References
Periwound skin care considerations for older adults
Abstract
Samantha Holloway and Kirsty Mahoney discuss the unique ageing effects on adult skin and how these changes can cause the skin to be more prone to damage
This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.
Skin ageing is a result of intrinsic factors, particularly a gradual decrease in the levels of oestrogen and progesterone, as well as extrinsic factors, principally ultraviolet (UV) irradiation that leads to photoaging (Papakonstantinou et al, 2012). Changes related to intrinsic aging are largely unpreventable as they are innate changes that result in structural and functional changes in the epidermis and dermis that places skin at increased risk of damage (Farage et al, 2013).
In relation to changes that occur within the epidermis, proliferation of keratinocytes reduces leading to a slower rate of epidermal turnover (Farage et al, 2013). The main role of keratinocytes is to produce new epidermis therefore a reduction in the number of these cells leads to thinning of the epidermis (Nigam and Knight, 2017). Simultaneously, epithelial extensions, known as rete ridges (or pegs), that help to anchor the epidermis to the dermis below flatten out (Parrish, 2017). Flattening of these ridges gives skin the typical wrinkled appearance associated with older individuals (Farage, 2013) (Figure 1).
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