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Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Monday, January 6, 2020

Woo's Pick, January 2020

Levine J. Clinical Aspects of Aging Skin: Considerations for the Wound Care Practitioner. Adv Skin Wound Care 2020:33(1):12-9.

Approximately one in every seven Americans is over 65 years of age. Further, the number of older adults has doubled in the past 10 years, and the fastest growing population is people who are age 85 years and over. This seismic shift in demographic demands a better understanding of aging skin and its implication on wound prevention and care. In this recent CE/CME by Dr. Levine, he reviews salient aspects of aging skin including concepts of skin failure, Skin Changes At Life's End, and frailty. The exact mechanisms for aging remain elusive, but it is linked to mitochondrial and DNA damages by free radicals, telomere shortening, chronic inflammation, and stem cell dysfunction. "Inflammaging" is a new term introduced to describe the deleterious effects of inflammation dysregulation on the immune-neuroendocrine system that leads to a plethora of chronic health conditions such as cardiovascular disease, dementia, infections, cancer, and skin changes. There are intrinsic age-related changes associated with inflammaging that can have a significant impact on the structural integrity of the skin and its barrier function. The skin becomes thinner because of the loss of its extracellular matrix and related major components that play a vital role in stabilizing the interwoven network of collagen and elastin fibers.

Visual changes of the aging skin have been described previously in the literature. Dermatoporosis is characterized by senile purpura, stellate pseudoscars, and skin atrophy, which make the skin more vulnerable to frequent lacerations. We also have the term "skin frailty" to refer to transient or chronic skin changes as evidenced by texture irregularity, atrophy, poor turgor, and loss of tensile strength due to abnormal skin hydration, insufficient perfusion, impaired desquamation, loss of collagen or elastin, excessive inflammation, and scarring. Early identification and prompt intervention to address skin frailty may help prevent skin breakdown, which is generally accepted as a standard indicator for quality of care, performance, risk, and patient safety.