The Evidence on Skin and Aging, Without the Hype

Key takeaways

• Main driver of visible aging on exposed skin: cumulative UV exposure
• Evidence-based topical: retinoids, with sunscreen
• Most useful single change: Use daily sun protection, which is the single most effective measure.
• Commonest mistake: Tanning beds.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

The changes in skin structure and function that come with age and cumulative UV exposure. It sits within Skin Health. The figures come from the bodies named at the foot of this page.

The numbers, in one place

What helps

You do not have to do all of it, and you do not have to start today.

• Use daily sun protection, which is the single most effective measure
• Stop smoking
• Moisturize; older skin is drier and more fragile
• Check your skin regularly, as skin cancer risk rises with age

What to avoid

The usual wrong turns. Some are more tempting than others.

• Tanning beds
• Expensive products with no evidence over basic sun protection
• Dismissing new or changing spots as "just age spots"

In depth

Skin ages in two overlapping ways. Intrinsic aging happens everywhere with time: the outer layer renews more slowly, the dermis produces less collagen and elastin, oil and sweat glands become less active, and the fat layer beneath thins. Skin becomes thinner, drier, less elastic and slower to heal. These changes are fairly subtle on skin that has been protected from the sun, such as the inner upper arm.

Photoaging, caused by years of UV exposure, adds much more visible change to the face, neck, chest, arms and hands. UV breaks down collagen and causes abnormal elastic tissue to build up, leading to deep wrinkles, leathery texture, uneven pigment, age spots and small broken blood vessels. Smoking, air pollution and poor sleep add to the damage through similar pathways involving inflammation and oxidative stress.

Aging skin is also more vulnerable. Thinner skin and more fragile blood vessels mean bruising and skin tears happen more easily. Fewer immune cells in the skin and years of accumulated UV damage raise the risk of skin cancer. Reduced sensation and slower healing make pressure injuries more likely in people with limited mobility. Skin care for older adults is therefore about comfort and safety as well as appearance.

Signs and symptoms

• Fine lines and deeper wrinkles, especially on sun-exposed areas
• Dry, rough or itchy skin
• Flat brown spots on the hands, face and arms, often called age or liver spots
• Raised, waxy, stuck-on growths called seborrheic keratoses
• Easy bruising and purple patches on the forearms
• Thin skin that tears with minor bumps

Causes and risk factors

• Cumulative ultraviolet exposure over a lifetime
• Smoking, which reduces blood flow and damages collagen
• Natural decline in collagen, elastin and oil production
• Hormonal changes, including lower estrogen after menopause
• Long-term use of steroids and blood thinners, which increase fragility and bruising
• Repeated facial expressions and sleeping positions, which deepen lines over time

How it is checked

Most age-related skin changes are recognized by a doctor or dermatologist on examination, and no test is needed. The main reason for a professional skin check is to distinguish harmless changes, such as seborrheic keratoses, cherry angiomas and sun spots, from precancerous actinic keratoses and skin cancers, which become more common with age.

Your doctor may use a dermatoscope to look more closely at spots and may take a biopsy if anything looks suspicious. They may also review your medicines if you bruise easily or have frequent skin tears, and check for conditions such as diabetes or poor circulation if wounds are slow to heal.

Treatment and support options

Daily sun protection

Using a broad-spectrum sunscreen of SPF 30 or higher on exposed skin every day, along with hats and shade, slows further photoaging and lowers skin cancer risk. It is never too late to start; protecting skin later in life still reduces new damage and allows some repair. Many daily moisturizers include sunscreen for convenience.

Retinoids and other topicals

Prescription retinoids, such as tretinoin, have the strongest evidence for improving fine lines, rough texture and uneven pigment from sun damage. Over-the-counter retinol is a milder option. Retinoids can irritate at first and increase sun sensitivity, so start slowly and use sunscreen. Other ingredients, such as vitamin C and alpha hydroxy acids, may offer modest benefits.

Moisturizing and gentle care

Older skin benefits from gentle, fragrance-free cleansers, shorter lukewarm baths and generous moisturizers, which ease dryness and itching and help protect against tears. Apply moisturizer while skin is slightly damp. Use soft towels and pat rather than rub. Protect fragile areas such as the shins and forearms with clothing.

Cosmetic procedures

Treatments such as chemical peels, laser resurfacing, injectable fillers and neuromodulators can improve the appearance of wrinkles and sun damage. They carry costs and risks, are generally not covered by insurance, and work best when performed by a board-certified dermatologist or plastic surgeon. Ask about expected results, downtime and side effects.

Prevention

• Protect skin from the sun every day, starting as early in life as possible
• Do not smoke
• Moisturize regularly, especially in dry weather
• Eat a balanced diet rich in fruits and vegetables
• Get the shingles vaccine as recommended for adults 50 and older

Day to day

Caring for aging skin is about comfort, protection and noticing change. Make skin checks part of your routine, paying attention to new spots, sores that do not heal and growths that change. Keep nails short to avoid scratching injuries, and remove trip hazards and sharp edges at home to reduce skin tears. Long sleeves and pants can protect fragile skin during gardening and household tasks.

For people with limited mobility, pressure injuries can develop over bony areas such as the hips, heels and tailbone. Changing position regularly, using pressure-relieving cushions and mattresses, keeping skin clean and dry, and checking for redness that does not fade are important. Caregivers should report any broken or discolored skin over pressure points to a doctor or nurse promptly.

For specific groups

Women after menopause

Falling estrogen levels after menopause are linked to drier, thinner skin and reduced collagen. Regular moisturizing, sun protection and gentle skin care can help. If skin changes are bothersome, talk to your doctor about options, including whether any treatments for menopausal symptoms are suitable for you.

People taking blood thinners or steroids

These medicines can cause easy bruising and fragile skin. Do not stop them without talking to your doctor. Protect your arms and legs, take care with sharp edges, and report large or unexplained bruises, which may need a medicine review.

People in long-term care

Residents of nursing homes and people who spend much of the day in bed or a chair are at higher risk of pressure injuries and skin infections. Good nutrition, regular repositioning, prompt incontinence care and daily skin checks by staff help prevent problems.

Questions to ask your doctor

• Are any of these spots precancerous or cancerous?
• How often should I have my skin examined?
• Would a prescription retinoid be appropriate for me?
• Could any of my medicines be causing easy bruising or skin tears?
• What can I do about dry, itchy skin as I get older?
• Have I had the shingles vaccine, and do I need it?

More questions, answered

Do expensive anti-aging creams work better?

Price does not predict effectiveness. Many expensive creams contain ingredients with little evidence. Daily sunscreen, a retinoid and a good moisturizer provide most of the proven benefits at a much lower cost. Be cautious of products promising dramatic results.

Are age spots dangerous?

Solar lentigines, commonly called age or liver spots, are harmless flat brown spots caused by sun exposure. However, melanoma can look similar, especially a type that appears on sun-damaged skin of older adults. Any spot that is changing, has irregular edges or color, or looks different from others should be checked.

Can I reverse sun damage?

Some sun damage can be partly improved with sunscreen, retinoids and procedures such as peels and lasers. Protecting skin from further sun allows some natural repair. However, deep wrinkles and the accumulated risk of skin cancer cannot be fully reversed, which is why prevention matters.

Why do I bruise so easily now?

With age, skin thins and the blood vessels beneath become more fragile, so minor bumps cause bruises, often on the forearms. Blood thinners, aspirin, steroids and some supplements add to this. Tell your doctor about frequent or unexplained bruising, or bruising elsewhere on your body.

Do diet and supplements affect skin aging?

A diet rich in fruits, vegetables and healthy fats supports overall health, including skin. Evidence that specific supplements, such as collagen, prevent aging is limited. Avoiding smoking and protecting skin from the sun have far greater effects than any supplement.

Is it too late to start using sunscreen?

No. Sun protection at any age helps prevent new damage and reduces the risk of skin cancers, which continue to develop in later life. Starting a daily sunscreen habit in your 60s, 70s or beyond is still worthwhile.

Related topics

• What the Guidance Really Says About Skin in Later Life (Healthy Aging)
• Bruising and Bleeding: Sorting the Evidence From the Noise (Blood Health)
• The Evidence on Sun and the UV Index, Without the Hype (Environmental Health)
• Skin Cancer: What Published Guidance Supports (Cancer Awareness)

Where to go next

• The Skin and Aging Checklist: What to Do and What to Skip
• What People Get Wrong About Skin and Aging
• Skin and Aging — the reference entry
• Skin Health: The Complete Guide
• Itching: What the Evidence Actually Says
• Sun Protection: What the Evidence Actually Says

When to speak to a doctor

See your doctor about any new, changing or non-healing skin spot, which becomes more common with age and should never be assumed to be a harmless age spot. Report skin tears, slow healing or easy bruising, which can reflect medicine effects or an underlying condition. Call 911 for a fall with a head injury in anyone taking blood thinners.

Where this comes from

• National Institute on Aging — Skin Care and Aging
• American Academy of Dermatology — How to prevent skin cancer

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.