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
As the skin ages the following syndromes occur:
- Thinning and reduction in the elasticity of the epidermis
in constantly sun-burnt spots
- Thinning and degeneration of the
- Decreasing connective tissue formations, blood vessels and
- Loss of the skin’s layer of subcutaneous fat
that affects its shielding and padding actions
- Slow healing of
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
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
- 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
- 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
- Place a container filled with water to increase room
- 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
- 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.