338 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS in pigmentation, and pigmentary responses are changed. Due to the uneven lessening of all skin functions, it can be theorized that there will be overcompensation for the loss of function with resultant occasional over- growth. This would partially explain the so-called "progressive changes" in a senile skin in the face of diffuse degenerative changes (10). On gross inspection of the skin in aging, we see what are called senile freckles appearing on the tops of the hands, face and shoulders. Vascular lesions appear, and several types of localized thickenings called keratoses develop. The senile keratoses are thickenings involving squamous cells, are skin-colored, and appear in light-exposed areas. They occur most frequently in individuals who have a thin skin, with sandy complexion. They also occur in persons who have exposed their skin to light to an excessive degree. Repeated actinic exposure, such as sunbathing and repeated use of sun lamps, take their toll, beginning five to fifteen years later. The same condition is seen in persons who work with light-sensi- tizing chemicals. Unfortunately, this state, to date, is not reversible, but requires constant medical attention to control the keratoses and their all too frequent further development into skin cancer. The seborrhoeic keratosis occurs in areas where oil gland activity has been excessive. This is a soft, yellowish-brown, greasy scale, of varying size, which can be scraped off, leaving a moist surface. This lesion occurs about the hairline, on the face in front of the ears, and on the neck and trunk. In people who have a history of ache or seborrhoea, we sometimes see almost innumerable seborrhoeic keratoses over the covered areas of the chest and back. These rarely become malignant, although they sometimes get quite large. They are unsightly and often create dis- comfort because they may itch a great deal. The telangiectases of Dubrueihl are tufts of arteriolar capillaries, little red marks, either fiat or elevated. Cutaneous tags are skin-colored masses, usually attached by a pedicle, and look just like pieces of outgrowing skin. Seborrhoeic warts are small sized filiform or sessile growths, either skin- colored or light brown, which usually grow on the neck and upper chest and axillae. They seem to be related to the sweat mechanism. They develop in "crops" and are seen often in women during pregnancy, or during any other major hormonal shift. Another change sometimes seen with aging is the development of tiny yellow fat deposits in the skin, especially on the face. These act as local irritants and we sometimes see low-grade skin cancers developing in them. Another interesting phenomenon with age is a noticeable differentiation between the male and the female skin. In old men there is two to three times as much skin fat secretion as in old women. But there is no relation

THE DERMATOLOGIST, THE OLDER WOMAN AND COSMETICS 339 between fat secretion and the amount of clinical wrinkling. The only relationship is to the size and activity of the pores. Large pores just produce more oil (11). Grossly, with age the hair becomes grayed, the skin looks a little de- hydrated, pale and off color, the nails become thick and sometimes horny. The cells of the skin which normally are being softened by sweat and oil even when being discarded become very dry. The skin develops a branny, fine, white scaling as a result. The completely keratinized cells of the nails do not fall off easily but are tightly and dryly adherent so that the nails are actually thicker. The decrease in appropriate amounts of fat and water accounts for some of the discoloration of the nails. In the older person we are faced with some special conditions. One of these we call "lichenification." This is a circumscribed area of diffuse thickening due mainly to friction. Constant scratching, nervous man- nerisms, repeated leaning on the same spots of skin--as on the elbows and knees--repeated rubbing, or spraying on of irritants, all give rise to this condition. Furthermore, the older person has a reduced oil barrier and becomes more sensitive to many agents, such as industrial and house- hold chemicals, and cosmetics such as hair dyes, depilatories and deo- dorants. Multiple etiologic factors influence the onset of aging. Environment is important in many ways. Weathering, by wind and by actinic rays, makes for a difference in quality of skin between a farm woman, or a golfer and the indoor type of person. Heredity is also significant. Nutritional factors, internally speaking, are of the utmost importance. Vitamin deficiencies, shortages in proteins, water, fats and carbohydrates produce specific changes. The effect of each of the endocrine glands is profound, and in this field there is still much exploration to be done. Disease of almost every type influences the condition of the skin. Cir- rhosis of the liver, cholesterol imbalance, fevers and malignancies take their toll. We know that nail growth, as an example, is slowed in in- fectious diseases, as in mumps. Nail growth is actually stopped when an individual has a stroke with paralysis on one side. Actually, this fact was utilized long ago by physicians. When the nails began to grow on a paralyzed side, recovery of motion to varying degrees could be expected to follow (12). Disease is not always of a purely physical nature. Of course, in dis- cussing women we are not supposed to admit that they could be any- thing but all beauty and loveliness. When they are emotionally ill, we tend to soften the label by calling them "nervous." Hostility, hate, fear, selfishness, demand, whether for money, position or affection, lust and dishonesty do occur in women and are reflected in the expressions