America is aging, with more people becoming “senior citizens” than ever before. The U.S. population is older today than it has ever been. And with these years come certain inevitable concerns, illness and disease being chief among them. Thoughts will typically turn to osteoporosis and the potential for broken bones which occur too easily in this population.
But other systems in the body are affected by the passage of time. Usually given only casual thought (except for the cosmetic effects, of course), changes to our skin are significant. Greater attention has been directed of late to ailing, aging, sun-damaged skin, with an appropriate diagnosis manifested. We have a new term in the medical literature: dermatoporosis.
By recognizing the existence of this condition via a specific diagnosis, many sufferers have felt vindicated. The initial part of the word ‘dermatoporosis’ refers to skin, as most people are well aware. The second part indicates a thinning process is occurring. As most know, osteoporosis means the bones are thinning, therefore more fragile. These are real and identifiable changes which are occurring to the skin, like the already mentioned ‘thinning,’ medically termed atrophy. This results in greater fragility of this all-important protective covering of the human body.
This population too often suffers from chronic wounds, a tremendous healthcare burden, leading to disability, infection, hospitalization. Healing of these wounds is problematic for many reasons, some not obvious such as neglect for the injury and inadequate social support. Many who are involved in the care of these skin injuries are unappreciative of the difficulties with their healing.
Dare to scratch your leg due to some dry skin? This simple act can lead to serious medical consequences in the presence of dermatoporosis. A loss of mechanical strength occurs because of chemical changes in the fluid surrounding skin cells, evidenced as a loss of elasticity. One of the most important proteins in skin is collagen, which becomes degraded in dermatoporosis.
A multitude of factors go into its development. Reduced arterial blood flow is a common element. The amount of UV exposure over the course of one’s lifetime seems to be a primary cause in many cases. Other important components are dehydration, malnutrition, sensory changes, mobility impairment, pharmacological therapies.
The classification of this disease consists of a primary type, the result of age and sun exposure, while secondary is from corticosteroid use, whether topical or oral. When one of the ultrapotent steroid medications is used topically, or an oral steroid, for long enough, this condition is more likely to occur.
One of the key findings with dermatoporosis is the presence of solar purpura. These are reddish or purplish bruises appearing on the skin. They’re the result of excess sun exposure to the blood vessels in our skin’s connective tissue and are most commonly seen on the face, neck, hands and forearms.
Another issue with this disease process is the occurrence of deep dissecting hematomas. These are an accumulation of blood in deeper tissues and are considered a medical emergency. The legs are always affected, more frequently in older women. Once again, the risk of these deep hematomas is greater with long-term systemic steroid use, as well as the use of anticoagulants. This collection of blood will present with pain, redness, and swelling, but no warmth. Too often, a deep dissection hematoma will cause skin death, but only later, when it’s typically too late to prevent.
Naturally, because the term is new, statistics as to its incidence, the frequency with which it occurs, varies widely. Some studies have claimed a third of individuals between 60 and 80 years of age are afflicted. Regardless of the specific number, it’s common. And, as in many illnesses, prevention is an effective means of reducing the complications that are associated.
Sun protection should be practiced from birth and onward. Certainly, this is especially important when diagnosed with this condition. UV rays (from the sun) act as an immunosuppressant, meaning they reduce immune function. Thus, another good reason to start practicing sun protection, if you don’t already, on a regular basis.
Patients should be counseled to improve their diet. A higher protein intake for older adults is recommended for health, more important for those with any illness, acute or chronic. An inadequate protein intake is a known problem in the older population and is directly related to the increased skin fragility and reduced healing abilities.
Various medications have been utilized, with some success. We are able to turn on collagen-producing genes with the application of a retinoid, a drug derived from Vitamin A which is added to numerous over-the-counter products. A derivative of Vitamin D is also used topically (although only by prescription), as is a medicine for psoriasis.
Dermatoporosis is a significant health concern, one that leads to pain, disability, infection, and more. It’s a chronic condition, which most sufferers never resolve. With poor skin health, the protective benefits of this vital organ system are lost. Sooner or later, an injury will result. Dermatoporosis is more than just ‘thin skin’ and has greatly impacted the lives of many Americans.
With our nation aging, we will be seeing more cases of dermatoporosis in our senior citizens. It will become a primary complaint for various doctors, rheumatology to podiatry, primary care to gerontology. The more we know about this chronic condition known as dermatoporosis, the better off will be the lives of the many individuals suffering with this new diagnosis.
Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.
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