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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
Total emollient therapy
Topical steroids
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Plaque Psoriasis
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Treatment
Total emollient therapy
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