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In the final episode of the Dermatology Through the Decades series, Dr. Zain Husain, Heather, and Courtney explore the biggest skin changes that occur in your 60s and beyond. From thinning skin, chronic dryness, bruising, and hair loss to skin cancer prevention and healthy aging, they share practical, evidence-based advice to help you care for your skin throughout your later years.
The team discusses why skin becomes more fragile with age, how medications and chronic health conditions affect your skin, when an "age spot" might actually be skin cancer, and why it's never too late to improve your skin's health. They also cover moisturizers, sunscreen, compression therapy, lifestyle habits, cognitive health, and treatments that can improve skin quality—even in your 80s and 90s.
Whether you're entering retirement, caring for an aging parent, or simply planning ahead, this episode offers practical guidance for maintaining healthy skin and a healthy quality of life.
00:00 – Welcome to Dermatology Through the Decades: Your 60s & Beyond
01:00 – Why skin becomes thinner, drier, and more fragile
02:00 – Dry skin, itching, and common causes after 60
03:00 – Moisturizers, humidifiers, and protecting your skin barrier
04:30 – When itching may signal an underlying medical condition
06:00 – Neuropathy, diabetes, and foot health
06:45 – Why skin cancer becomes more common with age
08:00 – Warning signs of skin cancer you shouldn't ignore
09:00 – Why sunscreen still matters after retirement
10:00 – Treatment fatigue and balancing quality of life
12:00 – Building trust with your dermatologist
13:00 – Benign growths vs. skin cancer
16:00 – When old scars and injuries deserve another look
17:30 – Easy bruising and fragile skin
19:00 – Venous stasis, leg swelling, and circulation problems
22:00 – Compression socks, movement, and preventing leg ulcers
24:00 – Hair thinning, scalp issues, and nail changes
28:00 – The best skincare routine for mature skin
30:00 – Lifestyle habits that promote healthy aging
31:00 – Gardening, exercise, brain health, and preventing dementia
33:00 – Frequently asked questions about aging skin
35:00 – Should you wear sunscreen if you're indoors?
36:00 – Persistent itching and when to seek medical care
38:00 – Is it ever too late to improve your skin?
41:00 – Final reflections on caring for older adults
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
63 - Skinside Out
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Dr. Zain: [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zane, with Courtney and Heather. So today we are continuing our journey through dermatology through the decades. So we have now entered our 60s and beyond. So what changes are we seeing?
Heather: I think one of the most common things we see is the skin thinning.
Dr. Zain: Mm-hmm.
Heather: Um, you're easy to bruise, you're easy to nick yourself, and it takes forever to heal. Um, we see it most commonly on forearms and, like, shins, but, um, lots of things are happening to cause this. You're losing collagen over time. The actual thickness of your skin is thinning. So, um, that's one of the biggest things that I see.
Dr. Zain: Hmm. And back onto the theme of dryness.
Courtney: Yeah.
Heather: Mm-hmm.
Dr. Zain: So from our previous [00:01:00] decades, um, you know, it's that continuing drying factor. Mm-hmm. Like s- oil production is decreasing. Um, patients get really dry, and they're also getting really itchy. Mm-hmm. Like asteatotic eczema- Yeah ... which is an eczema from that dryness.
You know, the skin barrier is getting disrupted and, you know, they're constantly itchy. We see a lot of itchy-
Courtney: Yeah ...
Dr. Zain: older patients.
Courtney: Yeah. Well, and you think about, too, like, you know, what medications they're on. Um, I think that can definitely play a influence. Um, you know- Yeah ... some of them might cause dryness that causes the itching.
Some of them might just cause itching. So-
Heather: And chronic diseases- Yeah ... like liver- Mm-hmm ... and kidney stuff can cause- Mm-hmm ... itching, too.
Dr. Zain: Yeah. Um, pigment changes, right? So continuing along with that. More sun exposure, more, um, you know, sunspots, or lentigos as we call them. However, you know, a lot of people are developing more seborrheic keratoses, and that's one of the leading driving forces for, like, patients to come and see us 'cause they think it's, oh, it's a melanoma, it's, like, a growth, you know, it's changing colors and getting bigger and having symptoms.
But [00:02:00] these age spots, um, or liver spots- Spots
Courtney: of wisdom ...
Dr. Zain: oh, wisdom spots. A
Courtney: lot of patients like spots of wisdom.
Heather: Leaves in the garden of life.
Dr. Zain: Yeah. That's right.
Courtney: Barnacles.
Dr. Zain: So we see a lot of benign stuff popping up, too. Yeah. And these are attributed to genetics.
Heather: Mm-hmm.
Dr. Zain: Yeah.
Heather: We see the skin, um, slower to heal, so it's gonna take a lot longer, especially the lower on the body, um, being further away from blood flow.
Um, so that takes time.
Dr. Zain: Yeah. So many of these concerns we see in our clinic, um, are related to these normal aging processes, but the good news is we can do certain things to help treat them. So let's talk about dry skin and itching. So what's going on with our skin?
Heather: Um, I think there are a lot of things that contribute to the dry skin.
So we have reduced natural oils at this age, um, especially in the winter, like with the lower humidity, it can be exacerbated. [00:03:00] Um, if you're bathing a lot or using harsh soaps, that can accentuate it as well, and like Courtney mentioned, certain medications. Um, so oftentimes this presents as dryness, flaking, um, rough texture, any sort of persistent itching and cracking skin.
Dr. Zain: Yeah. And when we have these, you know, patients who are complaining of dry skin, um, obviously we tell them to moisturize, but any other tips that you would recommend for dry, itchy skin?
Heather: Avoid hot water. Yeah. It feels so nice, but it's horrible-
Dr. Zain: Yeah ...
Heather: for your skin. Yeah. Figuratively, it melts your skin barrier.
I
Courtney: think the humidifier. Mm-hmm. I'm a big humidifier fan. Mm-hmm. Um, using thicker, like, creams or ointments can be really helpful, instead of lotions. A lot of people love a lotion, but a lotion, it's water-based so it's not as thick.
Heather: I have had a lot of people recently, not 60s and up, but just a lot of people in general, um, love Lubriderm.
And I felt [00:04:00] like Lubriderm- Oh, yeah ... was kind of, like, out.
Courtney: No, pe- you're right. Lu- Lubriderm? That and ponds. Yeah.
Heather: Those are- And ponds. Yeah. Yeah. They're like, um- That's what my parents used to use. Yeah. Yeah. I think they're... It's like a- They just
Dr. Zain: love it.
Heather: Yeah. It's like a cult or something.
Courtney: Yeah, my parents have a bottle of Lubriderm that I'm pretty sure has been there since before I was born, under their, um, bathroom counter.
Oh,
Dr. Zain: gosh. But, like, not all itchy skin is caused by just lack of hydration. Right. Um, so we have dry, itchy skin that can stem from more systemic reasons, right? Mm-hmm. So, medications.
Courtney: Mm-hmm.
Dr. Zain: And you can have systemic diseases, um, like especially our, like, kidney disease patients, especially those on d- dialysis, they're always dry.
Courtney: Mm-hmm.
Heather: Mm-hmm.
Dr. Zain: Um, so you know, make sure that you always are mindful of those other factors that can lead to dry skin.
Heather: Yeah.
Courtney: And I think one thing, too, that, um, a lot of people don't know is itching from, like, nerve compression or nerve damage. Mm-hmm. So, natalzia, uh, prursitica- Mm-hmm ... in the, in your back, over time as [00:05:00] your, you know, your body's kind of-
Dr. Zain: Mm-hmm
Courtney: getting more compressed, you can have those nerves get compressed, and it can create this, uh, itching sensation. So you might think that you have a rash back there, but really it's just, um, the, the nerves back there. So in that case, a lot of times we'll recommend something like capsaicin or, um... There used to be something else we used to recommend a lot, too, but something to help more with, like, the nerve damage rather than the actual dry skin.
Heather: Mm-hmm. Yeah. Thyroid disease.
Dr. Zain: Diabetes.
Heather: Yeah.
Dr. Zain: Diabetics are usually very dry.
Heather: Yeah.
Dr. Zain: And they can have neuropathy, too, so sometimes they're getting skin changes in their feet because they can't feel their, um, the surface of the, of the floor when they're walking, and there's constant stress on certain joints, in the skin.
Yeah. So we do see a lot of changes with that.
Heather: I had a lady recently who was like, "I've had this, um- I don't think she had diabetes, or maybe she was pre-diabetic, but she said, "I, I think I'm having a little pain in my foot, and I don't know why." Or, oh, [00:06:00] no, no, that's not what it was. It was a red spot. She had a red spot on the bottom of her foot, so she thought it was like- Mm-hmm
a mole, and she wanted it checked out. She did not have any pain or anything like that. Um, so I misspoke. But she had a piece of glass in her skin-
Dr. Zain: Oh,
Heather: wow ... in her foot. Mm. Yeah, and I was really surprised, um, because it wasn't so painful. Mm. So I think she did have- Some neuropathy ... pre-diabetes or, yeah, something like that.
So some sort of neuropathy, but I was really shocked that it was not-
Dr. Zain: Mm ...
Heather: bothering her at all.
Dr. Zain: Interesting.
Heather: Yeah.
Dr. Zain: That's why we do thorough skin exams. Yeah. Um, let's talk about sun damage and skin cancer. I feel like this is the time of life where we really see these sprouting up. So the accumulation of sun damage, more mutations, and eventually over time, your skin cells, you know, eventually just turn into these cancerous cells.
And you will likely see more than one if you have had s- heavy exposure. So, like, you know, I have patients who are constantly coming in for biopsies, you know, something new [00:07:00] popped up, you know, last week. And they ask me, "Why? I haven't been in the sun for the past, like, you know, couple years." I'm like, "Mm-mm.
This is back when you were in your 20s, 30s- Mm-hmm ... 40s, and, you know, not protecting yourself. And now unfortunately you're paying for the, the consequences of that." So.
Heather: Yeah.
Dr. Zain: Um, most common type of skin cancers?
Heather: Basal squamous melanoma.
Dr. Zain: Yeah. And in terms of things that we should look out for for cancer.
Courtney: Yeah, usually things that are there, especially if they're there for four weeks or more, I think that's always, um, worth getting it checked out.
Um, that sore that doesn't really heal. New spots, um, spots that bleed easily or, you know, get irritated, um, something that's growing really quickly. I think those are all kind of red flags to go see- Mm-hmm ... your dermatologist.
Heather: Or, like, a rough patch or, like, a rough- Mm ... like, little flake that you flick off- Mm-hmm
and then it just, like, comes right back.
Courtney: Mm-hmm. Yeah. Mm-hmm. Yeah, the comes and goes- Yeah ... of the pre-cancerous spots. Yeah.
Dr. Zain: So many of my patients [00:08:00] after I tell them that, "Oh, it's because of cumulative damage," they're like, "There's no point in protecting my skin now, right?" So what do you say to that? I mean, I already have the damage.
It's gonna come.
Courtney: Oh, are you planning on that? I need to get more. Like, yeah. Yeah.
Dr. Zain: I never understand these arguments.
Courtney: I know. I think people like to just argue. Yeah. Yeah. They just like to beg the question. Well, what if? Yeah. Yeah. I'm like, "Then why don't you try it?"
Heather: Yeah. I'll see you back. Well,
Courtney: and like you said, you know, last episode, people are living longer.
Mm-hmm. So, you know, I just think about like, yeah, do you still wanna be, like, 90, getting cut on? Like, I don't know. I wouldn't, but...
Heather: Yeah. At what point- Yeah ... it's, like, the quality of life. It's hard- Mm-hmm ... at that age, like, especially if they have a lot of skin cancers. It's like, what do you do?
Dr. Zain: Yeah. Mm-hmm. And I feel bad.
I mean, some of these procedures are painful.
Heather: Yeah.
Dr. Zain: You know, we're freezing, uh, pre-cancers and early skin cancers. We're doing surgery. Mm-hmm. We're doing, uh, field therapy with chemotherapy creams or photodynamic therapy. Yeah. These are all not pleasant things.
Heather: Yeah.
Dr. Zain: Yeah, and especially if [00:09:00] you're constantly having to come back to us.
Heather: Yeah.
Dr. Zain: And unfortunately, you know, sometimes we do. We have those frequent flyers.
Heather: Mm-hmm.
Dr. Zain: They're here all the time.
Courtney: I know. I th- I'm thinking about- I feel bad ... our, like, old man in his 90s. Yeah. Yeah. He's so sweet. I just saw him-
Dr. Zain: Yeah ... last week.
Courtney: He- yeah, yeah. Yeah. And he's in all the t- I love him. I love him. I, we're always- I love
Heather: old
Courtney: people.
I know. I just feel so bad every ti- I'm like, you know- Yeah ... you're, every time you come in, we're basically cutting on
Heather: you. We were, we were just talking about how, like, happiness and satisfaction, um, increase in the 60s, but if you're having to come in, like you said, to the office- Mm-hmm ... like, over and over and over to get treated on certain things, I feel like that can really affect-
Courtney: People get treatment fatigue.
We've had quite a few- Oh, yeah ... patients at our practice that- Yeah ... you know, they have, unfortunately, multiple... I mean, we're talking six or seven, maybe eight, nine skin cancers, and, you know, after that fourth one, they're just so fatigue. They don't wanna treat anymore. Mm-hmm. Yeah. And I get it. I mean, it's such a hard line, but again, it's, you know, obviously you wanna treat it.
It's [00:10:00] cancer. So, you know, I think from a provider standpoint, just trying to be understanding on the timeline- Yeah ... of, like, wanting to do your job, but also- Mm-hmm ... understanding.
Heather: Yeah. I think it's very interesting how- People view skin cancer very differently to other cancers. Mm-hmm, mm-hmm. I feel like if you had like a lymphoma or leukemia or something like that, you wouldn't just be like, "Eh, I'm not gonna treat it."
Yeah. I feel like-
Dr. Zain: It's just, "Oh, it's skin."
Heather: Yeah. You know, it's easier. They think it's just like that little spot- Mm ... and there's not gonna be any issue, it's just gonna stay there and-
Dr. Zain: Yeah ...
Heather: not really change.
Courtney: Yeah.
Dr. Zain: And remember, you know, squamous cell carcinoma, even though it's really common- Mm-hmm ... and unlikely to metastasize, it can.
Heather: Yeah. We've
Dr. Zain: seen it. Um, melanomas definitely can.
Heather: Mm-hmm.
Dr. Zain: And even basal cells can cause a lot of damage locally. I mean, I've had patients who have let these basal cells grow- Mm-hmm ... and, like, literally take over their entire orbit- Yeah ... of their eye. Yeah. And it's just these fungating masses coming out of there.
I'm like, "How did you let this go?" Yeah. But, you know, some patients just, you know, I guess are afraid to get treatment. Yeah.
Courtney: Yeah. [00:11:00] Yeah. I think I've talked about before the patient I had at my previous practice. Like they're in denial. Yeah. He had white coat syndrome for sure. Mm-hmm. And it just was unfortunate because it got to the point where it basically took his nose, a basal cell.
Yeah. And you know, you just think, wow- Mm-hmm ... if he had just come in- Mm-hmm ... like, when it first started, it would've been an easy Mohs procedure. Yeah. Probably would've had a tiny little scar, but-
Heather: Yeah. Well, the lady, um, that has eight basals that I'm treating right now- Mm-hmm ... or that I'm seeing, she didn't go to the dermatologist for years because she had a basal cell years ago, and she was kind of like traumatized.
Dr. Zain: Traumatized.
Heather: Yeah.
Dr. Zain: Yeah. I mean, the patient experience does matter. Um, you know, how your procedures go- Yeah ... how your skin exams go, like, that perception can change everything for the patient. Mm-hmm. And yeah, I mean, we want to empower our patients. We want them to feel really, um, you know, safe and, you know, also being, feel like they're being well taken care of.
Mm-hmm. And if you're rushing in and out and just doing biopsy left and right, or not really [00:12:00] taking the time to help, you know, comfort them-
Courtney: Mm-hmm ...
Dr. Zain: um, it can be pretty, pretty, um, scary.
Heather: Yeah.
Courtney: Yeah, that's what I was gonna say. I think even from like a patient standpoint, I think having, like, a trusted relationship with your provider, your dermatologist, is so important.
Like, it does give you that, like, you know, freedom to say like, "Hey, like, I do wanna treat this, but, like, I might need like a, a month or two." Mm-hmm. Yeah. Like, "I've been treating nonstop, and I'm just feeling a little fatigued." Yeah. And, like, being able to work- Yeah ... with your provider to say, "Okay" Mm-hmm. "Like, well, let's take a break," or, "Let's plan for this," or, "Here's some other options"-
Heather: Yeah
Courtney: I think just makes for a better treatment course for everyone, so.
Heather: Yeah. "Is it okay if I wait, like, till next month to
Courtney: treat it?" Mm-hmm. Mm-hmm. Yeah. Instead of just canceling, you know? Mm-hmm. I, I think it's always better to talk with your doctor and figure out a plan rather than just cancel and then, you know, you let it go and- And then you forget
Heather: about it
Courtney: you forget about it- Yeah ... and it grows and grows and- Yeah. Yeah.
Dr. Zain: And I always think of medicine as an art. It's not an exact science. Yeah. So yeah, you have to take, um, the patient's life into perspective, you know, what their wishes [00:13:00] are- Mm-hmm ... what they, you know, what their goals are for their treatment. I mean, some of them are just like, "Hey, if it's not gonna kill me-" You know, we, let's just do the minimum we can just to keep it at bay- Mm-hmm
and, you know, let me have my quality of life. So just making those judgment calls I think is really important, and I have, I've had to do that with a few patients. I'm like, "I don't think it's probably in your best interest to kinda keep pursuing aggressive therapy if that's not really what you're, what you're wishing.
And if we can just keep it under control using, like, you know, non-invasive methods like photodynamic therapy or chemotherapy, um, topically, um, I think that's, that's not a bad option."
Heather: Mm-hmm.
Dr. Zain: I mean, we can at least stunt the growth and prevent it potentially from spreading. Mm-hmm. Um, sometimes it does actually clear it up.
Mm-hmm.
Heather: Mm-hmm.
Dr. Zain: So, you know, sometimes doing less is more.
Heather: I think we see, like, the full spectrum of, like, this side where patients want every little spot-
Dr. Zain: Mm-hmm ...
Heather: removed, and then you have this side of the spectrum where it's, like, I think there's [00:14:00] actually a lot of younger people, too, who are totally fine with having things on their skin.
As- they're just like, "Oh, I just wanna make sure that it's benign- Mm-hmm ... and I'm not wor- like, I'm, if it's fine, I'm not gonna mess with it."
Dr. Zain: Yeah.
Heather: So I feel like we see a lot of differing opinions on that.
Dr. Zain: But regardless, I mean, if you are noticing, like, a lesion that's not healing, if it's just having s- new symptoms, it's always just safer just to come get checked out.
Heather: Yeah.
Dr. Zain: Yeah. So in contrast to malignant lesions, we see a lot of benign lesions growing. So what are our favorites that we see on skin exam?
Heather: Barnacles. I don't call them barnacles, but, um, seborrheic keratoses, which are little, um, genetic, usually rough and brown, um, spots that can get itchy, but, um, we called them wisdom spots earlier.
Um, solar lentigines, which are the little, like, sunspots, um, flat brown spots. Um, cherry angiomas, which are the little red dots. They're vascular. They're also genetic. You'll get more of them, [00:15:00] trust me. Um, and then skin tags, I think, just with, um, especially in high-friction areas, over time, that can induce more of those to form.
Dr. Zain: Yeah. I mean, most of these are, you know, they're harmless. They don't really cause issues. Sometimes they can get irritated, and that's sometimes when we would opt to, like, treat it, but usually you're just gonna just leave them be and they won't cause any problems. However, there are some times where they look very similar to skin cancers.
Yes. I've had patients referred to me for cosmetic shaves of mole. I'm like, "This is a basal cell." Um, and- I
Heather: had, actually, a patient, um, yesterday.
Dr. Zain: Really?
Heather: Yeah, the same exact thing. She thought it was a mole, and I think it's a pigmented basal cell, but we'll see.
Dr. Zain: Interesting.
Heather: Yeah.
Dr. Zain: Um, I actually had this interesting patient.
He's actually a physician, and he had got into a car accident many years ago. Um, and he had, like, this growth in the middle of his forehead, and he just thought it was glass from, like, you know, they just couldn't get out from the accident. Oh. And it was actually a [00:16:00] basal cell, and- Wow ... he's a physician himself, so I mean, I'm like, "This does not look like glass."
Yeah. "This looks like skin cancer." Yeah. So we biopsied, and lo and behold, it came back as skin cancer. But, um, you know, even, even really highly educated individuals in medicine- Mm-hmm ... can get that wrong.
Heather: That's why I think things like this, like the podcast, are really helpful because I think it's just getting awareness out there.
Mm-hmm People often assume it's one thing, and it's something completely different. Mm-hmm. But if you have, you know, a story in the back of their mind of like, okay, think something that's not healing or something that's bleeding easily, then they kind of know, um, like for the listeners to get it checked out.
Courtney: People naturally like to put puzzle pieces together, and especially when we start seeing, like, skin cancers arise in places of, like, old, like, scars or things like that. People naturally wanna say, "Oh, well, I've had this scar for years." Mm-hmm. And it's just the scar itself, and they don't realize that w- in that skin, in that damaged skin, it, you can be more likely to [00:17:00] develop skin cancers there.
Mm-hmm. So it's not always, yeah, a result of, "Oh, my scar is just getting a little more raised," or, you know, my- Yeah ... my wart that I had frozen off 20 years ago- Mm-hmm ... must just be the same thing. Mm-hmm. I think it's always worth getting it checked out.
Heather: Like the lady who had, like, got pricked by the rosebush. Oh, yeah.
Oh, yeah. And then it
Dr. Zain: was
Courtney: this thing, so. Yeah. Yeah.
Heather: She's like, uh-
Dr. Zain: She was so surprised.
Courtney: Yeah.
Heather: Yeah, yeah.
Dr. Zain: She was like, she swore it was like this, like, this splinter in there.
Heather: Yeah.
Courtney: Yeah.
Heather: Yeah. And
Courtney: I think we were surprised too. It looked, you know, it just came up so fast. Yeah. Yeah. You know?
Dr. Zain: And she gave that history, like, "Oh, I was in the garden."
Heather: Right.
Dr. Zain: And, you know.
Heather: Yeah.
Dr. Zain: All right. So let's talk about bruising. Um, what do we see in this decade of life?
Courtney: Yeah, I think a lot of, um, medications can contribute. Mm-hmm. So obviously your blood thinners. Mm-hmm. Um, Eliquis, Warfarin, even your baby aspirin, fish oil- Mm-hmm ... things like that can contribute- Mm-hmm ... to bruising.
Um, the thinner skin, of course, is definitely gonna play a role as well. Um, loss of, you know, [00:18:00] collagen and just overall that combination is, yeah, I think we see a lot of bruising. And it's unfortunate- Mm ... 'cause I think a lot of people think that, like, I feel like we get a lot of people who come in with bruises, and they think that they're, like, pigmented spots- Hmm
instead of realizing- Yeah ... that it's a bruise, you know?
Dr. Zain: Yeah.
Courtney: Um, so it's really interesting.
Dr. Zain: I have a lot of patients who are really distressed by them.
Courtney: Yeah. Mm-hmm.
Dr. Zain: They really don't like them. Mm-hmm. And they last forever and, you know, they ask me about therapeutic options.
Heather: Mm-hmm.
Dr. Zain: And there aren't many great ones.
Mm-hmm. So I always recommend, you know, things that help with blood vessel, um, integrity, right? So, um, things like, you know, arnica and bromelain, um, tend to help. I also think that there's certain prescriptions, like Vascula, I found actually pretty helpful. Mm-hmm. I don't know if you've seen it with your patients, but- Yeah
I, I've been impressed.
Heather: Yeah.
Dr. Zain: And some patients have come back with really good success with that. Mm-hmm. Um, but other than that, it's really tough.
Heather: Mm-hmm. Retinoids, like retinoid body creams can [00:19:00] potentially help thicken the skin slightly.
Dr. Zain: Yeah.
Heather: But, you know, it can only do so much.
Dr. Zain: Yeah.
Courtney: Best solution, don't hit your skin, and you won't bruise.
Heather: Don't hit your skin?
Courtney: Yeah. Don't run into anything, and you won't bruise. Oh, man. That's my advice. That's really good advice.
Heather: It's
Courtney: like- It's like when people come in, they're like, "Oh, it really hurts when I touch it." Okay, don't touch it.
Dr. Zain: Yeah. So what are some risk factors? So obviously we talked about blood thinners, and just being older, your skin's thinner, but are there other, um, systemic diseases that can contribute?
Heather: Mm-hmm, diabetes for sure. Mm-hmm. Um, poor circulation, we see a lot of, uh, like stasis dermatitis form as well. Ton of it. I
Courtney: was gonna talk about that- Yeah ... because
Heather: I think
Courtney: that's so common, and I think-
Heather: People- ... it's so...
Courtney: Yeah ...
Heather: I think a l- a lot of people don't know- Um ... what it is. Yeah. So
Courtney: what is it, for those who don't know?
Heather: So it's this, like, inflammation and kind of like a rash that forms most commonly on the shins [00:20:00] and the lower legs from decreased blood flow or, like, peripheral vascular disease.
Dr. Zain: Yeah. I mean, if you think about it, our lower extremities, um, you know, blood pools there- Mm-hmm ... and our venous system has to kind of bring it back to the heart.
Heather: And it uses valves to do it.
Dr. Zain: Exactly. It's really
Heather: just creating that
Dr. Zain: But as you age, those valves become incompetent, right? And now there's, like, more of that blood just pooling in the legs, and, you know, some of those red blood cells extravasate into the skin, and that's what leads to that, like, purple-ish, rusty color.
Mm. So we get pigmented purpura. Yeah. Um, those purple-y kind of, uh, legs that we see with venous stasis dermatitis. I mean, it can even lead to ulcerations, right?
Courtney: Mm-hmm.
Heather: Oh,
Dr. Zain: yeah. Yeah. And those are really tough to treat because the circulation's bad to begin with- Mm-hmm ... and wound care is just difficult in general.
Heather: It is.
Dr. Zain: So.
Heather: Yeah.
Courtney: Yeah, those ulcers are so difficult to treat, and they can take so long to- Yeah ... heal. I think, yeah, that's one of the, the hardest, hardest things to see.
Heather: Yeah. [00:21:00]
Dr. Zain: Yeah. So, like the swelling that we see associated- Yep ... with that really contributes. Mm-hmm. And longterm, like swelling, so even people with, you know, cardiac disease, like with heart failure- Mm-hmm.
Yeah ... um, kidney disease, um, they're just really swollen in their legs. Mm-hmm. And that constant, like, pressure- It's
Courtney: all
Dr. Zain: that fluid ... on the skin. Yeah. Yeah. Sometimes you can actually see the fluid- Yeah ... kind of just extravasate. You can, you almost see, like, sometimes even bulla- Mm-hmm ... or blisters- Yeah ... filled with all that fluid- Yep
because- Yeah ... it
Courtney: has nowhere to go.
Dr. Zain: Exactly.
Heather: Yeah.
Courtney: Yeah. Compression socks are, are the way to go. I mean, you know, elevating the legs above the heart. Um, but compression socks can really be helpful in preventing that. Um, I say that as I don't do it. But, um, but I do try to keep my legs elevated. Yeah. Um, I think that's really important.
Heather: I think a lot of people, you know, after their 60s, if they're losing mobility- Mm-hmm ... whether that's from, like, an injury or pain or anything going on, that can- [00:22:00] minimize the blood flow too, because, you know, when you're moving and, and you're exercising, that blood flow is constantly pumping, and so that can help, um, like excrete some fluid from the lower extremities.
So- Yeah ... um, movement helps.
Courtney: And there are medicines too, like Lasix or, um- Mm-hmm ... Furosemide. Um, I just went to go visit my friend's, uh, father-in-law this past weekend, and he's taking a over-the-counter supplement that he s- his legs are like the size of like, I don't know, my stomach. Mm. I mean, they're huge.
Yeah. And he's like, "Oh, I found this over-the-counter supplement that's supposed to help." And I'm like- Good luck ... maybe when they were like this small, but now they're really big. I don't think it's gonna drain all that fluid, so.
Heather: Yeah.
Dr. Zain: So when should you seek attention? Um, when like, you know, these lower extremity, you know, wounds or swelling, rashes, um, bruises, um, when is it a concern?
Heather: I don't know. I think that's kind of a tough question because [00:23:00] if your skin is showing signs of things like the rash- Mm-hmm ... or like an ulcer forming, definitely. Um, but even just trying to catch it early too, like if you are noticing just the swelling in general, um, if you can, um, get it treated before we get to- Mm-hmm
ulcers and having to do like Unna boots and all that stuff- Ugh ... it can really save you. That
Courtney: gave me PTSD. Yeah. A Unna boot, ugh. Yeah. I hope I never have to do one
Dr. Zain: again. So something that I saw a lot during training was, um, cellulitis of the legs, right? Yeah. And there was always this consult to be evaluated for bilateral cellulitis of the legs, but it was all essentially inflammation- Yeah
from venous stasis disease. And, you know, it w- they weren't really infected.
Courtney: Yeah.
Dr. Zain: Um, because unusual to have infection on both legs at the same time. Mm-hmm. Right. Um, so that's just something that I always keep in the back of my mind. But if you're noticing increasing warmth- Mm-hmm ... you know, a lot of pain, drainage, um, and [00:24:00] especially if it's unilateral or only one-sided- Mm-hmm
you know, you really do wanna be, um, you know, concerned about, you know, infection.
Courtney: Mm-hmm.
Dr. Zain: Yeah. All right. So let's move on to hair and nails. So what do we see in our 60s and beyond?
Courtney: Thinning hair.
Dr. Zain: Mm-hmm.
Courtney: Gray hair, even though I started seeing that in my 20s. Yeah. I think you too.
Heather: Same.
Courtney: Uh, most people- Yeah ... get it later in life.
Yeah. Um, and then definitely, uh, yeah, hair loss, I think, like, you know, the receding hairline. Mm-hmm. Um, lack of density for sure. Mm-hmm. I think people notice, uh, that, you know, dryness or itching, but on the scalp. I, I think we get a lot of older patients who do- Yeah ... experience that. Yeah.
Dr. Zain: Yeah, that seborrheic dermatitis or that itchy scalp is very common.
Heather: Yeah.
Dr. Zain: Yeah. And I don't know what it is, but like, it drives these patients crazy.
Courtney: Oh, yeah. Yeah.
Dr. Zain: Like crazy.
Courtney: Yeah. We had a patient who, um, at my last practice, he had dementia, and he was just tearing up his scalp. It was [00:25:00] like so itchy, and his wife- Mm-hmm ... like just didn't know what... I just felt so bad. She... You know, we were giving him steroid, and we were giving nonsteroidals, everything, and it's just, um, it was driving him up a wall and, you know, it's, it's so hard to treat.
Heather: Yeah. Yeah. Yeah, definitely. For the nails, we see a lot of thickened nails- Mm-hmm ... brittle nails, splitting, anything like that, but we also see fungal infections- Fungus ... a lot, a lot. Um- Do
Dr. Zain: you think it's worth treating at this point?
Heather: Um, I think it depends. Mm-hmm. Yeah. I think if they're in their 60s, um, I think they can get really good benefit out of it.
Mm-hmm. But, um, like later in life, especially if you're on a lot of medications- Mm-hmm ... um, it does become hard, and some people are not compliant. Even if they just wanna do topical, it's difficult. Yeah. And so, I don't know. I
Dr. Zain: feel like topical is, has such a low success rate. Yeah.
Heather: Yeah, and- And
Dr. Zain: patients get reinfected
Courtney: And the type of nail thickening they have is not conducive.
[00:26:00] Like-
Heather: Yeah ... more top- It's like you need, you need oral Yeah.
Courtney: They need more than just a topic- Yeah ... that topical's not even getting in there. No. You know? No.
Heather: And the nail grows a lot slower this- Yeah. Um, you know, in the 60s and beyond. So it's gonna take forever for things to heal.
Dr. Zain: Yeah.
Heather: Yeah. I
Courtney: know. I just...
I'm having, like, like PTSD flashbacks of, like the Unna boot with like the- With the, the ... yeah, with the fungus. And like you... A Unna boot, for those who don't know, is you're basically like wrapping up the legs, and-
Heather: It's like a zinc-impregnated wrap that you wrap up, and it's wet- Mm-hmm ... but then it dries. Oh, I see.
Kind of like a cast. Yeah. Like a soft cast.
Courtney: And like when you are a medical assistant, you have to do a Unna boot, and these older people, and God bless them, and I love them so much, but they come in with a really thick nail. The fla- like, the flakes are -
Heather: Yeah ...
Courtney: flakes of skin are coming everywhere. Yeah. It's really stressful, and you're like trying not to breathe, and you're trying not to move.
You're trying just to wrap this leg- I
Heather: was like- ... and like not touch anything ... the Unna boot specialist at
Dr. Zain: my previous practice. Oh, are you? Well, they had a lot of patients for you.
Heather: I have done a lot of [00:27:00]
Courtney: Unna boots. You know what I was thinking too? Is like I don't even know that a single one of our medical assistants right now know how to do- No
a Unna boot. No. And I'm gonna teach them. Yes, you gotta teach them. Yeah. I don't ever wanna do that again.
Heather: Yeah.
Dr. Zain: So you're gonna teach them photography and Unna boots.
Heather: Yeah. You're gonna have a fun training session. There's a specific way you gotta wrap it.
Courtney: Yeah.
Heather: Yeah, I mean- I've never had my patients come back 'cause their Unna boot fell off.
Courtney: Yep. That, that's good. Oh, nice. Yeah.
Heather: That's true. Yeah. Or it's too tight. It can be really tight. Yeah. And then they'll come in like two days later 'cause they're like- Yeah ... they got a little muffin top.
Courtney: Sometimes it's a little- Well, it's hard, too, when they're so swollen. You're hoping that that swelling goes down, and then it loosens a little bit.
Yeah. But yeah, if they're not-
Heather: Yeah ...
Courtney: if that swelling's not going down, then it's- We
Heather: did Unna boots after every- You're really
Dr. Zain: passionate about Unna boots.
Heather: I guess so, yeah. Terrible. I've done so many. I terrible. Yeah.
Dr. Zain: Like, let me tell you about the Unna boot.
Heather: We did Unna boots after every Mohs surgery on the lower leg.
Dr. Zain: Every single one.
Heather: Every Mohs surgery. Yeah.
Dr. Zain: I mean, apparently it's supposed to help outcomes.
Heather: It does, yeah.
Dr. Zain: Right. I honestly have had
Heather: no
Dr. Zain: problems. I know. Yeah. But then again, most of my patients, they're on the face, so-
Heather: Yeah, [00:28:00] yeah ...
Dr. Zain: much good vascular supply. All right. So skincare for our more mature skin. How do we go about dealing with this?
Courtney: Mm-hmm.
Dr. Zain: What do we advise our patients?
Courtney: Um, I think sticking to more gentle products is always- Mm-hmm ... key. Um, like I said earlier, just using a little bit more thicker moisturizers can be helpful. Not using so, so much of the lotion base where it's water-based, but something a little bit heavier. Um, obviously, yeah, your sunscreen.
Um, which again, will also help prevent future things, but it will... Like skin cancers, but it will also help with things like the bruising or, you know, um, melasma treatments that maybe are not as, you know, dangerous I guess you could say.
Dr. Zain: I've been really liking, um, you know, using sunscreens with patients that have more actives in it.
So like the Isdin with the- Mm-hmm. Oh, yeah ... enzyme repair. Mm-hmm. This is a great time to start using it 'cause not only will it protect you from, you know, future sun damage, but it's also repairing some of that damage that's currently in place. Yeah. [00:29:00] Mm-hmm. I love that stuff. So I'm a big fan of that.
Anything else?
Heather: Lifestyle. Oh, that's right. I'll get this one this time. Um, it's super important to, you know, incorporate other habits that can help your skin in addition to, um, using or having a really good skincare routine. So, like, making sure you're getting quality sleep. I know it's... Um, it gets a lot harder to have quality sleep.
You
Courtney: should be. If you're retired- Mm-hmm ... you should be getting-
Dr. Zain: Yeah ...
Courtney: quality
Heather: sleep.
Courtney: Yeah. That's right. Like, I hate talking to my
Heather: parents-
Courtney: But I think- ...
Heather: and they're
Courtney: like, "Oh, I didn't sleep well last night."
Heather: Yeah. What do you have going on? I think later, though. Yeah. Like, in the 70s and 80s, I think a lot of people don't sleep well.
Yeah. Yeah. Like, whether it's- I think there's
Dr. Zain: sleep disruptions and just with how-
Heather: Yeah ...
Dr. Zain: with aging. Mm-hmm.
Heather: Yep. Yeah. Um, trying to be active when you can, that is going to help longevity-wise in numerous ways. Um, avoiding smoking. It... I think we didn't really mention this previously, but, like, with the wound healing-
Dr. Zain: Mm-hmm
Heather: it, it makes a huge difference if you are a smoker. Yeah. Um-
Dr. Zain: You know, when I'm doing, like, Mohs, um, cases and [00:30:00] doing, like, complex reconstruction, like flaps and grafts, I tell them, "You are not to smoke." Yeah. "Otherwise, this thing will die."
Heather: Mm-hmm. Yeah. Yeah. And
Dr. Zain: because it really does make a huge difference.
Heather: Yeah.
Mm-hmm. Yeah. Yeah. I think that kind of brings light to a lot of people's eyes, too. Mm-hmm. Um, staying hydrated and making sure you're eating lots of fruits and vegetables, um, lots of antioxidant-rich foods. Mm-hmm. Nice.
Courtney: I think also, like, just separate from a dermatology standpoint, but also, like, getting into, like, more, like, I think brain-fueled activities.
Yeah. Like, doing puzzles or, like- Yeah ... you know- Mm-hmm ... Sudoku or, like, I don't know, keeping your brain active. I think that's huge. Like,
Heather: reading is so important. Learning a new language.
Courtney: Yeah. Yeah. Mm-hmm.
Heather: It can actually, um... I don't wanna, um, mess this up, so I'm not gonna say exactly percentage-wise, but learning a new language significantly reduces your risk of dementia over time.
Oh. Really? Yeah.
Courtney: Hmm. Yeah.
Dr. Zain: Yeah. And I think that, you know, especially, um, for me, my dad has Alzheimer's disease. And, [00:31:00] you know, I just have seen him just regress over time. And, you know, I just thought, like, "What could he have done to help stall this?" Mm-hmm. And, you know, I really do think, I mean, if he had spent more time with more, like, these cognitive puzzles- Mm-hmm
and other, you know, activity, I think it would be a lot better off than him watching TV. Yeah. He's watching the news all day long. Yeah. Yeah. You know? That's very scary. Like CNN. I'm like... Yeah. Yeah. So, um, that way, I am going to, you know, make sure that I, you know, keep up with that, keep my mind stimulated, keep my body stimulated, um, because otherwise I feel like stagnation's the first step to decline.
Courtney: Yeah.
Heather: Mm-hmm.
Courtney: Yeah.
Heather: I think one thing that came to mind, especially 'cause I love gardening, um, if you're having trouble, like, getting your body to move- Gardening is so... I think a lot of people in their 60s and beyond love gardening because they can do things, and [00:32:00] it's still like a very active hobby.
Dr. Zain: Mm-hmm.
Heather: Yeah, it's a great
Dr. Zain: hobby.
Heather: So yeah, finding hobbies that, you know, push your mind or push your body can be really beneficial.
Dr. Zain: And finding a good physical therapist- Mm-hmm ... that can be huge.
Heather: Mm-hmm.
Dr. Zain: And occupational therapists, that they can help with- Yeah ... not only keeping your muscles and your joints, um, intact, but also being able to carry out, you know, daily living activities- Mm-hmm
which are so important and crucial.
Heather: Mm-hmm. Yeah.
Dr. Zain: And limiting the fall risk. Oh, yeah. Yeah. I mean, once you, like, fall and break a bone, like, the mortality- Yeah ... goes whew.
Heather: Oh, yeah.
Dr. Zain: So high.
Heather: Yeah. Mm-hmm.
Dr. Zain: So whatever you can do to prime yourself, make sure that you're healthy. Um, bone health, huge. Yeah. You know, osteoporosis, like, you know, make sure you're- That's right.
Yeah.
Heather: Not
Courtney: naming names. As, as a 60-year-old trapped in a 31-year-old body Who has osteoporosis. But
Dr. Zain: at least you're taking action, right?
Courtney: Yes, I am. Yes. Take... Get your DEXA scan, get some exercise in the gym. Weight-bearing activities are so [00:33:00] important. Um- Calcium by the day ... vitamin D with K2. Mm-hmm. The K2 is a, a game changer.
It is, yeah. So,
Dr. Zain: yeah. Fantastic.
Courtney: Yeah.
Dr. Zain: So let's play a little game. So some frequently asked questions. Um, so I'm going to come up with some scenarios, and tell me what you would respond. So this patient comes in and says, "Well, you know, I don't really go outside anymore. Um, you know, I just kinda just hang out inside.
Do I really have to wear sunscreen?"
Heather: Yes. You can get UV, um, rays through windows
Dr. Zain: Mm-hmm
Heather: You probably go to the grocery store or the library or something like that. I don't think-
Courtney: Let me ask you guys this. You finish your story.
Heather: Finish. I was just gonna say, I don't think... A- are you in a cellar all day and, like-
you never see sunlight?
Dr. Zain: Vampire.
Heather: I mean, you're retired. Yeah.
Courtney: Yeah. If you're retired, you should be outside. Yeah. Yes. That's what I would say. Yeah. If you're retired, you should be outside. Please. There's something kinda wrong with you. Yeah.
Heather: Yeah.
Courtney: Respectfully. Yeah. Um, but [00:34:00] I was gonna ask you guys. There's a l- a little discourse online about if the UV index is one, do you need sunscreen?
Heather: Hmm.
Dr. Zain: I mean, who's out there, like, monitoring all this? And it could be, like-
Heather: Yeah ... you know- Are you really checking the UV
Courtney: index? I... Are- People do che- people check the UV. People check. I don't-
Heather: Because they don't wanna put on sunscreen? Or, like, why do you
Courtney: think they check? Some people like to go out when the UV's high.
Dr. Zain: It's tan
Courtney: maxing. Yeah. Tan maxing. That's tan maxing. That's right. That's tan maxing 101.
Dr. Zain: And that's, like, insane to me, but-
Heather: We're gonna do- Yeah ... our next episode on tan maxing.
Dr. Zain: Yes,
Courtney: tan maxing. Yeah.
Heather: Be on the lookout.
Courtney: But I say, the accumulation of UV anyways, just put it on. I've seen a couple of these, like... I don't know if they're nutrition- I don't even know what they are, but they're like, "Oh, if the UV is only one, you don't need sunscreen."
Like, get real. Hmm.
Heather: Sorry.
Dr. Zain: And honestly, also, I think about it, right? So we're in our later years of life. We've accumulated a lot of damage. When do we actually know we're gonna kinda get that next hit- Mm-hmm ... um, have that mutation- Mm-hmm ... and develop skin cancer? You [00:35:00] just don't know, right?
Heather: Yeah.
Dr. Zain: Like, you can't predict it.
Heather: Are they just hoping that this, like, they'll be dead before the- ... before the sun damage accumulates? I have no idea. Like,
Courtney: I don't know. That would be my... I'm not even gonna lie. That would be your- That would be my thought. Like, am I
really gonna make it another 10 years? Yeah.
Heather: I don't know. Yeah.
Courtney: Wear the sunscreen just- Just wear it ... what, what is it harming? Yeah. You know? Seriously, come
Dr. Zain: on. Like... Just put it on.
Heather: I don't know.
Dr. Zain: Is itchy skin just a normal part of aging, or is there something wrong with me?
Heather: Um, I mean, I would say it is kind of a expected part of aging, but it shouldn't be normal to be, like, itchy all the time, especially if it's significantly impacting your life.
Like, dryness is a big thing, and it can be really, um, you know, dry or itchy. Mm-hmm.
Courtney: We didn't touch on this, but scabies.
Dr. Zain: Yes, I had a patient with that
Heather: thing. Yeah.
Courtney: As someone that just went to a nursing home [00:36:00] last week, I w- I literally asked Dr. Hussain, I was like, "Can you prescribe me ivermectin?" 'Cause I was only in there for 30 minutes.
I didn't sit on anything or touch anything, but-
Heather: My first case of scabies that I've ever seen was when I was a CNA in a nursing home.
Dr. Zain: Mm.
Heather: And it went to the roommate- It's more common than you think ... and yeah, it
Courtney: was very common. Yeah, so yeah, if you're itching and you're in a senior living facility or a nursing home or- Yeah
I think it's definitely worthwhile getting evaluated.
Dr. Zain: Uh, so I had this patient a few weeks ago, super itchy for like four years. Went to multiple dermatologists. They, like, put him on, like, one of these eczema medications, DUPIXENT.
Courtney: Your patient had that happen.
Dr. Zain: Yeah. Yeah. Yeah. And I'm like, "Look at your hands."
Yeah. I mean, they were like... And his, him and his wife were both, like, having symptoms too. Oh, wow. Yeah. And I'm like, "You have scabies," and, like, literally, like, give him the treatment.
Courtney: Yep, better.
Dr. Zain: Gone. Yeah. But he was, like, put on biologics.
Courtney: Yeah, her- It's
Dr. Zain: insane ...
Courtney: Heather has a patient- Yeah ... that nurse who- Yeah ... I treated recently.
Mm-hmm. She told me that she went somewhere in-
Heather: Yeah ...
Courtney: somewhere [00:37:00] else, I will not name names, and they gaslit her and told her it was eczema. It was eczema. Oh, they
Heather: put her on DUPIXENT.
Courtney: Yeah. They put her on DUPIXENT. Yeah. Same, same, same. Yeah. Yeah. She's a nurse at a hospital, so, like, yeah, you can totally- Yeah
get scabies there. And she said when she went back home to Pennsylvania, her old dermatologist gave her, uh, permethrin and- Yeah ... ivermectin, cleared up like that. Yep. Yep. Yes. And same thing, for, like, two years, she's, that poor girl's itching. Yeah. Yeah.
Dr. Zain: I'm like...
Courtney: Yeah.
Dr. Zain: And if it's not working after, like, even a couple of months, I'm like, "We need to think about changing course."
Sometimes,
Courtney: what, how... They're, the side effect risk on, especially permethrin topically, like-
Dr. Zain: I mean, and- ...
Courtney: why not just treat? Yeah.
Dr. Zain: And honestly, like, they were so obvious. I saw- Yeah. It was, like,
Heather: classic
Dr. Zain: scabies. Yeah, it was classic. I'm like, "Did they not even look at you?"
Heather: Yeah.
Dr. Zain: Crazy.
Heather: Wow.
Dr. Zain: So age spots, I'm getting a lot of them.
Should I be worried?
Heather: Probably not, but like, but it's always good to get checked out. Yeah. Um, most age spots, if they are true age spots- Mm-hmm ... they're usually harmless. And that's the key- Yeah ... if they're true age spots-
Dr. Zain: Yeah ... like sometimes skin cancer can look very much similar to-
Heather: Exactly ...
Dr. Zain: some of these lentigos.
[00:38:00] So-
Heather: Yeah ...
Dr. Zain: I would say it's always safer to get checked.
Heather: Yeah, especially if they're new, changing, or bleeding.
Courtney: I think some people get nervous because, you know, they, they call them liver spots 'cause they think it's, like, a problem with their liver. Yeah. And they're get- this is, like, showing up on their skin.
Heather: Mm-hmm.
Dr. Zain: Yeah.
Courtney: But it's not. Yeah.
Dr. Zain: And I am getting old, but is it too late for me to do something about my skin to look better?
Courtney: No, it's never too late. No. Mm-hmm. We see, like, people in their 90s. Yeah.
Dr. Zain: I have the cutest, uh, patients. Yeah. Like, oh, sh- they wanna do everything, and- Yeah ... they just wanna look good because they feel good.
Yeah. Um, you know, they're chatting up at the nursing home and, like, at senior living, and, you know, they're, they're active social beings. Oh, yeah. So I'm like- 'Cause they're
Heather: retired.
Courtney: Yeah, they're retired. Yeah. They have the time. I think I told you guys about my patient who is, like, yeah, in her late 80s or early 90s that I had a few years back and she came in.
She was like, "Um, I just want something to kinda like refresh my skin," whatever. I talked a little bit about microneedling. I said, "You know, it can help with the wrinkles." She goes, "Well, I don't have wrinkles." And I don't know if maybe her vision was just not as [00:39:00] good as it used to be, but I was not gonna be the one to burst her bubble.
I was like, "Well, you know, just fine lines. Like, not wrinkles, but..." Yeah.
Dr. Zain: And then some patients, like, they really need resurfacing after all that damage. Mm-hmm. And I think it's a great time to do it because, hey, you're not working.
Courtney: Mm-hmm.
Dr. Zain: Downtime- Yeah ... um, doesn't really play that much of a role- Mm-hmm ... and you can get phenomenal results that'll be more longer-lasting.
Heather: Mm-hmm. You
Dr. Zain: know?
Heather: One big thing I think we didn't really mention was, uh, is like, um, like crepey skin or- Mm-hmm ... sagging skin in any location really, um, RF is really good, radio frequency. Mm-hmm. So there are, um, lots of different ways we can tighten. You know, I think people, like, a lot of times complain about their... What do people call them?
Their wings or whatever. Chicken
Courtney: wings?
Heather: Yeah, chicken wings. Chicken. Why are they chicken? They're... Did you get that? Yeah. Um, or like, I don't [00:40:00] know. Or it's, like, a- anywhere. Anywhere. The turkey
Courtney: gobble.
Heather: Yeah. Yeah. Yeah. Anywhere on your body, if you're feeling like you want a little bit more tightening- Yeah ... RF is perfect.
Dr. Zain: I love RF, um, you know, especially, like, with our device Exilis. I love pairing that with biostimulators.
Heather: Oh, yeah.
Dr. Zain: And we see some really nice responses.
Courtney: The questions that I've gotten actually recently from a few older patients have been when I talk about these procedures, they're like, "Can I even make collagen anymore?"
Mm-hmm. I'm like, "Well, yeah. It's not-" It's too late. "... maybe as much, but, like, you still can." Yeah.
Dr. Zain: Yeah. And then I th- I do think that, you know, like, they ask about collagen supplements, right?
Heather: Mm-hmm.
Dr. Zain: Mm-hmm. For this population, I don't think it's a bad idea- Mm. Right ... if they don't get enough protein 'cause a lot of patients don't get- protein, adequate protein in- Yeah
you know, later years, and that's really needed. I mean, that's a building block for keeping your muscle and just normal functioning.
Heather: Yeah.
Courtney: Mm-hmm.
Dr. Zain: Yeah.
Courtney: Yeah, 100%.
Heather: Yeah.
Dr. Zain: Cool. So we have completed our Dermatology [00:41:00] by the Decades, um, series, and it was a really insightful journey, and hopefully you learned a lot. I have a real soft spot for my older patients.
Um, I really do think that they're some of my favorite patients. Mm-hmm. And I just wanna remind, you know, you all to make sure that you just give them the dignity and respect that they deserve- 100%. Yeah. The time that they deserve. Yeah. Like, in the medical office, like, so many times I see them, like, brushed away.
Disrespected. Yeah. They're really neglected. Mm-hmm. Um, you know, and you know, they were the ones who took care of us. Mm-hmm. You know what I mean? So I think we have to be able to take care of the next generation. Mm-hmm. Yeah. And, um, you know, they're very important parts of our society.
Courtney: Uh, yeah. We live in a very capitalistic nation that I think values y- how much work you can contribute to this country.
Mm-hmm. And I think when people get older, they get disregarded. And yeah, I think we treat our elderly not as well as we really should be.
Heather: Mm-hmm.
Courtney: Yeah. That's my soapbox.
Heather: Yeah. [00:42:00] Yeah. I totally agree.
Dr. Zain: Yeah, so that goes with medical care especially. I feel like they're just shifted, like, into the hospital or to, like, this disjointed collection of, like, different doctors that they're going to- Yeah
and, you know, it's tough.
Heather: Yeah.
Dr. Zain: So what I try to do is make these patients feel really welcome, and really have a clear plan. Mm-hmm. Um, also be in touch with, you know, their caregivers, et cetera- Yeah ... so that, you know, they get optimal medical care.
Heather: Yeah.
Dr. Zain: Yeah.
Heather: They deserve it.
Dr. Zain: Absolutely. So, um, if you guys have any questions, please, um, feel free to ask.
Um, you can follow, like, and subscribe. And then until next time, Skin Side out. [00:43:00]