510 Review Geriatric dermatoses Jafferany et al.

infections were most common, followed by benign
tumors, eczematous dermatitis, keratinization disorders,
bacterial infections, viral infections, and finally xerosis.6
Skin changes in the aging skin
Two types of skin aging have been described: chronologi-
cal skin aging and photoaging. Both have different clini-
cal and histological features. Chronological skin aging is
characterized by physiological alteration in skin function.
Photoaging results from ultraviolet radiations, and the
effects are more prominent on exposed parts of skin.7
Skin changes in elderly population take the form of either
intrinsic or extrinsic changes. Intrinsic changes are
changes due to skin’s natural metabolic aging process.
These include thinning of the skin’s upper layer, diminish-
ing blood flow and compromising the skin’s inherent abil-
ity to nourish and repair cells. Changes in collagen
structure reduce overall elasticity. Moreover, a reduction
in immune function also contributes to the skin-aging
process by degrading the skin’s ability to defend against
bacterial assault.
Other intrinsic changes in skin in the elderly include
variable epidermal thickness, variation in size and shape,
fewer Langerhans’ cells, and fewer melanocytes, and there
may be occasional nuclei atypia. Decreased and irregular
epidermal turnover results in skin roughness and uneven
pigmentation. The capability of the skin to restrict water
loss does not change, but the skin is more permeable to
chemical substances. The chemical substances enter the
skin quickly but are removed slowly due to changes in
the dermal matrix and reduction in vasculature.8 There is
flattening of the dermoepidermal junction and thus a
smaller surface contact between the dermis and the epi-
dermis, resulting in less nutritional transfer and poor
adhesion between the dermis and the epidermis. This
leads to superficial abrasions with minor trauma and an
increased prevalence of bullous formation due to injury.
The wrinkling of the skin in old age is due to changes in
the dermis. The collagen bundles and elastic fibers are
fragmented and disoriented. There is a loss of dermal
thickness and reduction in mast cells and vasculature.
Age decreases the sensory perception and increases the
threshold of pain. Senile purpura is due to lack of support
of vasculature by collagen tissue and reduced perivascular
veil cells. Skin appendages also show a variety of changes.
The number of exocrine glands decreases with age, and
older people sweat less in response to heat. Apocrine
glands also regress with age and produce fewer odors.
The size of the sebaceous glands increases due to the
decreased turnover of cells, and these glands probably
produce less sebum. The hair slowly turns white in color;
graying starts in the temporal region of the scalp. In
males, eyebrows become bushier and hair grows in the
external auditory canal. In females, slight hirsutism
occurs as a result of endocrine changes. The linear growth
of nails also decreases with age. The ultraviolet light also
accelerates the intrinsic aging in the sun-exposed areas of
the body.9,10 The age-related changes due to alteration of
skin physiology are shown in Table 1.
Extrinsic changes may result from factors, such as UV
light exposure and environmental pollutants such as
smoking. A variety of skin changes have been seen in
aged skin due to prolonged exposure to sun. Sun expo-
sure contributes to a decline in dermatological integrity,
leading to skin that easily sags, breaks, bruises, and

Table 1 Age-related changes in skin physiology

Physiological changes Cutaneous effects

Decrease in skin lipids and barrier function Dryness

Decreased cell replacement
Decreased DNA repair
Fragmentation of collagen and elastic fibers
Reduced support of blood vessels
Decreased sensory perceptions
Impaired thermoregulation
Reduced hair growth and effects of androgen
Reduced function of apocrine glands
Reduced function of sebaceous glands
Reduced function of sweat glands
Decreased inflammatory response
Reduced subcutaneous fat
Flattening of dermal papillae
Reduced nail growth
Decrease in melanocytes
Roughness, delayed healing and uneven pigmentation
Increased photocarcinogenesis, malignancies
Wrinkles and lax skin, increased risk of pressure damage and decubitus ulcers
Purpuric lesions
Increased tendencies to injuries
Vulnerability to heat and cold
Color changes to gray, baldness, and male and female patterns of alopecia, bushier eyebrows,
and growth of hair in external auditory meatus in male
Reduced body odor
Decreased epidermal lipids
Risk of overheating and heat strokes
Delayed healing and vulnerability to infection
Increased risk of injury, less natural insulation, increased risk of hypothermia
Increased risk of blister formation and consequent infection
Decreased linear growth, onychogryphosis, longitudinal striations, dull and brittle nails
Gray hair, increased susceptibility to solar radiation

International Journal of Dermatology 2012, 51, 509–522 ª 2012 The International Society of Dermatology