Tune In: The Unexpected Signs of Skin Aging According To An MD

When we discuss aging within the context of beauty or skin care, the topic immediately zeros in on symptoms such as wrinkles, dark spots, and sagging. But these are not the only changes that the skin experiences with age. In fact some of the lesser known signs of aging skin are just as pressing of concerns—if not more.

"These lesser discussed components of aging that aren't necessarily the typical 'beauty' components are still very much front and center for people who experience them," board-certified dermatologist Anar Mikailov, M.D., tells me in this episode of Clean Beauty School.

Mikailov knows a thing or two about skin aging and appearance—as he co-authored a textbook on it, Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, Ninth Edition. He's also the founder of Skintensive and KP Away, both dermatological skin care brands that target specific skin concerns such as bruising, Keratosis pilaris, and so on. 

And while he's certainly correct that the beauty industry doesn't spend as much time discussing things like skin atrophy or bruising, these issues are fundamentally aesthetic. For example, skin thinning is the underlying mechanism behind what's commonly called "crepey skin," and increased bruising can lead to permanent skin discoloration. 

Just like your bones lose density or your muscles lose strength, your skin loses structure. This is a natural—and in many ways unavoidable—part of aging. 

"Fundamentally, there are biological processes that lead to skin, muscle, joint, and bone aging. In terms of bone, most people have heard of the term osteoporosis. Well, for skin there's a new term called dermatoporosis that's basically the same concept, which is chronic cutaneous insufficiency or fragility," he explains. 

And just like osteoporosis is a common concern (notably for women), so is dermatoporosis. "About 40% of individuals 60s and over will have some manifestation of this, and these manifestations can be both visual and functional." 

One of the most visual manifestations folks struggle with is skin atrophy. "My patients will often refer to it as maybe crepey skin, but it's just skin that is much, much, much thinner," he says. Crepey skin is often used to describe skin that appears crinkly, thin—much like crepe paper. It most often appears on the neck, chest, face, hands, and arms.

As frustrating as crepey skin can be for folks, it's not the visual manifestation of dermatoporosis—even if it is the most famous. 

"Dermatoporosis results in what is called dissecting hematomas, which are very large bruises that are much more frequent," she says. "When frequent bruising happens over and over and over again, it actually leads to the visual change of actinic purpura. This is what happens as the bruise heals; it can actually leave pigmentation in the skin, which is sort of darker or rust colored." 

As part of this aging process, skin loses some of its resiliency—its ability to bounce back, recover, and heal itself. Essentially, skin experiences a much slower wound response.

"As we age, we know our immune system slows down and becomes much less effective," he explains. We tend to think of our immune system as purely internal, an intangible system that fights off colds, infections, and diseases. In reality, the immune system is a network of organs that work together—one of which, being the skin. 

Yes, the skin has its own immune function, and when it falters, we see changes in the skin's appearance. "Its decline plays a key role in the body's inability to perform wound healing and repair," he says.    

One of the best ways to support your skin's immune system is to use antioxidant-rich topicals, in the same way that you may eat antioxidants to support your internal immune system.