ATROPHIA SENILIS

Synonyms.—Atrophia cutis senilis; Atrophoderma senile; Senile atrophy; Old
age of the skin.

Old age changes in the skin are commonly observed after the six­
tieth year is passed, and sometimes earlier, although rarely before the
age of forty-five or fifty.¹ The skin is noted to be of a dull yellowish
hue, with sometimes a greenish tinge; it is dry, inelastic, with often
positive thinning, sometimes slight scaliness, usually of a branny char­
acter; somewhat wrinkled, with here and there pigmented areas of
freckle-like nature, and pea- to bean-sized yellowish or brownish spots,
covered with a variable amount of grayish or brownish sebaceous scali-
ness or crusting, which, if removed, often discloses a red, sometimes
granular-looking, surface and atrophic thinning (degenerative seborrhea).
Sometimes, instead of being so covered, the coating is found to be hard,
somewhat horny, and firmly adherent, or there may be small, thickened,
corneous, pea- to bean-sized, slightly scaly or crusted areas, which may
also undergo surface degeneration—keratosis senilis. These senile
keratoses, as well as the degenerative seborrheic patches, which may often
begin as slightly horny, scurfy spots, are not infrequently the seat of
epithelial changes, which may develop into epithelioma, although they
frequently persist for years without displaying any destructive tend­
ency. In some instances slight white or grayish atrophic points or spots
are also noted, and dilated capillaries, isolated or in tufts, are quite fre­
quently seen. A pigmented pea- to finger-nail-sized slightly elevated
wart, covered with a greasy brownish coating (seborrheic wart, verruca
senilis), and sometimes present in considerable number, is also not an
uncommon lesion; at times the surface is slightly uneven or papillomatous.
Small, solid fibromata which may have existed, more commonly on the
neck and back, undergo central absorption or atrophy, and remain as
shriveled, pendulous sacs. The face and dorsal surface of the hands
are the sites where the changes are usually most conspicuous, although
the shoulders and upper part of the back, and also the lower part of the
legs, frequently show one or several of the described lesions. The upper
part of the back and less frequently the dorsum of the hand are favorite
regions for the sebaceous warts, where several to ten, fifteen, or more
sometimes develop.

These various lesions are not, however, necessarily present in the

¹ Rossbach (Ein merkwürdiger Fall von greisenhafter Veränderung der allgemeinen
Körperdecke bei einem achtzehnjährigen Jüngling), Deutsch. Archiv f. klin. Med., 1884-
85, vol. xxxvi, p. 197, reports with 4 illustrations, an extraordinary instance of senile
wrinkling and other changes in the skin in a youth of eighteen, giving him the appear­
ance of a man of advanced years.

618

ATROPHIES

same individual: in some a dry, inelastic, slightly harsh, possibly
somewhat branny, condition of the skin is noted, with an accentuation
of the natural folds or wrinkles, whereas in others the skin is somewhat
similarly affected, with a general dingy hue and with many pigmentary
or freckle-like spots, with, possibly, one or two small crusted seborrheic
patches. These latter are more common about the nose and sides of
the forehead. As a rule, there are no subjective symptoms associated
with these various conditions, although in those instances in which the
dryness and harshness, with a tendency to branniness, are especially
pronounced, there may be, particularly upon the extremities, a variable
amount of itching.

Fig. 146.—Old age changes—atrophic, pigmentary and keratotic, with shriveling or

wrinkling.

The histologic changes have been studied by Neumann, who found, in
the quantitative or simple atrophy, thinning of the epidermis and corium,
with its connective-tissue corpuscles usually smaller and less numerous.
Partial or complete disappearance of the papillæ is noted. Pigment
is found between the connective-tissue bundles and also here and there
in the vessels. The sebaceous glands and hair-follicles also generally
show some alteration, the former being sometimes observed with dilated
acini filled with epidermic scales and débris, and in other cases seem
made up of a yellowish-brown mass. The sweat-glands rarely show
change. In degenerative atrophy a granular or vitreous degeneration

STRIÆ ET MACULÆ ATROPHICÆ                    619

of the cutaneous elements, especially of the connective tissue, takes
place, considered by some as amyloid or fatty degeneration. Unna¹ is
inclined to believe that simple atrophy is not observed as a senile change,
but that it is always degenerative in nature, and that the different con­
stituents do not share in it equally. He calls attention especially to the
fact of the relative youth and proliferative power of epithelium in the
aged, compared to the connective tissue, as demonstrated by the tend­
ency to epithelial growths at such age.

Treatment.—While nothing can ordinarily stay the ravages of
time, the maintenance of a condition of good health, hygienic living,
and cleanliness, with frequent bathing, will do something toward dimin­
ishing its effects. Scurfiness and dryness can be counteracted by an
occasional oily application, such as almond oil, vaselin, or cold cream.
The tendency to degeneration, as displayed by the seborrheic spots and
the corneous accumulations, can best be stopped by ointments contain­
ing sulphur and salicylic acid, 5 to 30 or more grains (0.335-2.) of the
former, 3 to 20 (0.2-1.335) of the latter, to a half-ounce (16.) of cold
cream or vaselin: to be rubbed in nightly, the strength of application
depending upon irritability of the skin, stopping just short of irritation.
The timely use of such applications has, in my hands, often stayed the
tendency to epitheliomatous change, a fact to which Montgomery² and
others have also attested. (See also Keratosis senilis.)

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