Aging skin fragile, bruises more easily
DEAR DOCTOR: I’m 75 years old and have bruising on my hands, seemingly when anything touches them. I do not take blood thinners or aspirin. Occasionally I take an Aleve, which seems to make it worse.
DEAR READER: Easy bruising as we age can be traced to several factors.
First, the distribution of fat changes. This is one of the crueler aspects of aging. Older bodies store more fat in the belly and lose the fat under the skin. This is most easily seen in the face, arms and in the back of the hands. Skin that has lost its subcutaneous fat has lost much of its cushion to absorb trauma. Without this cushion, the small blood vessels that course within and below the skin are more susceptible to direct trauma, leading to bleeding underneath the skin.
Second, the skin loses collagen, its most common protein. After age 20, a person produces 1 percent less collagen in the skin each year. So by age 75, the collagen loss is substantial. This causes the skin to become thinner and more fragile. Without this protection, the blood vessels underneath the skin are more prone to damage.
Third, the skin is less elastic. This means that the skin loses its ability to stretch and absorb external forces.
Finally, the small blood vessels within the layers of skin lose their elasticity as well. This increased fragility allows them to break with only minimal force.
The loss of elasticity and collagen are made worse by prolonged sun exposure. Using sunscreen on your arms and the backs of your hands will help to preserve the collagen and elastin within the skin. In addition, topical vitamins, such as A,E,C and B3, may also help to prevent sun damage. Lastly, smoking cigarettes also degrades collagen and elastin, so I would recommend not smoking.
Nonsteroidal anti-inflammatory drugs thin the blood, making you more susceptible to bruising, as can supplements such as oral vitamin E or fish oil.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.