LAUSR

INTRODUCTION Large superficial tears frequently develop during minor trauma to the fragile skin of older men and women. These tears are more common in chronically ill or malnourished patients, can develop during attempted assisted transfer of weak patients, and were recently reported to have been treated annually in 1.5 3 10 MediCare patients during their care in an acute or long-term medical care facility. They also develop frequently in elderly out-patients and those using inhaled or systemic corticosteroids for extensively lengths of time. Postmenopausal hormonal supplementation and other systemic and local therapies have not been demonstrated to improve dermal thickening. Levels of dehydroepiandrosterone (DHEA) and of its sulfonated ester DHEAS are present in equilibrium. Their serum levels are most easily quantitated by measurement of DHEAS. Both decline rapidly with advancing age, and after age 60 years, average levels are only 20% of those of younger adults. Supplementation to increase DHEA and DHEAS levels is easily and inexpensively maintained by ingestion of oral DHEA, which is classified as a food additive in the United States and widely available without prescription; DHEA can be found in a variety of products that, however, contain unverified amounts, considering the product content advertised on the labels have not been verified. In the only available placebo-controlled trial of supplemental DHEA, Baulieu et al documented less progressive skin thinning, improved skin hydration, improved sebum production, and less bone mineral density loss in 140 postmenopausal women aged 60-79 years who ingested 50 mg DHEA daily for 12 months.