These are unprecedented times in human history. We are in the midst of an epidemic of aging, known as the graying of America. People over 65 account for approximately 12% of the American population, a figure that is expected to double in about 30 years. By that time, half the population will be over 50. Currently, people over 85 make up the fastest growing segment. At the beginning of the century life expectancy was approximately 50 years. Most women did not survive beyond menopause. Today, life expectancy for middle-class white women is approximately 75 years, which means that at least 25 years of their life-span will be postmenopausal. This impressive extension of the life-span is not quite the blessing one might suppose. Men, for various reasons, do not live as long as women, falling short by approximately 8 years, a gap that is actually increasing as longevity in women steadily increases while in men it decreases. This means that at advanced ages, women spend their last years without male peers. These changing demographics will have profound, some think catastrophic, social, political, and economic consequences.

Geriatric textbooks focus on age-associated chronic disorders such as arthritis, heart disease, and cancer while giving short shrift to skin. The former are life-threatening or disabling conditions, whereas no one dies of old skin. We are well packaged in our integument till the very end. There remains in medicine a widespread pejorative view that most skin disorders are nothing more than cosmetic impediments, minor disfigurements, and blemishes that are merely nuisances. This negative outlook is not only insensitive, it is misguided and wrong. We need to look at skin aging in an entirely different light, with special emphasis on the psychological distresses caused by deterioration in appearance.