Common Skin Disorders in the Elderly
Xerosis- Dry Skin
What is xerosis?
- Xerosis is also known as dry skin.
- Characterized by itchy, dry, cracked, and fissured skin with scaling.
- Occurs most often on the legs of elderly patients, but may be present on the hands and the body.
Why is it common in the elderly?
- Incidence increases with age and is most common in the elderly with more than 50% of older adults being affected.
- Primarily due to the fact that aged individuals have decreased sebaceous (oil secreting glands) and sweat gland activity which predisposes aged skin to moisture depletion.
- Causative factors include cold, dry weather, such as in winter or air conditioning.
- Daily use of cleansers and/or bathing without replacing natural skin emollients.
- Palliative factor includes warm, humid weather.
- Preexisting disease states, therapies, and medications make the elderly more susceptible to dry skin and include:
- Radiation
- End-stage kidney disease
- Nutritional deficiency; especially zinc and essential fatty acids
- Hypothyroidism
- Neurologic disorders with decreased sweating
- Antiandrogen medications (ex. Bicalutamide, Flutamide; for prostate cancer)
- Diuretic therapy
- HIV
Pressure Ulcers
What are pressure ulcers?
- A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight.
- Often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.
- A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.
- Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):
Diabetic Ulcers
What causes diabetic ulcers?
· Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers.
· In addition, high blood sugar can damage the nerves of the foot, decreasing a patient’s ability to notice pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidentally injure the skin, soft tissue, bones, and joints.
Why are they such a big deal?
· The most important underlying cause leading to foot ulceration is diabetic peripheral neuropathy, which is present to some degree in more than 50% of diabetic persons older than 60 years old.
· The prevalence of diabetic foot ulcers is reported at 2-10%.
· Lesions typically first appear on an average of 14 years after initial manifestation of DM.
· Although researchers don’t understand exactly how damage occurs, a high blood sugar level seems to impair your nerves’ ability to transmit signals to your brain.
· The most common cause of ulceration is repetitive mechanical forces of gait, which lead to callus, the most important pre-ulcerative lesion in the neuropathic foot.
Actinic Keratoses
What are actinic keratoses?
· Actinic keratoses (AKs) are premalignant lesions that develop only on sun-damaged skin, in contrast to basal cell carcinomas (BCC), which, although most common on sun-exposed areas, can occur on skin that is not exposed to the sun.
How are they formed?
· AKs result from a clone of abnormal squamous cells caused by UV light-induced gene alteration; invasive squamous cell carcinoma (SCC) then develops after further gene alteration due to additional UV exposure and damage; although the risk of malignant transformation within one year is only 1 in 1000.
What do they look like?
· AKs appear as patches of hyperkeratosis with some surrounding inflammation and redness on sun-exposed areas of the head and neck, forearms and hands, and upper back.
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