When is thinning skin too thin?

BY KEITH ROACH, M.D.

Dear Dr. Roach: I am an active 72-year-old male, who is in pretty good physical condition. I do understand that as you age, your skin thins out and is prone to bruising and blood spots during normal activity. However, I am concerned that the skin on my arms is especially sensitive. My skin tears easily and has ripped off just from the adhesive from a bandage. Is this normal? I am not on any blood thinners. Is there any underlying condition? Is there a way to promote the growth of my skin? It is very embarrassing. It is not the end of the world, but any suggestions or comments would be appreciated. — Anon.

Answer: It is normal to have some thinning of the skin as you age. It comes from a variety of reasons, including sun damage and loss of fat from underneath the skin. I have read that vitamin A-based skin creams, such as Retin-A, can reverse some of these changes, but I wouldn’t recommend it for this purpose.

A drop of mineral oil or petrolatum on the bandage (where the adhesive is) will help it be removed easily. You can also use plain gauze and self-adherent wrap (such as Coban or Medique wrap).

Dear Dr. Roach: I recently visited my doctor to schedule my blood screenings (for cholesterol and A1c) early in the morning because I would be fasting. She said I don’t need to be fasting, that it is a myth. Since when has this change occurred? — J.M.

Answer: An article in 2009 showed pretty conclusively that a nonfasting cholesterol and HDL level provides enough information about heart risk that, for most people, fasting is not necessary. Doctors can use the non-HDL cholesterol (calculated by subtracting HDL from total cholesterol) instead of LDL cholesterol (it requires a triglyceride level, which is very sensitive to food intake). People who have serious issues with high triglycerides need fasting levels, but for most people, I agree with your doctor. Some physicians are conservative about changing their ways.

The A1c level looks at the average sugar over the past two months or so, so fasting does not matter at all for that test.

Dear Dr. Roach: What happens with malabsorption? How is it treated? — M.M.

Answer:Malabsorption isn’t a diagnosis, it’s a condition where the body has a decreased ability to absorb nutrients. This can be caused by many different specific diagnoses. The treatment depends on the underlying cause. The hallmark symptoms of malabsorption are weight loss (or inability to gain, especially in children) and diarrhea; however, in some cases these can be subtle or absent, and the first indication that there is something wrong is due to deficiency of a particular nutrient, especially a vitamin (like B-12) or mineral (like iron).

One common cause of malabsorption is celiac disease, also called gluten sensitive enteropathy. Some people may present with weight loss and diarrhea, but others may have only a mild iron deficiency anemia. Celiac disease is treated by strict avoidance of gluten. Bacterial overgrowth, found especially in people with irritable bowel syndrome, may have deficiency in vitamin A or other nutrients, and is treated with antibiotics and treating the underlying condition, if possible. Pernicious anemia is caused by an autoimmune destruction of the cells in the stomach that make intrinsic factor (necessary for vitamin B-12 absorption); it is treated with B-12 supplementation.

There are many other causes. One useful screening tool is to look for fat in the stool. It is not normally present, and most people with malabsorption severe enough to lead to weight loss or diarrhea will have some amount of fat in the stool.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.