10/16/21

1

Skin Care for SeniorsCatherine Nguyen, MD, FAAD

1

What we will be covering

• Common skin lesions• Common skin conditions• Anti-Aging regimens• Skin cancer• Sunscreen safety and recent recall

2

Common Skin Lesions

3

Solar purpura

Benign bruising

Due to decreased collagen with aging

Sun protection

4

Seborrheic keratoses

• Benign lesions• If symptomatic, can be treated with liquid

nitrogen or removed with shave biopsy

5

Cherry hemangiomas

• Benign lesion• Superficial collection of blood vessels

6

10/16/21

2

Cutis rhomboidalis nuchae

FROM SUN DAMAGE FROM DISORGANIZED AND DECREASED COLLAGEN

7

Favre Racouchot

CLUSTER OF ACNE LIKE LESIONS AROUND THE EYES

CAUSED BY SUN EXPOSURE

8

Idiopathic guttate hypomelanosis

• White spots on arms and legs• Worsened by sun exposure• Prevent new lesions with sunscreen

9

Solar Lentigos

• Caused by sun exposure• Can be treated with lasers or

lightening creams• Has a malignant component

called lentigo maligna• Must be evaluated by a

dermatologist prior to treating

10

Actinic cheilitis

• Blurry of the borders of the lips• Scaling of the lips• Increased erythema• Mild edema

11

Common Skin Conditions

12

10/16/21

3

Hair loss – androgenetic alopecia

• Men

• Often affects the frontal scalpline and vertex of the scalp

• 80% of men affected by age 70

• Decreased levels of testosterone

• Women• Often affects the

part line• “Christmas tree”

shape• 50% of women

affected by age 70• Genetic component

13

Treatment

• See your dermatologist for evaluation• Minoxidil 2% or 5% solution daily (Rogaine)• Finasteride• Spironolactone (women)• Light therapy• Hair transplantation

14

Seborrheic dermatitis

• Dandruff of the face• Caused by a common fungus• Affects the eyebrows, nasolabial

folds, and ears most commonly• Treated with topical antifungals

and low strength steroid creams• Severe cases have an association

with Parkinson’s disease

15

Eczema and xerosis cutis

• Patients over the age of 12• Affects the hands and eyelids most commonly• Also affects the flexural parts of the body

Adult-onset eczema

• Patients over 60 years old• Marked dryness of the skin

Senile eczema

16

Hand Dermatitis

• Rise in cases due to frequent hand washing from the pandemic• Due to disruption of the skin

barrier from irritants such as soap• May be accompanied by small

blisters

17

Treatment

• Avoid triggers: excessive sweating, fabric softeners, harsh soaps, allergens, emotional stress, wool

• Appropriate skin care: emollients, proper bathing

• May require treatment with prescription strength topical steroids – see a dermatologist!

18

10/16/21

4

Gentle skin care tips

Take short lukewarm showers. Avoid long hot bath/showers.

1Use mild cleanser on dirty areas only such as groin, armpit, and buttocks.

2Pat dry upon exit from shower, and apply emollient to moist skin within 3 minutes of exit from shower.

3Use free and clear detergents, avoid products with scents/fragrances, avoid fabric softener.

4

19 20

Psoriasis

• Peak in new cases in 20 year oldsand in 50-60 year olds• Characterized by red, scaly

plaques• Common affected areas: knees,

elbows, buttocks, belly button, lower back, and scalp• May be accompanied by joint

pain and/or swelling suggestive of psoriatic arthritis

21

Treatment

• Will require treatment with prescription strength topical steroids• Severe cases or any case with joint

involvement requires pills or injections (biologics)

22

Pruritus – or ITCH

• Most commonly from dry skin –follow gentle skin care guidelines• Could be from a medical conditions

such as kidney damage, liver damage, or lymphoma• Please see your dermatologist for

persistent itch that is not relieved with emollients

23

Anti-Aging Regimen

24

10/16/21

5

Topicals • Morning Regimen• Vitamin C serum• Hyaluronic acid

serum• Niacinamide

serum• Azelaic acid• Moisturizer• SUNSCREEN

• Evening Regimen• Gentle cleanser• Retinol or

tretinoin• Moisturizer• Once weekly-

glycolic acid or other gentle acid peel

25

Botox

• Botulinum toxin- a neurotoxin that prevents movement, decreasing the formation of wrinkles• FDA approved for temporary

improvement in appearance of glabellar lines and crows feet. Also for excessive sweating of armpits.• Takes 1 week after injection for full

effects. Lasts about 3 months.

26

Skin Cancer

27

Fast Facts

• Skin cancer is the most common type of cancer• Over 5 million skin cancers are

diagnosed each year• There are more skin cancers in

the US population than there are all other cancers combined• 1 in 5 Americans will develop

skin cancer in their lifetime

28

Skin Cancer

Basal Cell Squamous Cell Melanoma

29

Basal Cell Carcinoma

• Most common type of skin cancer

• Slow growing• Rarely metastasizes or is fatal but

can be disfiguring if left untreated

• Caused by a large amount of total accumulated lifetime sun exposure• Incidence has increased 20-80% in

the last 30 years

30

10/16/21

6

Squamous Cell Carcinoma• Slow growing• Has the potential to metastasize

if left untreated• Incidence has risen 3-10% per

year• >400,000 invasive SCC cases

documented per year• Caused by a large amount of

total accumulated lifetime sun exposure

31

Melanoma

32

Does this affect me?

33

Yes• Melanoma affects everybody,

regardless of skin type• Caucasians are at a 20 time

higher risk for developing melanoma• Melanoma affects both genders• The risk of melanoma increases

with age, but is the one of the most common cancers diagnosed in individuals <30 years old

34

California

Of all the states, California will have

the greatest number of melanoma cases

Of all the counties in California, Orange County has the 3rd

highest annual count of melanoma

(surpassed by Los Angeles and nearly

tied with San Diego)

35

Risk factors for melanoma

Family history of melanoma Skin type

Tanning bed and UV exposure

Residence in equatorial latitudes

Immunosuppression Multiple nevi or atypical nevi

36

10/16/21

7

Risk Factors for BCC and SCC

• UV exposure, tanning bed use• Radiation• Fair skin, red hair, freckling• Chemical exposure (arsenic, caol

tar, nitrogen mustard)• Organ transplantation• Immunosuppressed states (eg. HIV,

leukemia) and drugs• Human papillomavirus (SCC)• Cigarette smoking (SCC)• Genetic syndromes

37

What causes skin cancer?

• UV exposure from sunlight• Both UVA and UVB have

been shown to be carcinogenic• Causes mutations in the skin

cells’ DNA• Induces immunosuppression• Impairs immune surveillance

against oncogenic viruses

38

”Healthy tans” do NOT exist

• If you have a tan, that means your skin sustained genetic damage from UV radiation

• Tanning beds use UVA radiation-yes, the same that causes skin cancer• These tans are NOT protective

against future skin cancers or sunburns

• The increase in melanin synthesis causes reactive oxygen species which induce breaks in the DNA

39

Sunburns are dangerous

• Blistering sunburn increases your lifetime risk of melanoma• Caused by both UVA and UVB• Sunburns are most likely

between the hours of 10 AM and 2 PM

40

Photoaging

41

Photoaging

• Caused by chronic and repetitive inflammatory responses to UV light• Increases proteins that break down collagen• Decrease collagen synthesis• Lose collagen• Increase abnormal elastin deposition

• UVA penetrates deeper in the dermis and is mostly responsible to photoaging• UVB does not penetrate deep but can causes

signaling originating from the top layers of the skin

42

10/16/21

8

What about Visible Light?

Spectrum of electromagnetic radiation that is seen by the eye

Primary source: sunlight

Artificial sources: light bulbs, computers, television, cell phones, lasers

43

Visible Light

• Melasma• Post inflammatory

hyperpigmentation• More common in darker skin

tones• Blue light was found to have the

biggest effect

44

• Have not concluded whether visible light from artificial sources causes pigmentary disorders• Study with participants

undergoing 8 hours of intense computer screen exposure for 5 days did not show increased pigmentationDuteil L, Queille-Roussel C, Lacour JP, Montaudie H, Passeron T. Short term exposure to blue light emitted by electronic devices does not worsen melasma. J Am Acad Dermatol. 2019.

45

How can I protect myself?

46

47

American Academy of DermatologySunscreen Recs

SPF 30 and above

Broad spectrum: covers both UVA and UVB• Both chemical and mineral

sunscreens are broad spectrum

Water resistant

Wear on both cloudy and sunny days

Reapply every 2 hours when outdoors

Reapply after swimming or sweating

48

10/16/21

9

Is a higher SPF better?

49

Water resistant?

Water resistant sunscreens are effective up to 40 minutes in water

Very water resistant sunscreens are effective up to 80 minutes in water

FDA has banned companies from claiming sunscreens are “waterproof” or “sweatproof”

50

How much sunscreen should I use?

• Use enough sunscreen to generously coat all skin that will be not be covered by clothing.

• To be sure you use enough, follow this guideline: • One ounce, enough to fill a shot glass, is

considered the amount needed to cover the exposed areas of the body. Adjust the amount of sunscreen applied depending on your body size.

• Most people only apply 25-50 percent of the recommended amount of sunscreen.

• Apply the sunscreen to dry skin 15 minutes BEFORE going outdoors.

• To protect your lips, apply a lip balm or lipstick that contains sunscreen with an SPF of 30 or higher.

51

Chemical vs. Mineral sunscreens

Mineral• Work like a shield-sit on the skin

and deflect UV rays• Zinc oxide• Titanium dioxide

Chemical• Work like a sponge-absorbs the

sun’s rays• Oxybenzone• Avobenzone• Octisalate• Octocrylene• Homosalate• Octinoxate

52

53

48 participants applied chemical sunscreens over 75% of their body for

4 days (4 times per day)

Collected blood samples over different time

points up to 21 days

54

10/16/21

10

Are chemical sunscreens unsafe?

The FDA is asking for more studies to classify chemical

sunscreen ingredients as “general

recognized as safe and effective”

(GRASE)

The FDA does NOT say that these

ingredients are unsafe

The FDA does NOT ask the public to stop

using these sunscreens

The data did NOT conclude that there

were any detrimental effects on a person’s

health

55

Sunscreen recall

56

57 58

Benzene

• Found in crude oils

• Human carcinogen if long term exposure

• Causes leukemia and lymphoma

• Poses a risk to the environment and marine ecosystems

• FDA restricts levels of benzene to <2 ppm (parts per million) in products

59

Analysis

• Tested over 280 sunscreen products• Only 27% of those tested (78

total products) had benzene• 26 of those had benzene levels

between 0.1 ppm and 2 ppm• 14 of contained benzene levels

>2 ppm• Large majority of products tested

did not have benzene

60

10/16/21

11

The Bottom Line

61

Should we continue to use sunscreen?

Absolutely

Protects again UV rays which are known human carcinogens

62

What should we do now?

Review the list of sunscreens that benzene was detected in

Several have been recalled by Johnson and Johnson

Avoid those listed

Start or continue using safe and effective sunscreens

63 64

65 66

10/16/21

12

If you are concerned

Use mineral sunscreens which have not shown to absorb into the bloodstream

1Use UPF clothing –cover up your arms and legs

2Wear a wide-brimmed hat and sunglasses

3Seek shade whenever possible and minimize exposure to the sun especially between 10 AM and 4 PM

4

67

Most of all…

68

Questions?

69

2501 E. Chapman AvenueSuite 301Orange, CA 92869714-628-3230

70

Thank you

71