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Aging Skin: Blemishes and Nonmelanoma Skin Cancers


An in-depth report on the diagnosis, treatment, and prevention of age-related skin problems.

Alternative Names

Actinic Dermatitis; Actinic Keratoses; Skin Cancer; Sun Protections and Sunscreens

Benign Skin Disorders

In addition to avoiding the sun, hundreds of other methods and cosmetic products are available to retard the progress of wrinkles. Some may actually work to a degree.

Severe Itching (Pruritus) and Preventing Dry Skin

About 30% to 40% of people over age 70 suffer from severe itching (pruritus), which can occur generally or in specific areas, such as bald spots in men.

Causes. Itching can be caused by various conditions, including but not limited to the following:

  • Excessive dryness. Dry skin is the cause of most cases of itching in older people. In some cases, it can become severe enough to cause general inflammation and even fissures in the skin. It most commonly develops on the legs in the winter.
  • Scabies. These are tiny parasites typically located under the armpits, in the webs of fingers and toes, or around the ankles. It causes small red pimples, red patches, and scaling. In this case, the itch is usually worse at night.
  • Medications. A number of drugs can cause itching and rash, particularly in response to sunlight. Stopping the drug resolves both the itch and rash. Common drugs that can cause this reaction include calcium channel blockers and thiazides (which are used for high blood pressure), common pain relievers known as NSAIDs (such as ibuprofen, naproxen, and aspirin and antibiotics).
  • Eczema.
  • Symptoms of Serious Illness. In rare cases, itching may be symptomatic of an underlying serious disease, so any persistent itching without an obvious cause should be reported to a physician. Such diseases include systemic lupus erythematosus (lupus), dermatomyositis, lymphomas, iron deficiency, liver and kidney disease, diabetes, and thyroid abnormalities.

Treating Dry Skin. The following measures may be helpful:

  • Moisturizing the skin is the most important first step. Patients should avoid hot baths and most soaps. They should take short lukewarm showers and apply oils or moisturizing lotions while the skin is still damp. Moisturizers containing aluminum lactate (Amlactin, Lac-Hydrin) are best, although they can have some side effects, including stinging, and may interact with certain drugs.
  • Colloidal preparations added to a lukewarm bath may be helpful. These are available in drugstores (e.g., Aveeno) or can be made at home by preparing a paste of two cups of Linit starch, cornstarch, or oatmeal plus four cups of water. The combination should be boiled then added to a tub half-filled with water. It is important to stress that these preparations may make the tub slippery.
  • For specific itchy areas, over-the-counter lotions may be helpful that contain calamine, menthol, and phenol or combinations of all these ingredients (Sarna, Calamine Lotion, Schamberg's Lotion, Rhulicream). Cold compresses may provide temporary relief.
  • Over-the-counter antihistamines, such as Benadryl, that are administered in the evening can help with generalized itching. (It should be noted that Benadryl will cause significant sedation if it is used during the day.)
  • Treatment from the physician may include topical corticosteroids (commonly called steroids), anti-itching creams containing the ingredients doxepin or pramoxine, or mild tranquilizers. Some experts do not recommend steroid creams, since in some cases over-use of corticosteroids can cause itchiness, particularly in aged, sun-exposed skin. In some severe cases, phototherapy with UVB radiation is helpful.

Liver Spots

Liver spots (medically referred to as lentigos or sun-induced or pigmented lesions) are flat brown spots on the skin. They are almost universal signs of aging. Occurring most noticeably on the hands and face, these blemishes tend to enlarge and darken over time. The extent and severity of the spots are determined by a combination of skin type, sun exposure, and age. These spots are harmless, but should be distinguished from lentigo maligna, which is an early sign of melanoma.

Changes in skin with age
Liver spots or age spots are a type of skin change that are associated with aging. The increased pigmentation may be brought on by exposure to sun, or other forms of ultraviolet light, or other unknown causes.

Treating Liver Spots. They do not require treatment, although some people are distressed by their appearance. Treatments may include the following:

  • Trichloroacetic acid (a chemical peel).
  • Tretinoin (Retin A) alone or in a combination with Mequinol (Solag). Tretinoin is a vitamin A derivative and is also effective in treating wrinkles.
  • Gentle freezing with liquid nitrogen (cryotherapy).
  • Laser treatment. Specific lasers, such as the Nd:YAG, are effective in eliminating 80% of liver spots in one treatment. (It may be more effective than cryotherapy and have fewer adverse effects.)
  • Bleaching creams. These are commonly available but are not as satisfactory as peels, and high concentrations can sometimes cause permanent loss of color.

Eczema in Older People

Eczema is an inflammatory response of the skin triggered by various factors, including stress. Although often associated with children, it is common in older people. All eczema is itchy and all produce areas of redness with pimples, blisters, scaling, or rough skin. Itching may be relieved using measures described above. Other specific treatments depend on the cause.

Eczema may have a rapid or slow course:

  • Eczema can erupt suddenly as red raised blisters that can ooze and crust over.
  • Eczemas can also become persistent, causing red, rough, scaly skin.
Click the icon to see an image of atopic dermatitis.

Both conditions can occur in the same person. There are many forms however, which are defined by their cause (if known) or their pattern of distribution. This report only deals with a few of the more common eczemas found in older people.

Some Forms of Eczema

Form of Eczema




Irritant contact dermatitis

Reaction to irritating or toxic substances (e.g., solvents, detergents) that have a toxic effect on the skin. Reaction can occur hours to months after exposure. Handwashing (so-called dishpan hands) is the most common cause. Symptoms are cracked, dry, and painful fingertips.

Determine irritant or toxin, if possible. Avoid irritants. For example, for dishpan hands use an emulsion cleanser (Cetaphil or Aquanil) instead of hand soap. When using detergents or other irritants, wear rubber gloves lined with cotton.

Topical corticosteroids (commonly called steroids).

Allergic contact dermatitis (Atopic dermatitis)

Allergic response (delayed for at least 10 days). Allergens include certain plants (poison ivy, oak, and sumac, etc.), nickel, hair dyes, rubber, topical medications, insecticides, and cosmetics. Hands are most often affected, but can be general or occur on the face.

Determine allergens and avoid if possible.

Topical corticosteroids (steroids) or, in severe cases, oral corticosteroids. Tacrolimus ointment (Protopic), an immunosuppressive drug, effective for moderate to severe allergic dermatitis.

Pimecrolimus (Elidel), a similar agent is also effective.


Narrowband ultraviolet B (UVB) phototherapy plus topical steroids.

Note: Many people use alternative therapies for atopic dermatitis. Aloe vera, green tea, and tea tree oil, for example, have been used. Evidence is mixed on benefits.

Photodermatitis, or actinic dermatitis

Triggered by exposure to sunlight after taking certain oral drugs (e.g., certain antibiotics, diuretics, antihistamines, and antidepressants) or topical chemicals (e.g., organic sunscreens). Reaction may be delayed with some oral medications. Eczema appears on light-exposed areas, such as the face, back of hands, forearms, and tips of the ears. In rare cases, it can become chronic.

Avoid sunlight and change or stop medications.

Topical corticosteroids or, in severe cases, oral corticosteroids.

Stasis Dermatitis

Poor circulation. May produce swelling (edema), inflammation, ulcers, and itching skin (usually in the lower leg).

Topical steroids for inflammation. Wet compresses and support stockings or elastic bandages to reduce swelling. Antibiotics may be used for infection. Note, however, allergic reaction to topical antibiotics for leg ulcers is common and some experts caution against them.

Investigative: Calcium dobesilate (Doxium).


Purpura occurs when tiny capillaries rupture and leak blood into the skin. In older people, the condition (called senile or actinic purpura) is usually caused by fragile blood vessels. The capillaries appear as flat purplish patches. These patches are called petechiae when they are smaller than 3 mm (about an inch). When they are greater than 3 mm, they are referred to as ecchymoses. Patients typically complain of a rash, which may appear reddish at first but gradually change color, turning brown or purple.

Treatment. Although there is no specific treatment for purpura, patients are advised to avoid trauma, including vigorous rubbing of the skin, which may be sufficient to damage the capillaries. Emollients that soften the skin may be helpful. Some physicians also recommend vitamin C, but its effectiveness is unproven.

Seborrheic Keratoses

Seborrheic keratoses are among the most common skin disorders in older adults. Their cause or causes are unknown. They usually appear on the head, neck, or trunk and can range in size from 0.2 cm to 3 cm (a little over an inch). They are well defined and appear to be pasted onto the skin, but their appearance can vary widely:

  • They can be smooth with tiny, round, pearl-like formations embedded in them.
  • They can be rough and warty.

Seborrheic keratoses sometimes look like melanoma, since they can have an irregular border, but they are always benign. A dermatologist can tell the difference between them, although experts warn that melanomas may "hide" among these benign lesions and go unnoticed without close inspection. In general, seborrheic keratoses have a uniform appearance while melanomas often have a smooth surface that varies in height, color density, and shading. In some cases, keratoses may cause itching or irritation. They can be easily removed with surgery or freezing.


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