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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 272-276

Skin diseases in elderly


Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission26-Sep-2018
Date of Decision23-Oct-2018
Date of Acceptance02-Nov-2018
Date of Web Publication25-Mar-2020

Correspondence Address:
Al Zahraa A Hasanin
Alterah Street, Mansoura, Dakahlia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_278_18

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  Abstract 

Objective
The present study aimed to determine the prevalence of the most common dermatological conditions in elderly patients and to investigate their associations with systemic diseases.
Background
Skin problems in the elderly population have rarely been the subject of scientific research.
Patients and methods
The study involved a group of 260 consecutive patients aged more than or equal to 60 years who were admitted to the Departments of Dermatology at the study institution. All participants were thoroughly evaluated in a clinical interview and physical examination in which special emphasis was placed on dermatological issues.
Results
All patients presented at least one dermatological condition. A significant correlation was found between the number of systemic diseases and the number of different skin lesions observed. The most common skin diseases presented in our study are dermatitis (24.2%), fungal infections (17.6%), papulosquamous lesions (11.5%), and immunobullous diseases (7.3%).Female cases showed significantly higher rate of fungal infections, hair and nail diseases, connective tissue diseases, and dermatitis but also lower rate of immunobullous diseases and bacterial diseases when compared with males.
Conclusion
Skin disorders are common in elderly people. Systemic diseases promote the development of dermatological conditions. A comprehensive approach to health problems in elderly patients requires knowledge of dermatology.

Keywords: aging, dermatitis, elderly, fungal, infection, skin


How to cite this article:
Gaber MA, Hasanin AA. Skin diseases in elderly. Menoufia Med J 2020;33:272-6

How to cite this URL:
Gaber MA, Hasanin AA. Skin diseases in elderly. Menoufia Med J [serial online] 2020 [cited 2020 Jun 6];33:272-6. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/272/281292




  Introduction Top


A long life is a cherished desire of every man, but all are not destined to enjoy it. The elderly are defined as those who are 60 years of age and above[1].

Management of dermatoses in older populations has emerged as an important area of consideration today. As the population older than 60 years increases, the number of patients in geriatric care facilities also climbs and also the clinical manifestation of skin disorders may differ and may not present as classically as they do in younger populations[2].

The pattern of skin diseases in any community is influenced by genetic constitution, climate, socioeconomic status, occupations, education, hygiene standards, customs, and quality of medical care. These factors give each community its unique pattern and account for the wide variation reported from different regions of the world and even in the same country[3].

The epidermal turnover rate slows down with age, delaying re-epithelialization time after injury. Older corneocytes accumulate, imparting a dull gray-white appearance and rough feeling to aging skin[4].

Cutaneous aging, a highly complex but not yet fully understood process, is particularly interesting because of the continuously increasing life expectancy in many countries[5].

Like all organs, skin suffers progressive decrement with increasing age[6].

Aging results in numerous adverse changes in the structure and function of multiple human organs, including the skin. Thus, the elderly population will pose significant challenges not only to physicians in geriatrics but also to those in other specialties, including dermatology[7].

The skin undergoes the processes of intrinsic and extrinsic aging each of which presents different clinical and histologic features[7].

Intrinsic or chronological skin aging is related to physiologic metabolic changes, affects all persons, and is inevitable[5].

Extrinsic skin aging is also referred to as photo aging as it is caused mainly by ultraviolet radiation[7].

It is also known as dermato actinosenesce[8].

However, various environmental, physical, chemical, and mechanical insults can collaborate in the process. Besides, ultraviolet radiation[9], infrared radiation, and tobacco smoking are by far the most aggressive environmental agents leading to the accumulation of abnormal elastin and the disintegration of collagen fibrils[7].

The process of intrinsic skin aging is similar to that occurring in most internal organs, involving slow deterioration in tissue function. It is largely genetically determined and clinically associated with increased fragility and loss of elasticity, and appears transparent[10].

Extrinsic aging primarily results from exposure to ultraviolet light. It has been suggested that as much as 80% of facial aging is attributable to sun exposure. Clinically, photo-damaged skin is characterized by loss of elasticity, increased roughness, dryness, irregular pigmentation, deep lines, wrinkles, and premalignant and malignant lesions[11].

The changes observed in the intrinsic and extrinsic skin aging process, from both the molecular and histopathological point of view, are responsible for the clinical consequences of cutaneous manifestations in the elderly. The skin changes can range from simple wrinkles to premalignant and malignant lesions[12].

Skin aging is particularly important owing to its effects on human health, as it produces serious social effect because of its visibility; therefore, it is an ideal topic for research.

As only few articles in the past have raised the importance of geriatric dermatoses, this study is aimed to determine the prevalence of the most common dermatological conditions in elderly patients and to investigate their associations with variable systemic diseases.


  Patients and Methods Top


This was a prospective study done on 260 geriatric patients who were 60 years and older and were seen from Mansoura, Aga, and Talkha cities, and some other around villages in ~7 months from August 2017 to February 2018. The study protocol was approved by the ethical committee in the faculty. An informed written consent was obtained from each participant.

Patients referred or transferred from other wards with skin complaints were also included in the study. The findings were then noted in a specially prepared proforma which included the patient's history, examination, and investigations findings. A clinical photograph was taken of the relevant skin changes.

The data and observations were then compiled, tabulated, and statistically summarized.

Finally, a master chart was prepared showing the entire patient details enrolled in the study with their history, examination findings, investigations, and diagnosis.

Type of the study

This was a prospective randomized study.

Study site

Outpatient clinic of Mansoura University of hospital from Mansoura, Aga, and Talkha cities and some other villages around were the site of study.

Inclusion criteria

Geriatric patients more than or equal to 60 years were included.

Exclusion criteria

Patients less than 60 years and those with burns, syphilis, dementia, and Alzheimer disease were excluded.

History

Personal data included name, age, sex, residency, and past job.

Medical history

Medically compromised or medically free.

Family history

Data on parents or others related were recorded.

Examination

General and local examination was done.

Investigation

Laboratory investigations such as complete blood count, urine analysis, liver and kidney function tests, erythrocyte sedimentation rate, lipids profile, blood glucose level, and virology were performed.

Statistical analysis

The collected data were coded, tabulated and analyzed by statistical package for the social science software, version 16, on IBM compatible computer (SPSS Inc., Chicago, Illinois, USA).

Data were presented as frequency and percentages (qualitative variables) and mean ± SD (quantitative continuous variables).

χ2 was used for comparison of categorical variables, and was replaced by Fisher's exact test if the expected value of any cell was less than 5.

The difference was considered as follows:

P value less than or equal to 0.05 to be statistically significant.

P value more than 0.05 to be statistically insignificant.


  Results Top


Most of the elderly patients in our study are medically compromised with higher prevalence rate of diabetes mellitus (36.2%), hypertension (33.5), hepatic diseases (29.2%), renal diseases (14.2%), and others (1.2%), that is, one case of hepatitis C virus infection, one case retinopathy, and one case neuropathy, as shown in [Table 1].
Table 1: Associated diseases among studied patients

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The highest rate of pruritic dermatitis was found in patients with renal diseases (43.2%), especially end-stage renal diseases, who are commonly are affected by severe pruritus. Moreover, 36.8% of hypertensive patients and 28.9% of patients with liver diseases have dermatitis.

An association was observed between diabetes mellitus and the occurrence of fungal infections. In our study, it was found that patients who are diabetic and had fungal infection represent 20.2% compared with 10.3% of patients who had fungal infection but not diabetic.

The most common skin diseases presented in our study are dermatitis (24.2%) as [chronic dermatitis (16.9%), allergic contact dermatitis (3.5%), irritant contact dermatitis (1.2%), seborrheic dermatitis (1.2%), and stasis dermatitis (1.5%)], then fungal infections (17.6%) [tinea pedis (7.0%), onychomycosis (4.2%), tinea versicolor (2.3%), candida interdigitalis (1.5%), paronychia (1.9%), candida intertrigo (0.4%), and tinea circinata (0.4%)], then papulosquamous (11.5%) [psoriasis vulgaris (8.8%) and lichen planus (2.7%)] and immunobullous diseases (7.3%) [pemphigus vulgaris (6.5%), pemphigus foliaceus (0.4%), and linear IgA bullous dermatoses (0.4%)], as shown in [Table 2].
Table 2: Dermatological diagnosis of the studied patients

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Moreover, other skin lesions are presented in our study, such as warts (3.8%), bacterial infections (5.4%), urticaria (4.2%), ulcers (1.9%), tumors (2.3%), viral infection (1.9%), papulosquamous diseases (11.5%), connective tissue diseases (1.1%), hair and bail diseases (5%), pigmentary disorders (6.2%), erythema multiform (0.8%), erythroderma (0.4%), foot cracks (3.1%), ichthyosis (0.4%), keloid (1.2%), necrobiosis lipoidica (1.2%), lichenoid eczema (0.4%), pretibial myxedema (0.4%), pyoderma gangrenosum (0.4%), and vasculitis (3.1%), as shown in [Table 2].

Female cases showed significantly higher rate of fungal infections, hair and nail diseases, connective tissue diseases and dermatitis but also lower rate of immunobullous diseases and bacterial diseases when compared with males. There was no statistically significant difference between male and female cases regarding the distribution of other variables.


  Discussion Top


In this study, dermatitis represents the highest prevalence (24.2%). Its prevalence in our study was higher than those reported in a study carried by El-Khateeby and Imam[13]whichwas(22%). These variations may be attributed to the difference in the number of cases.

Different types of fungal infections [tinea pedis (7%), tinea circinata (0.4%), pityriasis versicolor (2.3%), candidiasis (1.9%), and paronychia (1.9)] occur commonly in the old patients owing to the decrease in personal care, epidermal turnover, and immunologic function. They are the second most common dermatoses in this study (17.6%). Our results were higher than those in a study carried by Raveendra[14] at 11%, and lower than those in a study carried by Shukla[15] at 20.7%. These differences may be owing to variations in medical care, and personal hygiene between patients.

Bacterial infection [erysipelas (0.4%), cellulitis (1.2%), impetigo (0.4%), and abscess (0.4%)] also have a significant ratio in the study (5.4%). This could be owing to decreased immunity in the aged people and associated systemic diseases that give the chance for the development of bacterial infection. This matches a study carried by Raveendra[14] which reported 5.2% of bacterial infection.

Viral infection especially herpes zoster are very common in the old patients as a result of exacerbation of the virus that remains dormant in the cutaneous neurons at times of stress and immunosuppression. Viral infection represents (1.9%) [herpes zoster (1.2%), postherpetic neuropathy (0.4%), and pityriasis rosea (0.4%)] in this study, which is lower than its prevalence in a study carried by Shukla[15], where it was 14%.

In this study, psoriasis was seen in 8.8% of patients. The incidence of psoriasis in the present study is in concordance with that of the study by Patange and Fernandez[16] and Sahoo et al.[17].

Various systemic diseases contribute to the presence of cutaneous disorders.

An association was observed between diabetes mellitus and the occurrence of fungal infection. In our study, it was found that patients who are diabetic and had fungal infection, representing 20.2% compared with patients who had fungal infection but not diabetes, representing 10.3%. This agrees with a study carried by Reszke[18]which found that patients with diabetes had fungal infection about twice as frequently as patients without (26.8 vs. 13.4%; P < 0.05).

In our study, patients who medically compromised had higher rate of dermatitis.

The highest rate of pruritic dermatitis was found in patients with renal diseases (43.2%), especially end-stage renal disease, who commonly are affected by severe pruritus. The pathogenesis of this pruritus is unknown, but improving the quality of dialysis can reduce the prevalence and severity of pruritus[19].

In older series, up to 90% of patients were affected with pruritus, but now between 20 and 50% are affected[20].

In other side of our study, 36.8% of hypertensive patients and 28.9% of patients with liver diseases have dermatitis.

In one of the studies that was conducted in Canada, the most common skin disease in the elderly were actinic keratoses, ecthyma, benign tumors, and malignant tumors[21]. In an another study carried out in Australia, Smith et al.[22] showed that the most common skin disease in elderly were fungal infection, stasis dermatitis, and malignant skin tumors, which indicate higher prevalence of tumors.

In our study, the ratio of benign tumors of skin is 2.3%, whereas malignant tumors is 0%.

Generally in western countries, the prevalence of skin tumors is much higher than in the southern region. This may be related to increased sun exposure in fair skin population who have less protection against sun rays[23].

The fewer incidence of skin tumors in the Islamic world may be owing to the way of dressing, which discourage body exposure especially in women[24].


  Conclusion Top


Aging is an ongoing process occurring in the skin as well as other organs. There are two types of skin aging: intrinsic aging which is the result of physiological changes occurring throughout life and extrinsic aging that is influenced by external factors, mainly sun exposure, affecting the skin.

Various systemic diseases contribute to the presence of cutaneous disorders, indicating the possibility that a skin abnormality may sometimes be the first and only symptom of a much more serious medical problem. A comprehensive approach to the management of health problems in the elderly population is a challenge that requires knowledge of dermatology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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El-Khateeb EA, Imam AA, Sallam MA. Pattern of skin diseases in Cairo, Egypt. International journal of dermatology 2011; 50:844-53.  Back to cited text no. 13
    
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Raveendra L. A clinical study of geriatric dermatoses. Our Dermatology Online/Nasza Dermatologia Online. 2014; 5.  Back to cited text no. 14
    
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Pavithra S, Shukla P, Pai GS. Cutaneous manifestations in senile skin in coastal Goa. Nepal Journal of Dermatology, Venereology & Leprology. 2010; 9:1-6.  Back to cited text no. 15
    
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Patange SV, Fernandez RJ. A study of geriatric dermatoses. Indian J Dermatol Venereol Leprol 1995; 61:206–208.  Back to cited text no. 16
    
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Sahoo A, Singh PC, Pattnaik S, Panigrahi RK. Geriatric dermatoses in Southern Orissa. Indian J Dermatol 2000; 45:66–68.  Back to cited text no. 17
    
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Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis 2007; 50:11–20.  Back to cited text no. 19
    
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    Tables

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