Dry skin in the elderly.
Skin diseases (Risk factors)
Skin diseases (Diagnosis)
Skin diseases (Care and treatment)
Skin diseases (Research)
Cold (Health aspects)
|Publication:||Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2007 National Herbalists Association of Australia ISSN: 1033-8330|
|Issue:||Date: Spring, 2007 Source Volume: 19 Source Issue: 1|
|Topic:||Event Code: 310 Science & research|
|Geographic:||Geographic Scope: Australia Geographic Code: 8AUST Australia|
Martin JA, Finlay A. 2006. Skin disease in the elderly.
Few skin diseases are confined exclusively to the elderly but may be influenced by the physiological changes in aged skin. Successful treatment may also be influenced by the age of the patient, their physical impairment, practicalities of applying topical treatments, co-morbidities and other medications.
Xerosis and asteatotic eczema
Dry skin (xerosis, asteatosis) is common in elderly patients due to a dysfunction of the horny layer of the skin with aging and environmental factors, leading to the development of eczematous changes (asteatotic eczema). Treatment with topical steroid ointment will quickly settle these changes, but treatment of underlying xerosis with is essential to avoid flare ups. Treatment includes regular use of emollients, particularly those containing urea or lactic acid, and modifying environmental factors (e.g. using a humidifier).
Pruritis with no identifiable primary rash can be difficult to diagnose and treat. Systemic disease should be excluded by carrying out a full history and clinical examination, full blood count, renal and hepatic function tests, thyroid tests and age appropriate screening for hematological and solid organ malignancies.
Senile (idiopathic) pruritus is common and causes considerable distress. Traditional treatment with antihistamines is only useful for the sedative effect, however recent advances in understanding the neurophysiology of itch have led to new therapies targeted at different pruritogenic mechanisms including opioid antagonists (e.g. naltrexone), antidepressants (SSRIs, doxepin) and neuroleptics (gabapentin).
Scabies should be considered in all patients with pruritus. Treatment is 5% permethrin cream applied for 8-12 hours on two occasions one week apart. A single treatment for personal contacts is essential even if they are asymptomatic.
A significant proportion of the elderly suffer from psoriasis. Long term side effects of potent topical steroids should be monitored but are still the first line of choice to achieve better quality of life. The new 'biologic' monoclonal antibody treatments (e.g. infliximab, etanercept and efalizumab) may prove useful.
Cutaneous drug reactions
Two thirds of drug eruptions are macular, maculopapular or urticarial and can present a challenge in diagnosis. A careful history regarding timing of new drugs and symptoms is required.
Basal cell carcinoma (BCC)
Most treatments of BCC involve destructive techniques. Imiquimod 5% has recently been approved as an efficacious topical treatment for superficial BCCs. This is an immunomodulator that induces inflammation and subsequent death and shedding of diseased tissue.
Squamous cell carcinoma (SCC)
SCC is most commonly seen on sun exposed sites in fair skinned individuals. Surgical removal is the ideal choice however small SCCs may be effectively treated using cryotherapy or curettage and cautery which may be more acceptable to the elderly patient.
|Gale Copyright:||Copyright 2007 Gale, Cengage Learning. All rights reserved.|