Abigail Waldman, MD
Abigail Waldman, MD, instructor of dermatology at Brigham and Women’s Hospital and Harvard Medical School, both in Boston. She is also director of Mohs surgery at VA Boston Healthcare System.
Bottom Line: Harvard dermatologist’s easy tips for more youthful skin now!
Wrinkles may get most of the attention, but thinning skin is another age-related skin issue you’ll want to pay attention to. Thinning skin not only makes you look older but can cause other skin problems as well.
Fortunately, there are some exciting new advances as well as some effective well-established treatments that can help make your skin thicker and restore its smoothness and elasticity.
Skin is composed of a scaffold called the extracellular matrix, which is made up of proteins including collagen and elastin. This matrix is what gives durability and resilience to skin, allowing it to “snap back” and keeping it from being easily damaged.
As we age, some of the components that make up the extracellular matrix break down. Eventually, fibro-blast cells within the skin no longer make enough collagen…and the old, “worn out” proteins that make up the extracellular matrix don’t get replaced. The result is skin that is thinner and more fragile, which can look saggy, crepey and wrinkled, especially on the face and hands.
In addition to age, a main cause of thinning skin is UV radiation from sun exposure. UV radiation causes -oxidative damage to DNA, skin proteins and the extracellular matrix. People who have had a lot of sun exposure are at increased risk of having thinner skin at an earlier age.
At greater risk:People with very pale skin have less protection from UV radiation, so they are more susceptible to thinning skin. Smoking—another powerful source of oxidative damage—also increases the risk for thin skin.
At less risk: On average, men’s skin is thicker than women’s because men have a higher testosterone-to-estrogen ratio, which helps stimulate collagen production and other skin proteins. So while men’s skin is susceptible to the same factors as women’s skin, it will take longer to be affected.
Risky medication: Prescription-strength topical corticosteroid creams also can thin the skin where they’re applied, and long-term use of oral steroids can cause thinning as well—and the thinning can be -permanent. Areas of special concern are places where the skin is already thin, such as the face, or areas that absorb medication more easily, such as in the armpits or groin. Always follow a doctor’s instructions when using a prescription cortico-steroid. Note: Over-the-counter (OTC) hydro-cortisone cream is generally safe and not a risk for thinning skin.
While you can’t regain the skin of your 20s, there are more options than ever for turning back the clock…
• My top advice: Hydrate! The outer layer of skin (the stratum corneum) acts as a kind of brick wall to prevent water from leaving the body. As we get older—and if you have skin damage from the sun or cigarette smoking—that brick wall gets holes in it, which makes it harder for the skin to retain moisture, resulting in a dry, sallow appearance.
Water is the best all-around hydrator, but any liquid you drink counts, even coffee and tea. It’s a myth that the diuretic effect of caffeine offsets hydration. Of course, you’ll want to avoid soda and other sweet drinks.
To help trap water in skin, I advise an emollient ointment, such as petroleum jelly or Aquaphor (if you prefer not to use a petroleum-based ointment, look for a glycerin-based ointment)…or a product that contains hyaluronic acid, a natural compound that preserves moisture. Many drugstore products containing hyaluronic acid (such as Neutrogena Hydro Boost Water Gel) are as effective as more expensive creams.
• Use this topical, cream, serum and/or supplement. As with any skin-care regimen, the key is consistency and patience. Your skin didn’t thin overnight—it could take weeks or even months before you see a difference when using these therapies…
Topical retinoids are chemical compounds derived from vitamin A. They have been shown to boost the activity of the extracellular matrix, increasing production of collagen and elastin and making the skin measurably thicker. Topical retinoids are available by prescription or OTC (Retinol). Note: A retinoid can cause irritation, so begin by using it for just two to three nights per week until the skin adjusts.
Glycolic acid creams and vitamin C serums increase collagen by combating oxidative stress. Many OTC creams and face washes contain glycolic acid, including Glytone. For vitamin C serums, look for brands that contain vitamins C and E and ferulic acid. Note: Use these products in the morning if you are also using a retinoid, as the combination can be irritating.
Newest treatment: Nicotinamide, a form of vitamin B-3. Research has shown that nicotinamide can actually reverse sun damage that causes skin cancer. A typical dose to combat skin damage from UV radiation is 500 mg of OTC nicotinamide, taken orally, twice a day. Check with your doctor before taking this (or any) supplement.
• Try skin treatments. There are a wide variety of treatments available to help thinning skin. A board-certified dermatologist or plastic surgeon can evaluate your condition and recommend the most appropriate treatment based on your skin and discuss possible risks. Some treatments could be painful, so pain medication or anesthesia may be advised, and you may require more than one treatment to achieve desired results. All treatments should be performed by or under the supervision of a board-certified dermatologist or plastic surgeon.* Examples…
Laser treatments use pulses of light to remove damaged skin, correct imperfections and stimulate production of collagen. Different lasers and frequencies are used for different problems. For example, some lasers target areas of skin discoloration…others correct surface wrinkling…and others penetrate more deeply to correct heavy wrinkles.
Microneedling works to stimulate collagen production via tiny needles that poke minuscule holes in the skin.
Ultrasounduses high-frequency sound waves to boost collagen. The result is tighter skin in areas where the ultrasound is used.
• Guard against injury. People who have thin skin do tend to bruise more easily (see below), especially on the tops of the hands. The greatest risk is when the fragile skin tears open, leaving it vulnerable to infection. These tears should not be covered with an adhesive bandage—removing it may cause more injury. Instead, I advise applying an emollient ointment several times a day to keep the tear moist until it heals.
• Wear sunscreen. To avoid further sun damage, be sure to use a sunscreen with an SPF of at least 30 every day…and wear a wide-brimmed hat when outdoors. Also, avoid being out in the sun during the warmest part of the day (10 am to 2 pm).
Most people become aware of thinning skin because they start to bruise much more easily. Even seemingly insignificant bumps could result in a large purple bruise. They also may start to notice crepey or sagging skin, especially on the face and hands.
Self-test for thinning skin: Pinch the skin on the back of your hand. In a younger person, the skin will immediately snap back flat. In people with thinning skin, the pinched wedge of skin will continue standing and very slowly sink back down to the hand.
*Check with your doctor for costs—they will vary depending on your location.
