Jul 28

Skin Care for an Older Generation

by Dillon Kato

Montanans of all ages love their outdoor lifestyles. One of the drawbacks to so much fun in the sun, though, is the potential for long-term skin damage as we age, said Dr. Samuel Reck, dermatologist at Billings Clinic and president of the Montana Academy of Dermatology.

The vast majority of skin problems, including skin cancer, come from being out in the sun, he said. As people age, their skin begins to change, largely due to exposure from the sun and ultraviolet light.

“I always tell them to look at their arm, the upper inside is nice and white, with only a few fine wrinkles, then look at the outside,” Reck said.

While some patients tell him they don’t feel they spend that much time under the sun, he said ultraviolet light is a form of radiation, so the dose they receive accumulates over time. UV rays are also a carcinogen, which can cause mutations in the DNA of the skin. They also suppress the immune system.

“We probably all make a few skin cancers every week, but our normal immune system knocks them out,” Reck said.

That doesn’t mean people should shut themselves indoors, he said. Especially in a state like Montana, there is no reason not to be able to go outside and do the things you love.

The best ways to protect yourself are fairly straightforward. Stay in the shade during the day, and wear photoprotective clothing to help block UV rays. Wear a broad-brimmed hat, as a baseball cap doesn’t cover the ears, and wear sunscreen on any areas that are still exposed, Reck said.

With sunscreen, the higher SPF number the better, although it is equally important to find sunscreen that specifically protects against UVA rays in addition to the normal UVB. In addition, people also don’t use enough sunscreen.

“If you’re tanning, you don’t have enough on,” Reck said.

An important area to apply sunscreen, especially in men, is the ears, as certain types of skin cancer on the ears are more likely to metastasize than other parts of the body, Reck said.

The most common type of cancer is basal cell carcinoma. While it is far less deadly than other forms of cancer, it can cause permanent damage and disfigurement, especially around the face. Reck said around 20 percent of white Americans will develop basal cell carcinoma. The most common treatment is a fairly straightforward surgical operation to cut the cancerous tissue out.

“Cutting out a basal cell carcinoma is not like having bypass surgery. It takes about an hour, but you’ll have a nice scar to remember it by,” Reck said.

For cancers that are in a particularly visible area like the face, surgeons can use an advanced technique called Mohs micrographic surgery. This allows them to more precisely locate the cancer during the operation, which can minimize the scar tissue left behind and decrease the chance of a recurrence in the cancer.

One of the most serious skin issues is melanoma, which causes the majority of skin cancer-related deaths. White males over the age of 50 are the highest risk group for developing melanoma, Reck said. In the United States, someone dies of melanoma every hour, and the rates have been going up every year.

It’s very important to catch melanoma early. If found in the early stage, the five-year cure rate is 98 percent, Reck said. If it is able to metastasize, the survival rate is only 16 percent. Early warning signs include a mole that has become abnormal. Asymmetry, border irregularity, change in color or increase in size are all signs that something needs to be looked at, Reck said.

If a person is concerned about something on their skin, they should see a doctor. Unlike some types of specialists, most dermatologists do not require a person to have a referral, although Reck said many people start with a primary care physician.

Apart from the serious issue of skin cancer, Reck said many seniors also struggle with dry skin, especially in a dry climate like Montana. Some types of medications, including those for cholesterol problems, can compound problems with dry skin. One thing the doctor tells older people is that when they shower, they do not need to use soap everywhere, as it dries the skin.

“Soap separates oil from our skin, and as we get older we produce less oils,” Reck said.

Dry skin can be very uncomfortable and itchy, especially in the winter, and can lead to cracked skin that can become infected or inflamed. For patients, especially women, Reck recommends using a moisturizing lotion with sunscreen in it year round, and to apply it right after getting out of the bath or shower.

A person who has had a skin condition, or even some form of skin cancer can, by improving their prevention habits, have their skin heal itself to a certain extent. Reck said it’s never too late to make positive changes and live the type of lifestyle you want.

Dillon Kato is a Missoulian reporter. He can be reached at dillon.kato@missoulian.com.

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