What are the common skin problems occurring in the elderly?
Appearance and Texture Changes
The skin is constantly renewing itself. New cells are formed on the lower layer of skin which slowly move upward. By the time they reach the surface of the skin, these cells are dead and are removed daily. With ageing, this process of cell renewal slows down. The "dead cell" layer remains longer on the surface of the skin giving the .skin a dull look. This skin feels rough and scaly.
The supporting structures and elasticity of the skin decreases with age. The skin sags and wrinkles appear.
Fig.1 Senile purpura
Fig.2 Asteatotic eczema
a. Senile purpura Fig.1
The skin of an aged person is thinner and easily disrupted. Blood vessels, too, are easily disrupted, resulting in bruises called senile purpura. Senile purpura is commonly seen on the forearms. Its presence does not indicate vitamin deficiency or a bleeding disorder. The skin heals slowly following injury.
b. Xerosis /Asteatotic Eczema Fig.2
The skin becomes dry and flakes easily as the oil contents of skin decreases with age. Dry skin becomes itchy. Sensations of dryness and tautness are common.
Dry skin has a rough and finely flaking or scaly surface. These are seen in the upper back and the limbs, especially the shins. Sometimes asteatotic eczema occurs in areas of dry skin. These are seen as poorly demarcated, scaly round red patches. Sometimes a distinctive appearance of red scaly fissures in an irregular netlike pattern resembling cracked porcelain is seen.
Skin Infections / Infestations
Bacterial Infection : The fissures/cracks on dry skin predispose bacteria entry into the skin to cause superficial infection.
Fig. 3 Scabies is an infectious, very itchy skin infestation caused by a mite. The infestation spreads frequently among elderly living in crowded homes. Sometimes crusting and scaling can cover the whole body (Norwegian scabies).
Ringworm Infections: The elderly often have ringworm infections of the nails and skin, especially on the feet. Ringworm infection of the nails will appear as discoloured and thickened nails. Ringworm infection of the feet might show redness and blisters in addition to scaling.
Fig.4 Senile freckles
Brown spots that look like freckles are often seen. These are larger and more irregular than freckles. They are sometimes called senile freckles Fig.4. They are the result of skin damage from the sunlight. If the freckles become larger or thicker or develop a crust you should consult a doctor. A skin cancer has to be excluded. Senile freckles can be removed easily by freezing, electrosurgery or the application of certain chemicals.
The pigment cells in the skin of elderly also become less active and the skin may look sallow.
Fig.5 Blistering eruption
Fig.6 Bullous pemphigoid
a. Blistering eruption Fig.5
The elderly can develop blistering disorders of different causes. A common blistering disorder is herpes zoster Fig.5 which is a reactivation of the chickenpox that an individual had when young. This presents as a band of blisters on one side of the head or body or along one limb. It can be associated with severe pain.
b. Bullous pemphigoid Fig.6
Blistering problems can also be due to an immune disturbance. A common condition in this group of disorders is bullous pemphigoid Fig.6, in which an individual develops many large blisters, arising from red or normal skin. This condition usually requires potent medications for suppression.
DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)