As the skin ages, it becomes more susceptible to certain dermatological conditions due to changes in its structure, function, and accumulated environmental exposure. Recognising these common age-related skin conditions and understanding their available treatments is important for maintaining skin health and addressing cosmetic concerns.
One of the most prevalent age-related skin changes is the development of solar lentigines, commonly known as age spots or liver spots. These are flat, darkened patches of skin that appear on sun-exposed areas such as the face, hands, and chest. They are caused by a localised increase in melanin production due to chronic sun exposure. Treatment options for solar lentigines include:
Topical lightening creams: Containing ingredients like hydroquinone, retinoids, azelaic acid, or kojic acid can help fade these spots over time.
Cryotherapy: Freezing the lesions with liquid nitrogen can destroy the pigmented cells.
Laser and light therapies: Q-switched lasers, pulsed dye lasers, and intense pulsed light (IPL) can selectively target and break down the excess melanin in the lentigines.
Chemical peels: Superficial to medium-depth peels can exfoliate the pigmented outer layers of the skin.
Actinic keratoses (AKs) are rough, scaly patches that develop on sun-damaged skin. They are considered precancerous lesions and can potentially progress to squamous cell carcinoma if left untreated. Common locations include the face, scalp, ears, and backs of the hands. Treatment options for actinic keratoses include:
Topical medications: Creams containing 5-fluorouracil, imiquimod, ingenol mebutate, or diclofenac can be applied to treat multiple AKs in an area.
Cryotherapy: Freezing individual AKs with liquid nitrogen is a common and effective treatment.
Curettage and electrodessication: Scraping off the lesion followed by cauterisation can be used for individual AKs.
Photodynamic therapy (PDT): Applying a photosensitising agent to the skin followed by exposure to a specific wavelength of light can destroy AK cells.
Laser ablation: CO2 or erbium lasers can be used to remove AKs.
Telangiectasias, also known as spider veins, are small, dilated blood vessels that appear as fine red or purple lines on the skin’s surface. They are common on the face, particularly the nose and cheeks, and can be associated with sun exposure, rosacea, and aging. Treatment options for facial telangiectasias include:
Laser and light therapies: Pulsed dye lasers, KTP lasers, Nd:YAG lasers, and IPL can selectively target and destroy the visible blood vessels.
Electrocautery: Using a fine needle to deliver an electrical current to coagulate and close the blood vessels.
Poikiloderma of Civatte is a condition characterised by redness, brownish pigmentation, and telangiectasias primarily on the sides of the neck and upper chest, sparing the skin under the chin (which is often protected from the sun). Chronic sun exposure is the main contributing factor. Treatment options for poikiloderma of Civatte include:
Laser and light therapies: Pulsed dye lasers and IPL can help reduce the redness and telangiectasias.
Topical retinoids and hydroquinone: May help with the pigmentation component, although results can be variable.
Strict sun protection: Essential to prevent further progression of the condition.
Sebaceous hyperplasia presents as small, yellowish papules with a central depression (umbilication) on the face, particularly the forehead, nose, and cheeks of middle-aged and older adults. They are caused by an enlargement of the sebaceous glands. While benign, they can be cosmetically bothersome. Treatment options include:
Electrodessication: Using an electrical current to destroy the enlarged glands.
Laser ablation: CO2 or erbium lasers can be used to remove the lesions.
Photodynamic therapy (PDT): Can sometimes be effective in reducing the size and appearance of sebaceous hyperplasia. It is important to note that while these conditions are commonly associated with aging, not everyone will develop them, and the severity can vary depending on genetics, lifestyle, and sun exposure history. Regular skin examinations by a dermatologist are crucial for early detection, accurate diagnosis, and appropriate management of these and other age-related skin conditions, including skin cancers.