of physiological events. Inflammation limits the extent of injury, partially or fully eliminates the cause of injury, and initiates repair and regeneration of damaged tissue. Necrosis, or accidental cell death, causes inflammation. Apoptosis is programmed cell death, a normal step-by-step process that destroys cells no longer needed by the body. By mechanisms still under investigation, apoptosis does not initiate the inflammatory response. Acute inflammation resolves over time by the healing of tissue. If inflammation persists, it becomes chronic and leads to diseased conditions. Arthritis and tuberculosis are examples of chronic inflammation. The suffix “-itis” denotes inflammation of a specific organ or type, for example, peritonitis is the inflammation of the peritoneum, and meningitis refers to the inflammation of the meninges, the tough membranes that surround the central nervous system

The four cardinal signs of inflammation—redness, swelling, pain, and local heat—were first recorded in antiquity. Cornelius Celsus is credited with documenting these signs during the days of the Roman Empire, as early as the first century AD. A fifth sign, loss of function, may also accompany inflammation.

Upon tissue injury, damaged cells release inflammatory chemical signals that evoke local vasodilation, the widening of the blood vessels. Increased blood flow results in apparent redness and heat. In response to injury, mast cells present in tissue degranulate, releasing the potent vasodilator histamine. Increased blood flow and inflammatory mediators recruit white blood cells to the site of inflammation. The endothelium lining the local blood vessel becomes “leaky” under the influence of histamine and other inflammatory mediators allowing neutrophils, macrophages, and fluid to move from the blood into the interstitial tissue spaces. The excess liquid in tissue causes swelling, more properly called edema. The swollen tissues squeezing pain receptors cause the sensation of pain. Prostaglandins released from injured cells also activate pain neurons. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain because they inhibit the synthesis of prostaglandins. High levels of NSAIDs reduce inflammation. Antihistamines decrease allergies by blocking histamine receptors and as a result the histamine response.

After containment of an injury, the tissue repair phase starts with removal of toxins and waste products. Clotting (coagulation) reduces blood loss from damaged blood vessels and forms a network of fibrin proteins that trap blood cells and bind the edges of the wound together. A scab forms when the clot dries, reducing the risk of infection. Sometimes a mixture of dead leukocytes and fluid called pus accumulates in the wound. As healing progresses, fibroblasts from the surrounding connective tissues replace the collagen and extracellular material lost by the injury. Angiogenesis, the growth of new blood vessels, results in vascularization of the new tissue known as granulation tissue. The clot retracts pulling the edges of the wound together, and it slowly dissolves as the tissue is repaired. When a large amount of granulation tissue forms and capillaries disappear, a pale scar is often visible in the healed area. A primary union describes the healing of a wound where the edges are close together. When there is a gaping wound, it takes longer to refill the area with cells and collagen. The process called secondary union occurs as the edges of the wound are pulled together by what is called wound contraction. When a wound is more than one quarter of an inch deep, sutures (stitches) are recommended to promote a primary union and avoid the formation of a disfiguring scar. Regeneration is the addition of new cells of the same type as the ones that were injured.

Tissue Healing During wound repair, collagen fibers are laid down randomly by fibroblasts that move into repair the area.

Homeostatic Imbalances

Tissues and Cancer
Cancer is a generic term for many diseases in which cells escape regulatory signals. Uncontrolled growth, invasion into adjacent tissues, and colonization of other organs, if not treated early enough, are its hallmarks. Health suffers when tumors “rob” blood supply from the “normal” organs.

A mutation is defined as a permanent change in the DNA of a cell. Epigenetic modifications, changes that do not affect the code of the DNA but alter how the DNA is decoded, are also known to generate abnormal cells. Alterations in the genetic material may be caused by environmental agents, infectious agents, or errors in the replication of DNA that accumulate with age. Many mutations do not cause any noticeable change in the functions of a cell. However, if the modification affects key proteins that have an impact on the cell’s ability to proliferate in an orderly fashion, the cell starts to divide abnormally. As changes in cells accumulate, they lose their ability to form regular tissues. A tumor, a mass of cells displaying abnormal architecture, forms in the tissue. Many tumors are benign, meaning they do not metastasize nor cause disease. A tumor becomes malignant, or cancerous, when it breaches the confines of its tissue, promotes angiogenesis, attracts the growth of capillaries, and metastasizes to other organs (image). The specific names of cancers reflect the tissue of origin. Cancers derived from epithelial cells are referred to as carcinomas. Cancer in myeloid tissue or blood cells form myelomas. Leukemias are cancers of white blood cells, whereas sarcomas derive from connective tissue. Cells in tumors differ both in structure and function. Some cells, called cancer stem cells, appear to be a subtype of cell responsible for uncontrolled growth. Recent research shows that contrary to what was previously assumed, tumors are not disorganized masses of cells, but have their own structures.

Cancer treatments vary depending on the disease’s type and stage. Traditional approaches, including surgery, radiation, chemotherapy, and hormonal therapy, aim to remove or kill rapidly dividing cancer cells, but these strategies have their limitations. Depending on a tumor’s location, for example, cancer surgeons may be unable to remove it. Radiation and chemotherapy are difficult, and it is often impossible to target only the cancer cells. The treatments inevitably destroy healthy tissue as well. To address this, researchers are working on pharmaceuticals that can target specific proteins implicated in cancer-associated molecular pathways.

Age spots, once called "liver spots," are flat, brown spots often caused by years in the sun. They are bigger than freckles and commonly show up on areas like the face, hands, arms, back, and feet. Using a broad-spectrum sunscreen that helps protect against two types of the sun's rays (UVA and UVB) may prevent more age spots.

Skin tags are small, usually flesh-colored growths of skin that have a raised surface. They become common as people age, especially for women. They are most often found on the eyelids, neck, and body folds such as the armpit, chest, and groin.

Age spots and skin tags are harmless, although sometimes skin tags can become irritated. If your age spots or skin tags bother you, talk to your doctor about having them removed.

Many older people suffer from dry spots on their skin, often on their lower legs, elbows, and lower arms. Dry skin patches feel rough and scaly. There are many possible reasons for dry skin, such as:

• Not drinking enough liquids
• Spending too much time in the sun or sun tanning
• Being in very dry air
• Smoking
• Feeling stress
• Losing sweat and oil glands, which is common with age

Dry skin also can be caused by health problems, such as diabetes or kidney disease. Using too much soap, antiperspirant, or perfume and taking hot baths can make dry skin worse.

Some medicines can make skin itchy. Because older people have thinner skin, scratching can cause bleeding that may lead to infection. Talk to your doctor if your skin is very dry and itchy.

Here are some ways to help dry, itchy skin:

• Use moisturizers, like lotions, creams, or ointments, every day.
• Take fewer baths or showers and use milder soap. Warm water is less drying than hot water. Don't add bath oil to your water. It can make the tub too slippery.
• Try using a humidifier, an appliance that adds moisture to a room.

Older people may bruise more easily than younger people. It can take longer for these bruises to heal. Some medicines or illnesses may also cause bruising. Talk to your doctor if you see bruises and don't know how you got them, especially on parts of your body usually covered by clothing.

Over time, skin begins to wrinkle. Things in the environment, like ultraviolet (UV) light from the sun, can make the skin less elastic. Gravity can cause skin to sag and wrinkle. Certain habits, like smoking, also can wrinkle the skin.

A lot of claims are made about how to make wrinkles go away. Most of them don't work. Some methods can be painful or even dangerous, and many must be done by a doctor. Talk with a doctor specially trained in skin problems, called a dermatologist, or your regular doctor if you are worried about wrinkles.

Skin cancer is a very common type of cancer in the United States. The main cause of skin cancer is the sun. Sunlamps and tanning booths can also cause skin cancer. Anyone, of any skin color, can get skin cancer. People with fair skin that freckles easily are at greatest risk. Skin cancer may be cured if it is found before it spreads to other parts of the body.

There are three types of skin cancers. Two types, basal cell carcinoma and squamous cell carcinoma, grow slowly and rarely spread to other parts of the body. These types of cancer are usually found on parts of the skin most often exposed to the sun, like the head, face, neck, hands, and arms. But they can happen anywhere on your body. The third and most dangerous type of skin cancer is melanoma. It is rarer than the other types, but it can spread to other organs and be deadly.

Check your skin once a month for things that may be signs of cancer. Skin cancer is rarely painful. Look for changes such as a new growth, a sore that doesn't heal, or a bleeding mole.

Check Moles, Birthmarks, or Other Parts of the Skin for the "ABCDE's"

A = Asymmetry (one half of the growth looks different from the other half)

B = Borders that are irregular

C = Color changes or more than one color

D = Diameter greater than the size of a pencil eraser

E = Evolving; this means the growth changes in size, shape, symptoms (itching, tenderness), surface (especially bleeding), or shades of color

See your doctor right away if you have any of these signs to make sure it is not skin cancer.

What it is:

Sometimes referred to as “photoaging,” premature aging is the result of unprotected UV exposure. It takes the form of leathery, wrinkled skin, and dark spots.

Why it happens:

Although the causes of premature aging are not always clear, unprotected exposure to harmful UV rays break down the collagen and elastin fibers in healthy young skin, and cause wrinkles and loosened folds. Frequent sunburns or hours spent tanning can result in a permanent darkening of the skin, dark spots, and a leathery texture.

Symptoms:

• Wrinkles
• Dark spots
• Leathery skin

Treatment:

A dermatologist or plastic surgeon can develop a treatment plan based on your needs. Treatments can include chemical peels, dermabrasion, and skin fillers.

The Bottom Line:

Premature aging is a long-term side effect of UV exposure, meaning it may not show on your skin until many years after you have had a sunburn or suntan. Avoiding UV exposure is essential to maintaining healthy skin.

Some products are marketed with claims that they will make people look younger. But are these products cosmetics? It depends.

• Products intended to make people more attractive are generally cosmetics. For example, moisturizing is a cosmetic claim. So, if a product is intended to make lines and wrinkles less noticeable, simply by moisturizing the skin, it’s a cosmetic. Similarly, makeup or “primers” intended to make the signs of aging less noticeable just by hiding them are also cosmetics.
• But, products intended to affect the structure or function of the body, such as the skin, are drugs, or sometimes medical devices, even if they affect the appearance. So, if a product is intended, for example, to remove wrinkles or increase the skin’s production of collagen, it’s a drug or a medical device.

Under the law, cosmetics must be safe when consumers use them according to product labeling, or the way in which the products are customarily used. But the law does not require cosmetics to be approved by FDA before they go on the market. Drugs, however, must have FDA approval for both safety and effectiveness before they go on the market. Similarly, medical devices must go through FDA’s clearance process.

FDA is concerned about drug claims made for products marketed as cosmetics, such as skin care products with anti-wrinkle or anti-aging claims that involve supposed effects on the structure or function of the skin.

Some sun can be good for you, but to keep your skin healthy, be careful:

• Limit time in the sun. It's okay to go out during the day, but try to avoid being in sun during peak times when the sun's rays are strongest. For example, during the summer, try to stay out of the sun between 10 a.m. and 4 p.m. Don't be fooled by cloudy skies. The sun's rays can go through clouds. You can also get sunburned if you are in water, so be careful when you are in a pool, lake, or the ocean.
• Use sunscreen. Look for sunscreen with an SPF (sun protection factor) number of 15 or higher. It's best to choose sunscreens with "broad spectrum" on the label. Put the sunscreen on 15 to 30 minutes before you go outside. Sunscreen should be reapplied at least every 2 hours. You need to put sunscreen on more often if you are swimming, sweating, or rubbing your skin with a towel.
• Wear protective clothing. A hat with a wide brim can shade your neck, ears, eyes, and head. Look for sunglasses that block 99 to 100 percent of the sun's rays. If you have to be in the sun, wear loose, lightweight, long-sleeved shirts and long pants or long skirts.
• Avoid tanning. Don't use sunlamps or tanning beds. Tanning pills are not approved by the U.S. Food and Drug Administration (FDA) and might not be safe.

Your skin may change with age. But remember, there are things you can do to help. Check your skin often. If you find any changes that worry you, see your doctor.