Skin Health for Seniors

Dr Nidhi Singh is Senior Consultant, Department of Dermatology, Gleneagles HealthCity Chennai. She  is currently working as an Assistant Professor at JIPMER. She has been actively involved in patient management with great passion and commitment. She has experience in independently managing various dermatological disorders including emergencies and procedural dermatology. Her current areas of interest include paediatric dermatology, dermatological diseases in females, dermoscopic imaging and clinical dermatology.

Dr Singh has received several gold medals and certificates of honour in Surgery, Obstetrics & Gynaecology, Pathology, Paediatrics, ENT, Forensic medicine, Pharmacology, Physiology and Biochemistry and this includes the ‘Best final year student in MBBS’, the ‘Roubavathi David Gold Medal’ and “the ‘Indian Association of Dermatology and Venereology Medal’. 

Skin is the largest organ of the human body.  

The skin is a markedly visible organ and can thus help us in identifying certain diseases occurring inside the body with the help of skin changes as a marker.

Functions of skin:

• The main and major function of skin is protection from injuries, infections, etc. 
• It also helps in temperature regulation of the body 
• Skin is also a sensory organ
• It also helps in storage of certain nutrients 
• Helps in formation of Vit D3 
• Absorption of certain vitamin and nutrients- this is seen when we use topical medications and formulations
• Excretes toxins 
• Immunosurveillance 
• Mechanical functions 
• Cosmetic function

Structurally, the skin has 3 layers:

1. Epidermis: Outermost/ the top most layer 
2. Dermis
3. Subcutaneous layer also known as the hypodermis

Your skin care dos and don’ts:

• Gentle cleansing for 5- 10 mins is enough. The water used should be normal/ room temperature water or lukewarm water. Hot water should be avoided. 
• Avoid vigorously scrubbing the face 
• A gentle cleanser or a mild soap should be used for cleansing 
• In areas with body odour glands such as armpits, groin, buttocks, feet- these areas require daily cleaning. But in other areas, if they are dry, the cleansing can be limited to twice or thrice a week.
• After washing your face, if your face feels dry, tight- it means that you are cleaning it too much and riding the face of its natural oils, which is not good for your skin in the long run. 
• Your cleansing should be followed by moisturising.
• Moisturising should be done minimum twice a day. Once should be after a bath on a damp/ moist skin- for your face and your body. The second time could be after wet towelling- for the body and since we tend to wash our face twice a day- during the morning and at night, the second time can be after washing your face at night/ evening. 
• We tend to wash our hands more frequently. If you do so or use a hand sanitizer regularly, you need to moisturise your hands multiple times in a day.  
• Your lips need a hydrating coating throughout the day, this can be achieved using a hydrating lip balm or white petroleum jelly, especially if one is outdoors or in a dry indoor environment. 
• At night, before sleeping your feet and soles should be looked after and should also be examined for any wounds, cuts, blisters on the sole or in the interdigital space. 
• It should also be ensured that your feet and toes do not stay in a very moist/ wet environment for a prolonged period, especially if you are wearing closed footwear. The interdigital space should be aired, to avoid any infection to develop. 
• Your moisturising should be followed by applying sunscreen. 
• Sunscreen is the most important preventive anti aging strategy. Ideally, an SPF 30 or more and PA +++ or above should be used for application, 15 mins before stepping out and a reapplication every 3 hours.  
• Apart from sunscreen additional garment protection in the form of long sleeves, hats, umbrellas, etc. can be used for protection.
• More than 1/2 a teaspoon of sunscreen should be used for the face and neck and each arm. 
• You should also moisturise your feet before going to bed. 
• Face scrubs should not used more than once a week during the summers and not more than once in 2 weeks during the winter season
• Scrubbing is not recommended for patients with sensitive skin or those who have a dry skin 

A common query around sunscreens is- if sunscreen application is necessary on cloudy days? On most days, the white clouds allow 90% of the UV rays to shine through. 30- 35% UV rays still shine through dark/ grey clouds, thus, it makes sense to use sunscreen even on cloudy days. 

The UV rays even pass through our car windows and glass doors and windows at home, which is why sunscreen application is also advised indoors. 

Taking care of your nails is also important. This can be done by:

• Taking a healthy and nutritious diet to ensure we have healthy nails 
• Wear comfortable footwear
• Wages wearing closed footwear, it should be ensured that it does not have a very narrow foot space  
• As we age, our nails become thick. If you have thick nails, you should soak them for 30 mins before cutting them. 
• You should cut your nails straight, you should not curve them at the ends/ arches. If you curve at the accrue, there is a risk of ingrowing of nails, especially in the great toe nails- they can become very painful. Thus, you need to keep the nail longer and not cut too deep and keep them as straight as possible
• The area between the skin and the beginning of the nail, there is the cuticle, this area should be kept safe- avoid pushing it or cutting it. If you feel it is dry or rough just apply a moisturiser regularly. In case it is projecting out all you should do is trim it. 

Common skin issues in seniors:

1. Dry skin
2. Itching: this can either be 

1. Localised 
2. Generalised: causes include dry skin. Gentle cleansing and moistening can help.

• It can also be due to some skin disease 
• Systemic diseases such as poor glycemic control in patients with Diabetes, thyroid disorders, iron deficiency anemias
• Drug related itching  

1. Skin infections: depending upon the organism causing the infection, it can be:

1.  Bacterial: these can present as boils over the skin. 
2. Viral: chickenpox in children, which can at a later stage present as Shingles in the adult life can presents with painful blisters, Herpes Simplex Virus infection 
3. Fungal: ring worms are common commonly seen in the areas oaf body folds, candida infections- more common in diabetic infections 
4. Infestational: scabies, head lice
5. Rashes 
6. Bruises 
7. Chronic skin diseases 

You can avoid and prevent skin infections by taking the following measures:

• Wearing loose cotton clothes 
• Dry your clothes in direct sunlight 
• Keep your skin fold areas dry 
• Avoid prolonged occlusion of sights such as waist
• Keep your feet and the space between your fingers dry and aerated 
• In case you see swelling in your feet- get it evaluated at the earliest 
• Good glycemic control in patients with diabetes