Cruisin' for a Bruisin'?

plus, a moment of neediness from your devoted correspondent

Welcome readers, old and new! How happy I am to see you here again, where judgment about aesthetic choices is suspended and we gaze with admiration upon each other’s noble presence… and sneakers.

Please remember to tap the ❤ to let the powers at HNTFUYF know we’re not writing into the void.

The other day, as usual, I went down to the lobby of my building to pick up my mail. It was early-ish in the morning, so I didn’t expect to see anyone in the elevator, which is probably why I left on the white, bony corset I sometimes wear around the house to stabilize my back—and why I didn’t bother to wear a bra under my T-shirt. As the elevator filled with only male passengers (odd), and I greeted them in the neighborly way we greet one another in this friendly building, I noticed they all kept their eyes glued to the floor (again, odd), as if I were a Royal and they, being my subjects, were discouraged from looking directly at me.

What was that? I wondered, as I let myself back into my apartment. I glanced in the hallway mirror: OMG. Because of the way the corset elevated and emphasized my regrettably unharnessed bosom, the effect was an unsettling cross between grannycore and, well, soft-core.

Which precipitated a wave of feelings: surprise, amusement, mild concern. Also, an inevitable question: Am I turning into the kind of old woman who… goes outside in her house slippers… without combing the back of her hair… forgets her keys… grocery list… address… ?

Gentle readers, a moment of neediness: Please assure me I’m not alone in this.

And now, a question about an aptly (and unsavorily) named condition.

Q: The purple bruising looks as bad as it sounds—Senile Purpura. I’m a 60-year-old, board-certified dermatology nurse and I still have few answers about how to fix this unattractive problem. I concocted a special mixture that’s helped a little: I combine one-half jar of CeraVe cream, 20-25g of 0.1% tretinoin cream, and about 1 tablespoon of arnica oil, which I apply 1-2 times a day. When I use it, the bruising isn’t quite as bad and maybe heals a bit quicker. But I hear that intense pulsed light treatments are showing promise. What do your experts know?

A: Personally, I prefer the alternative name for this condition: Solar Purpura, which sounds more like violet light emitted from a tropical sunset.

But both describe the purple blotches that can appear on severely photo-damaged skin on the arms and legs, said HNTFUYF DermDiva, Heidi Waldorf. I’ll bet you know that “senile” means old and “solar” means sun; but did you know that “purpura” means the condition of purpleness, or for our purposes, bruise?

Because it’s caused by chronic sun exposure, the incidence of SP increases with age, said Waldorf. Approximately 12% of people age 50+ have it, and 30% of people age 75+. (In my family, 100% of the people 85+ have had it.) The cause? Obviously, bumping into things. Plus, adds a more serious Waldorf, severely damaged dermal structure.

Because the connective tissue (collagen and elastin) can’t support the microvasculature (blood vessels), even minor injury causes blood to leak from the vessels. This leads to bruising, a.k.a. those purple blotches. There’s more: As the skin becomes thin and fragile with advanced age, SP is often associated with tears, as the epidermis shears off and then heals with scarring. Welcome aboard the train to Scary Town. Tickets, please!

Treatment options for early signs include all the things generally recommended for aging and photoaging to improve the epidermis and dermis, such as sun protection, moisturizers, retinoids and/or alpha hydroxy acids, advised Waldorf. Once the skin becomes fragile, it’s important to maintain the skin barrier with gentle cleansing, moisturizers, alpha hydroxy acid lotions (which help reduce atrophy) and, if necessary, wound care.

Bruises can be treated with topical arnica in products like Alastin INhance; Waldorf doesn’t recommend oral arnica because its safety or efficacy isn’t known for long-term use. And to answer your question about intense pulsed light therapy, Waldorf said that although doctors use vascular lasers and pulsed light to speed clearance of bruises, it’s not realistic for recurrent bruising like SP.  

In spite of the evidence of my sun-loving, banged-up relatives, the kind of bruising seen with SP isn’t a fact of life for everyone, said Waldorf.  The healthier your skin is as you age, with a minimum of photo-damage and a maximum of a healthy skin barrier, the less likely you’ll be to bruise. A few other considerations that might influence bruising: As we age, we’re more likely to be taking anticoagulant medications (blood thinners) and supplements like vitamin E and fish oils/omegas (which also have anticoagulant effects). Plus, thin-skinning medications like chronic steroids increase bruising at any age.

As for your topical mix, dear enterprising reader, Waldorf said it’s very reasonable. But you might get more effectiveness by rubbing in just a pea-sized amount of prescription tretinoin on the top of each forearm and hand nightly. (If 0.1% is too irritating, try 0.025% or 0.05%.) Alternatively, you could try an over-the-counter retinol or, because it’s easily available and cost-effective, invest in a large bottle of 10-15% alpha hydroxy acid cream or lotion like AmLactin, Lac-Hydrin, or Neostrata. Using a moisturizer daily—whether bland like CeraVe, Lipikar, or one with a retinol or AHA—is important to maintain the stratum corneum (the dead outer layer of the epidermis), which provides an intact skin barrier, said Waldorf. And don’t forget sunscreen. Always sunscreen.

One last point: Any new episodes of unexplained bruising should be evaluated by your doctor. And watch where you’re going!

A Moment of Personal Horn-Blowing

HNTFUYF was recently included in a roundup of the “23 Best Health and Wellness Newsletters of 2023” by the (what else?) health and wellness website Ness. Thanks, Ness, and thanks to all you HNTFUYF-ers for inspiring me with your thoughtful questions and comments. xo

Serious about selling you kinder self-regard.

HNTFUYF, a Payola-Free Zone

Readers, a few of you have asked if I get a cut from sales when I mention a product. I do not. I only mention products I’d like to buy myself, and therefore think you might like, too. I share this so you know my recommendations are offered without obligation.

Val Asks You

Don’t be shy! What’s your most vexing or intractable appearance issue? Send your beauty-related questions to valeriemonroe@substack.com. If I don’t have a good answer, I’ll find someone who does.