You’ll have heard of osteoporosis, where bones become weaker and more prone to breakage, often with age – but have you heard of dermatoporosis?
You would probably recognise the symptoms, especially if you’ve spent any time with older people: thin skin that bruises and tears easily and is slow to heal.
The term was coined by dermatologists at the University of Geneva – from ‘derma’ relating to skin, and ‘porosis’ which relates to porosity – to convey a sense of it being age-related, yet preventable.
‘Dermatoporosis is an age-related phenomenon particularly prevalent on sun-exposed areas, such as the forearms and lower legs,’ says Dr Clare Kiely, a consultant dermatologist and a lecturer in skin ageing at the University of Manchester.
This is because sun damage accelerates the ageing process. While the face can be affected as well, it tends to be the limbs that cause concern when it comes to thinning skin because they are more prone to being knocked or scratched.
And when skin is thin like this, even the slightest trauma can result in a bruise or tear that takes a long time to heal.
It’s not a well-studied area of dermatology, but with an ageing population it could be a future health crisis, says Dr Kiely.
‘It might seem trivial, but it can lead to major health issues. For example, skin that is slow to heal can easily lead to cellulitis [infection in the deeper tissues] which can sometimes require treatment in hospital.’
Retinoids are one of the most well-studied ingredients in skincare and can be used to treat dermatoporosis because they help boost levels of collagen and hyaluronic acid
It also makes any surgery on the elderly potentially problematic.
‘Sewing people up when the skin is so thin is like trying to stitch through butter,’ says Dr Kiely. ‘We have to put a bandage on either side of the wound to give the skin extra support so we can stitch it together.’
So what is it that causes dermatoporosis – and how can you prevent it? Dr Magnus Lynch, consultant dermatologist at Guy’s and St Thomas’ NHS Trust in London, says: ‘Skin has two layers: the thin top layer, the epidermis; then the deeper layer, the dermis, a leathery tissue that gives the skin its structural integrity.
‘In younger people, this layer is thick and elastic thanks to the proteins, collagen and elastin, which are produced by cells called fibroblasts. Over time, the collagen and elastin become damaged, while the fibroblasts become less efficient.
‘The result is that skin has less of the proteins that give it strength, bounce and resilience, and the proteins that are there are not organised as uniformly and not replenished as rapidly.’
While the combination of age and sun exposure is largely responsible, dermatoporosis can also be caused – or, in older people, exacerbated – by oral or topical steroids which thin the skin.
‘We now know there are ingredients in prescription and cosmetic creams that could help bolster the skin, so the current thinking is that we should be prophylactically treating skin to prevent dermatoporosis,’ says Dr Kiely. In other words, after the age of around 60, we should think about looking after our skin – and not just for the sake of appearance.
While this is a growing area of study, anti-ageing skincare could have a role to play. Retinoids – forms of vitamin A – and specifically tretinoin, which is the prescription version – are an obvious choice.
‘Retinoids are one of the most well-studied ingredients in skincare and can be used to treat dermatoporosis because they help boost levels of collagen and hyaluronic acid, a component of skin that helps keep it hydrated and supple, but decreases with age,’ says Dr Kiely.
But as this isn’t what it’s licensed for, it could not be prescribed on the NHS. (Although if you saw a dermatologist privately they could prescribe it.) Instead, you might want to look for cosmetic products containing retinol, a less potent form.
Because it can cause irritation, start at a low percentage, around 0.25 per cent, and gradually work your way up to something stronger, around 1 per cent.
One of the interesting ingredients being studied in treating dermatoporosis is calcipotriene, a synthetic vitamin D cream.
According to Dr Kiely: ‘It’s inexpensive and low risk, and in some case reports has been shown to limit the thinning of the skin.
‘That could potentially be prescribed on the NHS, but we need more evidence to back this up before recommending it.’
Antioxidants, such as vitamin C, could also be important.
Dr Kiely adds: ‘We know UV depletes vitamin C in the skin and one study [published in the Journal of the European Academy of Dermatology and Venereology in 2017] suggested the bruising seen in dermatoporosis could be a form of scurvy in the skin.
‘Researchers found treatment with 5 per cent topical vitamin C led to an improvement of the skin symptoms, with beneficial effects on skin elasticity and thickness.’
This ingredient is widely available in cosmetic formulations for the face – but could easily be used on the body, too.
From a prevention perspective, it’s important to use sun protection on exposed skin. ‘For all that this is a condition associated with ageing, we tend not to see it on totally UV protected areas such as buttocks!’ says Dr Kiely.
