Frequent (and less frequent) Skin Conditions in Elderly

1. Frequent (and less frequent) Skin Conditions in Elderly Rozenman Dganit Dermatology Department Haemek Medical Center

2. Pruritus The most common complaint of the elderly

3. DEFINITION Pruritus, or itch, is defined as an unpleasant sensation that provokes the desire to scratch.

4. Frequency: • In the US: Pruritus occurs in approximately 20% of adults. It is present in approximately 25% of patients with jaundice and in 50% of patients receiving renal dialysis. • Internationally: An underlying systemic disease is reported in 10-50% of patientswho seek medical attention for pruritus.

6. GENERALIZED PRURITUSCLASSIFICATIONOn the basis of the underlying causative disease • Renal pruritus (uremic) • Cholestatic pruritus • Hematologic pruritus • Endocrine pruritus • Pruritus related to malignancy • Idiopathic generalized pruritus

7. Investigation of Generalized Pruritus • Careful history (to exclude drug hypersensitivity) • Full physical examination( including pelvic and rectal) • CBC, thyroid, renal and liver function tests • Stool examination for parasites and occult blood • Chest x-ray (no need for extensive imaging) • Follow up as long as symptoms persist

8. Pruritus of Aged Skin • At least 50% of persons aged 70 or over • Consequence of desiccation of skin • Senescent skin holds water less readily than youthful skin

9. Treatment • Cooling lotions, emolients • 1% menthol lotion • Capsaicin • UVB phototherapy, PUVA (for aqagenic pruritus) • Opioid antagonist – naltrexone • Cholestyramine, rifampicin • Danazol(for polycytemia vera and myeloproliferative disorders)

11. Neurotic excoriations

12. Prurigo nodularis

13. Bullous Pemphigoid

14. Bullous Pemphigoid

15. Bullous Pemphigoid

16. Drug Eruption Most common eruption in elderly Maculopapular Rash Most common Presentation

20. Steven Johnson

21. Toxic Epidermal Necrolysis

22. Fixed Drug Eruption

23. Irritant Dermatitis

24. Senile Purpura

25. Erythema ab Igne