A brief review of important life stages and their influence on the skin is as follows:
PUBERTY. In males, at puberty, the beard, the pubic hair, and other body hair begin to grow in characteristic patterns that differ from the hair growth in females. Both sexes at this time notice increased activity of the apocrine glands, with axillary perspiration and body odor and increased development of the sebaceous glands, with the formation of varying degrees of seborrhea and the comedones, papules, and pustules of acne. Certain skin diseases tend to disappear around the onset of puberty, such as the infantile form of atopic eczema, tinea of the scalp, and urticaria pigmentosa.
PREGNANCY. Certain physiologic skin changes occur. Perspiration is increased. Hyper-pigmentation of the abdominal midline, nipples, vulva, and face (chloasma) is seen, and, in some brunettes, nevi and freckles also become more prominent and more pigmented. Malignant melanoma is not more common in pregnancy. Hypertrichosis of the scalp may be unnoticed until the excess hair begins to be shed after delivery. Striae of breasts, abdomen, and thighs appear. The skin diseases of pregnancy are herpes gestationis (see Fiig.M..26-11D-E), impetigo herpetiformis, vulvar pruritus (often due to candidal infection), palmar erythema, spider hemangiomas, pyogenic granulomas, rarely erythema multiforme, and pedunculated fibromas. The following dermatoses are usually better, or disappear, during pregnancy: psoriasis, acne (can be worse), alopecia areata, and, possibly, systemic scleroderma.
MENOPAUSE. Common physiologic changes in the skin of women during menopause include hot flashes, increased perspiration, increased hair growth on the face, and varying degrees of scalp hair loss. Other skin conditions associated with menopause are chloasma, pedunculated fibromas (skin tags), lichen simplex chronicus, vulvar pruritus, keratoderma climacterium (palmar psoriasis), and rosacea.
GERIATRIC STATE. The diffuse atrophy of the skin that occurs in the aged person is partially responsible for the dryness that results in senile pruritus and winter itch. Other changes include excessive wrinkling and hyperpigmentation of the skin. Specific dermatoses noted with increased frequency are seborrheic and actinic keratoses, basal cell and squamous cell carcinomas, senile purpura, pedunculated fibromas, and capillary senile hemangiomas.
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