100 Questions & Answers About Aging Skin Robert A. Norman, DO, MPH Associate Professor of Dermatology Nova Southeastern University Fort Lauderdale, FL Director Dermatology and Skin Cancer Center Tampa, FL World Headquarters Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA [email protected] Canada United Kingdom www.jbpub.com Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jbpub.com. Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations. 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Production Credits Senior Acquisitions Editor: Nancy Anastasi V.P., Manufacturing and Inventory Control: Duffy Therese Connell Editorial Assistant: Sara Cameron Composition: Appingo Publishing Services Production Director: Amy Rose Printing and Binding: Malloy, Inc. Production Assistant: Tina Chen Cover Printing: Malloy, Inc. Marketing Manager: Ilana Goddess Cover Credits Cover Design: Colleen Lamy Cover Images: © AbleStock , © Ryan McVay/Photodisc/Getty Images Library of Congress Cataloging-in-Publication Data Norman, Robert A., 1955- 100 questions and answers about aging skin / Robert A. Norman. p. cm. Includes index. ISBN-13: 978-0-7637-6245-2 ISBN-10: 0-7637-6245-8 1. Skin—Aging—Popular works. 2. Skin—Aging—Miscellanea. 3. Skin—Care and hygiene— Popular works. I. Title. II. Title: One hundred questions and answers about aging skin. RL73.A35N67 2009 616.5—dc22 2008052310 6048 Printed in the United States of America 13 12 11 10 09 10 9 8 7 6 5 4 3 2 1 CONTENTS Introduction vii Dedication ix Part 1: The Basics 1 Questions 1–9 describe the basic facts about your skin: • What are the layers of the skin, and what are their functions? • Why are geriatric dermatology and aging skin receiving particular attention? • What happens as we age? Part 2: Dryness, Itches, and Allergies 9 Questions 10–20 address common causes of dry skin and treatment options, including: • What causes dry skin? • What about dry skin and itch? • What can you do about dry skin? Part 3: Skin and Pathogens 21 Questions 21–27 describe diseases that affect the skin, such as: • Can I get HIV now that I am older? • What is shingles? • What can I do to prevent shingles? Part 4: Rashes and Bumps 29 Questions 28–38 discuss the types of bumps and rashes that are common with aging skin: • I have a lot of small, warty growths on my back and other places. Should I be worried that these are cancerous? • I get little yellow bumps on my face. Are these cancerous? • It looks like I have acne on my upper cheeks. What is that? 100 Q&A ABOUT AGING SKIN Part 5: Systemic Diseases 37 Questions 39–42 review skin conditions that affect different parts of the body: • What is psoriasis? • I have several small, scaly red patches on my face and arms. What are these, and what can I do? • What is rosacea? Part 6: Cancer 41 Questions 43–49 discuss skin cancer and methods of treatment and prevention, including: • What is skin cancer? • What about melanoma? • How do you prevent these cancers from growing and killing? Part 7: Discoloration 51 Questions 50–53 provide an overview of numerous skin discolorations that are common in aging skin: • Why does my skin seem to bruise easily? • Are liver spots a sign of liver disease? • I have brown patches on my face where it looks like my skin is stained. What are these? Part 8: Skin and the Circulatory System 55 Questions 54–61 review different skin conditions directly affected by the circulatory system, such as: • My leg veins stick out, and I don’t like them. What can I do? • I get little cherry-colored bumps on my skin. What are they? • If I get a dark blue bump on my lip, is it skin cancer? Part 9: Cosmetic Procedures 63 Questions 62–73 describe cosmetic surgeries common among people looking to reverse the signs of aging skin, including: • What can I do for skin rejuvenation? • What is a chemical peel? • What about laser resurfacing? iv 100 Q&A ABOUT AGING SKIN Part 10: Hair and Nails 71 Questions 74–83 review how to treat your hair and nails as you age: • My nails are getting yellow and brittle. What can I do? • My hair is gray and feels thinner. What should I do? Contents • Why do some older people grow excess body hair in places they don’t want, especially the ears, nose, and eyebrows? Part 11: Feet 79 Questions 84 and 85 discuss the best ways to keep your feet healthy, including: • How can I maintain healthy skin on my feet? • I have ugly heels. What can I do? Part 12: Prevention 83 Questions 86–100 provide an overview of how to protect your skin from damage as you age, including: • What role does diet play in skin health? • How does sun protection do me any good now? • What are ways to improve sun protection and prevent skin cancer? Appendix 93 The appendix contains a list of organizations and Web sites to provide more information on how to treat and protect aging skin. Glossary 95 Index 105 v intr Oduction Many people throughout the world are living well into their old age. A person’s physical, as well as psychological, well being is directly affected by his or her general health and the health of his or her skin. Most of us have at least one, if not three or four, skin conditions that can be treated or at least improved with good advice and action. The skin is a magnificent organ. If you could look quite closely at each square inch of skin, you would find about 19 million cells, 90 oil glands, 600 sweat glands, 65 hairs, and tens of millions of microscopic bacteria, and each square inch is nourished and kept active by 19,000 nerve cells and 19 feet of miniscule blood vessels. All of this amazing collection helps to eliminate one third of the body’s waste products and toxins, regulates and maintains water balance and body temperature, uses touch receptors to help us sense pain and avoid harm, and forms a barrier to protect us from outside damage. Clearly, you need to keep this marvelous organ at its best. More today than ever before, the aesthetic function of our skin has taken the forefront in modern media and our own perceptions. The multibillion- dollar cosmetic industry has brought in wave after wave of new techniques and products and has filled our offices, magazines, and televisions with the promise of a forever youthful glow. This is an uphill battle, however, unless you have the right advice that can cut through the avalanche of information, keep up with the advancements, and capture and use what is important to you and your skin type. Although the constant turnover of skin cells allows for renewal and repair, the skin also keeps its own diary, and the cumulative changes show as we age. I see many different skin conditions in the older person, whether they’re in a nursing home or in my office, and I believe that not enough attention is given to skin problems as we age. A delay in recognition leads to a delay in care of those problems. Also, in many areas, there is little access to specialists. 100 Q&A ABOUT AGING SKIN Albert M. Kligman, MD, PhD (inventor of Retin-A®), wrote, “This tradi- tional neglect of the skin is well-nigh unforgivable and has cruel consequences for the well being of the elderly. These diseases do not kill but they are per- sistent pestilences which spoil the quality of life. It is the skin more than any other organ which most clearly reveals the cumulative losses which time prints on the visage of the high and low alike.” Dr.