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Geriatric Dermatology

»	How common are skin disorders in the elderly population?
»	What is intrinsic aging of the skin?
»	What is extrinsic aging of the skin?
»	How does intrinsically aging human skin vary from young skin under the microscope?
»	Why does skin wrinkle as we age?
»	Does smoking cigarettes accelerate skin aging?
»	What is solar elastosis?
»	What is nodular elastosis with cysts and comedones?
»	How do liver spots, solar lentigo, and lentigo senilis differ?
»	Why do elderly patients frequently develop bleeding into the skin on the dorsum of their hands and arms?
»	Advertisements in newspapers and magazines frequently tout products that “rejuvenate” the skin or make the skin younger. Is there truth to these claims?
»	What is the difference between superficial, medium, and deep chemical peels?
»	Are some sunscreens better than others in preventing wrinkles due to photodamage?
»	Which are the most common inflammatory skin diseases in the elderly?
»	Why are elderly patients prone to develop xerosis?
»	What is the best way to treat xerosis?
»	How common is chronic venous insufficiency in the geriatric population?
»	Explain the pathogenesis of chronic venous insufficiency.
»	How should you manage chronic venous insufficiency?
»	What is rosacea? How does it present?
»	Is rhinophyma related to alcohol abuse?
»	Name the most common types of skin tumors seen in the elderly.
»	What are seborrheic keratoses?
»	What are stucco keratoses?
»	What is sebaceous hyperplasia?
»	A 70-year-old man presents to your clinic with the sudden onset of hundreds of seborrheic keratoses. Is there any reason for concern?
»	Describe the methods for treating seborrheic keratoses.
»	An elderly man presents with a soft blue papule on the helix of his cheek and is concerned about malignant melanoma. What is the most likely diagnosis?
»	Is there a future in geriatric dermatology?

What is intrinsic aging of the skin?

Aging of the skin may be divided into that due to intrinsic aging and that secondary to extrinsic aging (Table 59-1). Intrinsic aging includes those changes that are due to normal maturity and senescence and thus occurs in all individuals. Classically, intrinsic aging has not been considered to be preventable, but there is renewed interest in the role of antioxidants, such as vitamins C and E, in preventing intrinsic aging. Despite numerous articles in the lay literature, there is no proof that these treatments are effective.

Table 59-1. Age-Related Changes in the Skin
	INTRINSIC AGING	EXTRINSIC AGING (PRIMARILY UV LIGHT)
	Decrease in corneocyte adhesion Slight decrease in epidermal thickness with flattening of rete pegs Decreased number of eccrine sweat glands Decreased numbers of hair follicles Canities (gray hair) Thinning and ridging of nails Decreased dermal collagen (decreases 1% per year) Decreased number of dermal elastic fibers Decreased dermal ground substance Loss or increase in subcutaneous fat (site-dependent)	Altered keratinocyte maturation (xerosis) Freckles (ephelides) Solar lentigo Guttate hypomelanosis Wrinkling Elastosis (yellowish skin) Telangiectasia Senile purpura Venous lakes Comedones