Managing dermatitis in the aged is a matter of care and concern for the medical community. Many times, the aged fail to undertake a proper skin care routine and this leads to both physically and psychologically distressful dermatitis. The elderly should realize that ageing skin is more vulnerable to diseases and this is all the more vital against the backdrop of the increase of our average lifespan. The first step to creating awareness is to know about the skin conditions and factors that lead to dermatitis in the elderly.

Skin conditions causing dermatitis in the elderly

Ageing skin

As the skin ages the following syndromes occur:

• Thinning and reduction in the elasticity of the epidermis
• Hyperpigmentation in constantly sun-burnt spots
• Thinning and degeneration of the dermis
• Decreasing connective tissue formations, blood vessels and nerve endings
• Loss of the skin’s layer of subcutaneous fat that affects its shielding and padding actions
• Slow healing of wounds.

Dry skin

A dry skin lacks enough fatty acids and water in its epidermis. This aggravates with ageing, with increasing space between skin cells (due to drying) and hence more moisture evaporation coupled with the entry of irritants. If the dehydration and contamination is not checked, the skin becomes red, blistered and itchy. Scratching aggravates the condition and causes infection.

Ways to prevent dry skin are:

• Use of emollients - creams, ointments, gels, lotions - that add an oily film over the skin and also trap moisture. They are more effective when used after a bath and should be reused all through the day.
• Avoidance of soap and use of substitutes (aqueous cream) is vital.
• If the skin is very dry, medicated bath oils/shower oils can also be used. However, be sure to use a bath mat as the oils make the bathroom slippery.

Itching

Itching or pruritus is closely associated with dry skin. It is a common distress among the aged, which is at its peak at night. However, it can also be an indication of the following ailments:

• Renal disorder
• Diabetes
• Thyroid
• Scabies
• Anemia caused by iron deficiency

Ways to prevent itching:

• Identification of the cause of itching
• A proper skin care routine with use of moisturizing emollients
• Cleanliness and care of the environment one lives in

Types of dermatitis in the aged

Asteatotic, gravitational and discoid eczemas are a common occurrence among the aged and atopic eczema generally affects children and youngsters.

Asteatotic eczema or eczema craquele

This develops due to loss of skin moisture and oil. It generally occurs in the legs of the elderly. The clinical features are:

• Severe dryness of affected skin
• Fissures between skin chunks

Aggravating causes are:

• Overheated, dry room conditions
• Prolonged exposure to radiator or fire
• Excess use of soap

Treatment and preventive methods are:

• Bathe with soap substitutes and then pat dry the skin. Do not rub hard with a towel.
• Use moisturizing emollients at frequent intervals all day.
• Place a container filled with water to increase room humidity.
• Avoid placing the central heating too high.

Gravitational eczema (varicose eczema/stasis eczema)

It is caused due to inadequate venous blood flow from the lower legs to the heart. Patients with varicose veins, deep vain thrombosis or phlebitis and obese people form the high-risk group.

Therapeutic methods are:

• Compression therapy.
• Use of regular emollients such as a 50/50 blend of white soft paraffin and liquid paraffin.
• Medicated bandages (though not in allergic individuals).
• Avoid standing still or sitting with the legs down for prolonged periods.
• Raise legs when sitting to watch television, reading etc.

Discoid eczema or nummular eczema

This recurrent dermatitis is characterized by itchy, crusty, proportioned, disc like lesions. It mainly occurs in the lower legs and forearms, but may also affect the trunk, hands and fingers. Its exact cause is unknown, though emotional stress may have a partial role to play.

Treatment means are:

• Emollients and topical steroids can be used though they cause slow healing.
• Few lesions can be treated with an emollient that combines an antibiotic and steroid.
• Soap should be avoided.

The use of topical steroids in aged patients

Though topical steroids are often used as an anti-inflammatory agent in eczema patients, more care should be taken when it is prescribed to the aged. The type and strength of topical steroids should be determined by the age of the patient, the body location where the eczema has developed and a detailed history of other medications.