Skin after 65: dryness, itch and fragile skin

If your skin feels drier, itchier and easier to bruise or scrape than it used to, you’re far from alone. Skin changes with age in ways that make it lose water faster and repair more slowly. The good news is that a few gentle habits make a real difference, whether you’re caring for your own skin or helping a parent.

Why skin gets drier with age

Your skin’s outer layer, the stratum corneum, works like a brick wall: flattened cells held together by fats (lipids) that keep water in. With age, that wall changes.

A 2020 review of itch in older adults describes what happens:

• Fewer lipids in the “mortar” between skin cells, and less activity in the enzymes that make ceramides, key barrier lipids.
• Less oil and sweat, because oil and sweat glands become less active.
• A less acidic surface. Skin pH drifts up, which slows the enzymes that build the barrier.
• Slower repair. When the barrier is damaged, it takes longer to recover.

The result is dry skin, which doctors call xerosis. A 2023 analysis that pooled 28 studies found that about 53% of older adults have xerosis, with rates highest in nursing homes. It was just as common in men as in women, and the lower legs were the most commonly affected area.

Canadian winters make it worse. Cold outdoor air and dry, heated indoor air pull even more water out of skin that’s already struggling to hold it.

Itch: the most common complaint

Dry skin itches, and in older adults that itch can be constant and hard to ignore. The same 2020 review reports that chronic itch affects somewhere between 11% and 78% of older people, depending on the study, and that it can disturb sleep and mood as much as chronic pain.

Dry skin is the most common cause. But not the only one. The review lists other causes worth ruling out:

• kidney disease, liver disease and thyroid problems
• iron deficiency
• side effects of medications
• skin conditions such as scabies or bullous pemphigoid (a blistering condition more common in older adults)
• nerve-related itch, for example after shingles

That’s why itch that doesn’t settle with two weeks of good moisturizing deserves a visit to the doctor, especially if it’s widespread, keeps you awake, or comes with a rash or blisters. It’s also worth asking your pharmacist to review your medications.

When dry skin cracks: asteatotic eczema

Sometimes very dry skin goes a step further. DermNet describes asteatotic eczema, also called eczema craquelé, as a rash caused by dry skin. It has a distinctive cracked look, like crazy paving: diamond-shaped plates of dry skin separated by thin red lines.

It’s most common on the shins of older people and can spread to the thighs, arms and trunk. DermNet lists these triggers:

• low humidity and winter weather
• frequent bathing, soaps and detergents
• direct heat, such as sitting close to a fireplace or heater
• some medications, including diuretics (water pills) and retinoids

Treatment starts with bathing less often, switching to a gentle cream cleanser and applying a thick moisturizer every day. Inflamed areas may need a mild prescription steroid cream for a short time, so see your doctor if the skin is red, sore or spreading.

Skin tears: fragile skin needs gentle handling

Older skin is also more fragile. A skin tear is a wound caused by mechanical force, such as a bump against furniture, friction from a sheet, or pulling on the skin while helping someone move. The top layer can peel back like a flap.

According to wound-care experts writing in Wounds International, about 1.5 million skin tears happen each year worldwide, and they can lead to hospital stays or make them longer. People at higher risk include older adults with fragile skin, dementia, limited mobility, very low or high body weight, or several long-term health conditions.

Moisturizing matters here too. The same experts report that applying moisturizer twice a day has been shown to cut skin tears by about 50% in care settings. Other prevention steps they recommend:

• use a pH-balanced cleanser instead of ordinary soap
• avoid hot water and rough towels
• check the skin regularly, and teach family and caregivers what to look for

If a skin tear happens, the aim is to preserve the flap and the skin around it. The experts recommend silicone-based dressings over standard sticky adhesives, which can damage fragile skin further. Have a nurse, pharmacist or doctor look at it, especially if it’s large, bleeding a lot, or shows signs of infection.

A gentle daily routine

The same basics help with dryness, itch, asteatotic eczema and skin tears.

Washing

• Keep baths and showers short and lukewarm, not hot.
• Use a mild, fragrance-free cleanser instead of alkaline bar soap, and only where it’s needed.
• Pat dry with a soft towel; don’t rub.

Moisturizing

• Moisturize at least twice a day, and always after washing. Pay special attention to the shins, feet, hands and arms.
• Choose products that both add water and replace lipids. A 2019 German position paper suggests that the drier the skin, the richer the product should be, and says the best evidence among ingredients is for urea. Ceramides and other natural moisturizing ingredients may add to its effect.
• Fragrance-free is a safer bet for skin that reacts easily. A fragrance-free moisturizer is a good place to start.

Around the home

• Consider adding humidity in winter, as the 2020 review suggests.
• Wear soft, non-irritating clothing.
• Handle fragile skin gently when helping someone dress, wash or move.

If moisturizing is hard to manage, for example because of arthritis or reduced mobility, ask for help: home-care or nursing staff can build it into a daily routine, as the wound-care experts recommend for care settings.

Skin after 65 is drier and more fragile because its barrier has fewer lipids, less oil and a slower repair system. That dryness causes much of the itch older adults feel, can crack into asteatotic eczema, and makes skin tears more likely. Short lukewarm washes, gentle cleansers and moisturizing at least twice a day protect against all three. And if itch or dryness persists despite good care, it’s worth a doctor’s visit to look for other causes.