In old age the sex hormones which exerted a significant influence on certain areas of our skin in the decades from puberty to menopause are no longer active. Blemishes which may proliferate on the skin at this time are by no means confined to females.
The earliest signs of photoageing (see chapter 9) start to appear in the fifties or even earlier. Skin cancers are more likely to appear in later life. Solar lentigines (large irregular flat freckles) appear on the face and hands. As the collagen in skin degenerates, bruising occurs easily on the exposed areas of the hands and forearms, resulting in large purplish bruises which seem to `come from nowhere' after very minor knocks and scrapes.
Seborrhoeic keratoses and skin tags start appearing in increasing numbers (chapter 9). Many women put on weight at this time, and this seems to encourage growth of skin tags around the armpits and sometimes in the groin. They are also common under and between the breasts and on the neck. A frequent complaint is that they rub on clothing or catch on necklaces etc.
A recurring nuisance, particularly in overweight women, is a red itchy rash under the breasts, in the groin and other skin folds, called intertrigo. (See chapter 5.) Moisture and sweating in the warm skin folds encourage the yeast candida, resulting in the complication of thrush. Treatment is targeted at alleviating the sweating by using drying powders andwearing clothing which allows the skin to breathe, and is also aimed at reducing inflammation and clearing up the thrush. Hair tends to decrease in most areas except the face, and some women develop coarser eyebrow hairs. Many women discover to their extreme exasperation that whilst they no longer need to worry about hair removal on the legs or armpits they now need to don their bifocals to pluck stray hairs from their chin.
Apocrine sweat glands become less active in old age, so sweat odour usually becomes less of a problem. Nails thicken and become ridged. Itchy skin associated with dryness and exaggerated by cold weather and low humidity can be a problem for some older women. Waterdispersable bath oils are helpful. It is also helpful to use less soap and aim to use mild unperfumed soap or to apply emollients immediately after bathing and towelling dry. Moisturisers containing 10 per cent urea, glycerine and olive oil are all effective in aged, dry skin.
In later life cherry angiomas, which are also called `Campbell de Morgan spots' start appearing in increased numbers. These are bright cherry red raised or flat spots consisting of collections of tiny, dilated blood vessels. They vary in size from pin point to a few millimetres in diameter, and occur mainly on the trunk from middle age on. They tend to disappear in very old age. The tendency to dilated blood vessels (telangiectases) on the cheeks and nose becomes more exaggerated in the elderly as the skin becomes thinner and less elastic. Elderly women may develop dilated veins, called venous lakes, on the lips, causing bluish swellings which can look quite alarming but are not dangerous. Likewise, the venous networks or so-called starburst vessels on the legs are exaggerated as the ageing skin becomes thinner.
There are methods available to remove or at least significantly diminish many of the unwelcome blemishes that pro-liferate on the skin as a result of ageing and photoageing. These are discussed in chapter 9. Potentially dangerous spots should be treated on medical grounds. As for the innocent or benign blemishes which are of only cosmetic nuisance, thenthis is up to the individual. Many middle-aged and ageing women are not concerned about minor blemishes. They believe, quite rightly, that they have earned their wrinkles and skin spots and are entitled to keep them! In The Change Germaine Greer writes of `secret marks of age, the witch marks' which could be seen `if we were to be hauled off and stripped naked at our own witch trial'. But she urges us to have the last word against the ageists and `assume the witch's right and cackle in our turn'.
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