What helps thin skin in elderly?

Over the years, our skin becomes thinner, more fragile, and the protective layer of fat that lies just below it begins to disappear, causing skin to bruise and tear more easily. Moreover, medications commonly used by older people, such as aspirin; topical and oral corticosteroids, such as prednisone; and anticoagulants such as Coumadin, Plavix, and Eliquis; also lead to thinning skin. In addition, chronic medical conditions common to seniors, such as diabetes and circulation problems, also result in fragile skin.

For seniors, weakened skin leads to a greater likelihood of skin tears, which can lead to complications such as infection.

The following senior skin care tips can help prevent thinning skin, a normal aspect of aging, from becoming a problem.

Create a Safe Environment

• Make sure there is adequate lighting in all areas.
• Cushion sharp corners and edges.
• Ensure walkways are wide and uncluttered.
• Remove tripping hazards, such as throw rugs.

Protect the Most Vulnerable Areas of the Body

• Most bruises and tears occur on the arms and lower legs, so it is wise to wear long sleeves and either long pants or knee-high socks.
• People who are especially prone to bruises and skin tears should wear shin guards and padded arm guards.

Treat Skin with Care

Senior skin is prone to dryness (xerosis), so it needs to be handled with care to keep it supple and to prevent itchiness (pruritus), both of which can lead to irritation and tearing. To keep skin properly hydrated:

• Take showers rather than baths, since baths are more dehydrating.
• When showering, use warm water rather than hot water.
• Use unscented, pH balanced soaps to minimize irritation.
• Pat, rather than wipe, skin dry after bathing.
• After bathing, while skin is still moist, apply a thick moisturizing cream. The Mayo Clinic recommends Vanicream, CeraVe or Cetaphil.
• When bandaging wounds, use paper tape bandages. These are often marked “for sensitive skin.”

With proper care, senior skin can still be healthy skin.

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There are questions related to common dermatology conditions that come up repeatedly. They are not the main reason for a dermatology clinic appointment and patients usually consider them too minor to mention until I am walking out of the room.

One of the more common problems is:

Why does the skin on my arms and hands tear and bruise so easily?

This common problem usually occurs on the backs of the forearms and hands, as we get older. It occurs due to a combination of chronic sun exposure, thinning of the skin with aging. It is worse in patients on chronic corticosteroids, prescription blood thinners, OTC aspirin, or NSAID’s (Advil, Aleve etc.).

The skin on the forearms and back of the hands gets sun exposure daily over many years. People who work or recreate outside often do so in short sleeves and without gloves. Many people rarely apply sunscreen to those areas. Moreover, of course, many people who are now experiencing the effects of chronic sun exposure over many years received their exposure long before good sunscreens were available and before the harmful effects were widely known, and long before they had enough sense to protect their skin.

Ultraviolet radiation over years damages the collagen and elastic fiber framework diffusely throughout the skin and in the supporting structure surrounding the blood vessels in the skin. Unfortunately, skin naturally thins with aging. Prescription or OTC medications increase bleeding tendencies. Chronic corticosteroid medications make skin more fragile. Combined together, these problems cause the skin to tear and bruise easily. In patients who are not on chronic corticosteroids, the most severely affected areas are the sun-exposed backs of forearms and hands. One of the easiest ways to see the effects of long-term sun exposure is to look at the back of your forearm, then turn it over and compare it to the sun protected inside.

The next question is then – “very interesting but what do I do now?”

How can I get rid of the bruises and thin skin on my arms and hands?

The best approach by far is prevention, which includes sun protection with either clothing or sunscreen every single day starting as early in life as possible. Like much of the damaging results from chronic sun exposure, the easy bruising and skin fragility occur many years later. While you are at it, don’t forget to protect your neck and the V of your chest. You will be thankful you did later.

To try to thicken then skin, reduce wrinkling and spots too, anti-aging creams and lotions that increase collagen production help to some degree if used over a long time. Thicker skin with more collagen doesn’t tear as easily, and increasing collagen around the fragile blood vessels makes them more resistant to bruising.

Like most of our anti-aging skin strategies, it is definitely best to start early to prevent damage. But even after the damage is done, it is never too late to get some improvement The most effective, but more costly, strategy is to use the same anti-aging skin care products you use on your face on your arms and backs of hands. Anti-aging skin care products designed for the face usually have higher concentrations of the active ingredients than those designed for the body. This is due to the cost of the ingredients for the surface area covered, and customer’s willingness to spend more money on their face than their body.

Ingredients that increase collagen:

• Prescription retinoid (Retin A, Renova, Refissa, Differin, Tazorac)
• Non-prescription retinol
• Alpha hydroxyacids (Glycolic Acid, Multi-Fruit Acid)
• Peptides
• Growth Factors

What about vitamin K creams for bruising on the back of arms and hands?

There are quite a few vitamin K creams promoted to improve the bruising, but not the thinning skin, on the back of the arms and hands. Vitamin K, also known as phytonadione, is a cofactor in the biosynthesis of clotting factors II (prothrombin), VII, IX, and X. There have been few studies on the usefulness of vitamin K creams in the treatment of chronic purpura (bruising). Most of the few studies done have investigated it for treating laser-induced bruising and those few studies have had varying outcomes. For this reason, it needs more study before I would recommend it.

Are there any other treatment options?

Very dilute injections of Sculptra can increase collagen production in some patients.

Do creams really work to improve bruising and thin skin on the back of the arms and hands? Is it worth the money?

My opinion is that it is definitely worth it to use the creams as a preventative anti-aging, anti-thin skin, and anti-bruising strategy and start very early. Once the problem occurs, the correct decision is not so clear. As treatment, to reverse the problem, the improvement after long-term use is somewhere between worst-case none to best-case modest. There is a cost involved and a relatively large surface area to cover. Some of the creams, especially the prescription retinoids, can cause skin irritation and rashes on the thin skin of the arms and hands. You have to do your own cost-benefit-hassle analysis.

Without doubt, the single most clinically effective and cost-effective thing you can do is sun protection as a preventative strategy. Prevention is much easier, and much more effective than treatment after the problem occurs. Dare I say—an ounce of prevention is worth a pound of cure. Seems a lot of life is like that.

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