Some geriatric skin diseases, such as skin cancer, occur almost exclusively in photoaged skin. Poorly defined rough, red dysplastic areas of actinic keratoses are associated with more severe damage and a higher risk of skin cancer. The overall picture may be hypertrophic or atrophic, depending on the patient's complexion and the severity of the sun damage. Thrombocytopenia is often suspected, but platelet function and quantity are not altered. Depigmented stellate pseudoscars on the extremities also indicate photoaging.
Cigarette smoking exacerbates the coarse wrinkling of photoaging.
Loss of immunologic and inflammatory responsiveness is greater than that caused by intrinsic aging alone. Because damage due to photoaging is cumulative, preventive measures are most successful if begun during childhood. However, evidence strongly suggests that avoiding sun exposure and regularly using sunscreen, even after marked actinic damage, achieves considerable clinical improvement. Patients of all ages should be encouraged to wear hats, keep their shoulders covered, and apply sunscreen before going out, as part of their daily routine. Patients should especially avoid going outdoors unprotected when UV radiation is strongest, around midday.