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Skin Disorders in the Elderly

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Chapter
  • 1.8k Downloads

Abstract

There are two types of ageing of the skin. One is intrinsic and is attributable to the passage of time and the other extrinsic caused by environmental factors such as chronic exposure to sunlight (photoageing). The former moves at a genetically determined pace. With ageing structural and functional changes occur in all the structures of the skin. The epidermis, dermis and the subcutaneous layers become thinned out, the keratinocytes shrink and there is a decrease in the number of melanocytes, Langerhans cells and Merkel cells. There is a reduction in the fibroblasts as well as nerve endings, blood vessels and exocrine sweat glands. Exposure of the skin to UV light over several years is associated with the development of skin cancers. Cellular pathways with a high frequency of mutations include p53 and extensive UV exposure causes mutation of p53 gene. The melanocytic malignancies have been categorised as subgroups which include the BRAS-, NRAS- and KIT-mutated melanomas. The RAS/BRAF/MAPK pathway is a common site for genetic deviations in melanoma. Skin diseases in the elderly are more often than not the effects of sun damage or vascular disease. In the elderly the common dermatoses seen are xerosis, pruritus, eczematous dermatitis, stasis dermatitis and fungal and viral infections. Immunosenescence leads to similar levels of occurrence of autoimmune skin disorders such as bullous pemphigoid, paraneoplastic pemphigus and pemphigus vulgaris and in older women lichen sclerosus and potential reactivation of the zoster virus. These autoimmune skin disorders result from either the production of antibodies that react with the host tissue or to autoreactivity of the immune effector T cells.

Keywords

Age-related changes Skin disorders Melanoma Autoimmune skin disorders Pruritus 

References

  1. 1.
    Farage MA, Miller KW, Elsner P, Maibach HI. Characteristics of aging skin. Adv Wound Care (New Rochelle). 2013;2(1):5–10 (abstract).CrossRefGoogle Scholar
  2. 2.
    Lifshitz OH. The ageing skin. Cleveland Clinic for continuing education. Accessed 29 Oct 2013.Google Scholar
  3. 3.
    Montagna W, Carlisle K. Structural changes in aging skin. Br J Dermatol. 1990;122 Suppl 35:61–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73–86 (abstract).CrossRefPubMedGoogle Scholar
  5. 5.
    Kligman AM, Balin AK. Aging of human skin. In: Balin AK, Kligman AM, editors. Aging of the skin. New York: Ravin Press; 1989.Google Scholar
  6. 6.
    Ullrich SE. Mechanisms underlying ultraviolet induced immune suppression. Mutat Res. 2005;571(1–2):185–205.CrossRefPubMedGoogle Scholar
  7. 7.
    Yaar M, Gilchrest BL. Skin aging. Postulated mechanisms and consequent changes in structure and function. Clin Geriatr Med. 2001;17:617.CrossRefPubMedGoogle Scholar
  8. 8.
    Uitto J. Understanding premature skin ageing. N Engl J Med. 1997;337(20):1463–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Berger TG, Steinhoff M. Pruritus in elderly patients-eruptions of senescence. Semin Cutan Med Surg. 2011;30:113–7.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Yalcin B, Tamer E, Toy GG, Oztaz P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006;45(6):672–6 (abstract).CrossRefPubMedGoogle Scholar
  11. 11.
  12. 12.
    Jemal A, Siegel R, Xu J, Ward E. Cancer statistics 2010. CA Cancer J Clin. 2010;60:277–300.CrossRefPubMedGoogle Scholar
  13. 13.
    Lasithiotakis KG, Petrakis IE, Garbe C. Cutaneous melanoma in the elderly: epidemiology prognosis and treatment. Melanoma Res. 2010;20:163–70.PubMedGoogle Scholar
  14. 14.
    Swetter SM, Boldrick JC, Jung SY, Egbert BM, Harvell JD. Increasing incidence of lentigo maligna melanoma subtypes: northern California and national trends 1990-2000. J Invest Dermatol. 2005;125:685–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Smith DR, Leggat P. Prevalence of skin disease among the elderly in different clinical environments. Australas J Ageing. 2005;24(2):71–6.CrossRefGoogle Scholar
  16. 16.
    El- Ghassassi F, Baan R, Straif K, Grosse Y, Secretan B, Bouvard V, et al. A review of human carcinogens-part D: radiation. Lancet Oncol. 2009;10:751–2.CrossRefGoogle Scholar
  17. 17.
    Omar MH. Common skin disorders in the elderly. SA Fam Pract. 2006;48:29–34.Google Scholar
  18. 18.
    Webster GF. Common skin disorders in the elderly. Clin Cornerstone. 2001;4:39–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Fisher GJ, Voorhees JJ. Molecular mechanisms of photoaging and its prevention by retinoic acid: ultraviolet irradiation induces MAP kinase signal transduction cascades that induce Ap-1 –regulated matrix metalloproteinases that degrade human skin in vivo. J Investig Dermatol Symp Proc. 1998;3(1):61–8 (abstract).PubMedGoogle Scholar
  20. 20.
    Fisher GJY. The pathophysiology of photoaging of the skin. Cutis. 2005;75(2 Suppl):5–8 (abstract).PubMedGoogle Scholar
  21. 21.
    Brenneisen P, Sies H, Scharffetter-Kochanek K. Ultraviolet-B irradiation and matrix metalloproteinases: from induction via signalling to initial events. Ann N Y Acad Sci. 2002;973:31–43 (abstract).CrossRefPubMedGoogle Scholar
  22. 22.
    Rijken F, Kiekens RCM, van den Worm E, Lee PL, van Weeldeen H, et al. Pathophysiology of photoaging of human skin: focus on neutrophils. Photochem Photobiol Sci. 2006;3:184–9 (abstract).CrossRefGoogle Scholar
  23. 23.
    Webster GF. Common skin disorders in the elderly. Am Fam Physician. 1993;47(6):1445–50.Google Scholar
  24. 24.
    Scheinfeld NS. Skin disorders in older adults: age-related pigmentary changes. Consultant http://www.consultant360.com/content/skin-disorders-older-adults-agr-related-pigment. Retrieved 31 Mar 2015.
  25. 25.
    Balakrishnan KP, Narayanaswamy U. Botanicals as sun creams: their role in the prevention of photoaging and skin cancer. Int J Res Cosmetic Sc. 2011;1(1):1–12.Google Scholar
  26. 26.
    Luong KVQ, Nguyen LTH. The roles of vitamin D in seborrhoeic keratosis: possible genetic a cellular signalling mechanisms. Int J Cosmetic Science. 2013. doi: 10.1111/ics.12080. (abstract).Google Scholar
  27. 27.
    Shumack SP. Non-surgical treatments for skin cancer. Aust Prescr. 2011;34:6–7.CrossRefGoogle Scholar
  28. 28.
    Graham JH. Selected precancerous skin and mucocutaneous lesions. In: Neoplasm of skin and malignant melanoma. Chicago: Book Medical Publishers; 1976. p. 69.Google Scholar
  29. 29.
    Lebowhl M. Actinic keratosis epidemiology and progression to squamous cell carcinoma. Br J Dermatol. 2003;149(Suppl 66):31–3.CrossRefGoogle Scholar
  30. 30.
    Tomas D. Apoptosis, UV-radiation, precancerous and skin tumours. Acta Med Croatica. 2009;63 Suppl 2:53–8 (abstract).PubMedGoogle Scholar
  31. 31.
    Erb P, Ji J, Kump E, Mielgo A, Wernli M. Apoptosis and pathogenesis of melanoma and nonmelanoma skin cancer. Adv Exp Med Biol. 2008;624:283–95 (abstract).CrossRefPubMedGoogle Scholar
  32. 32.
    Massari LP, Kastelan M, Gruber F. Epidermal malignant tumours: pathogenesis influence of UV light and apoptosis. Coll Antropol. 2007;31 Suppl 1:83–5 (abstract).PubMedGoogle Scholar
  33. 33.
    Rass K, Reichrath J. UV damage and DNA repair in malignant melanoma and nonmelanoma skin cancer. Adv Exp Med Biol. 2008;624:162–78 (abstract).CrossRefPubMedGoogle Scholar
  34. 34.
    Erb P, Ji J, Wernli M, Kump E, Glaser A, Buchner SA. Role of apoptosis in basal cell and squamous cell carcinoma. Immunol Lett. 2005;100(1):68–72 (abstract).CrossRefPubMedGoogle Scholar
  35. 35.
    De Gruijl FR, van Kranen HJ, Mullenders LH. UV-induced DNA damage, repair, mutations and oncogenic pathways in skin cancer. J Photochem Photobiol B. 2001;63(1–3):19–27 (abstract).CrossRefPubMedGoogle Scholar
  36. 36.
    Uminski A. New systemic treatment options for advanced basal cell carcinoma. Cancer Forum. 2012;36(3):138–141.Google Scholar
  37. 37.
    Lee MM, Wick MM. Bowen’s disease. CA Cancer J Clin. 1990;40(4):237–42.CrossRefPubMedGoogle Scholar
  38. 38.
    Neubert T, Lehmann P. Bowen’s disease-a review of newer treatment. Ther Clin Risk Manag. 2008;4(5):1085–95.PubMedCentralPubMedGoogle Scholar
  39. 39.
    Lin K, Baritaki S, Militello L, Malaponte G, Bevelacqua Y, Bonavide B. The role of B-RAF Mutations in Melanoma and the Induction of EMT via Dysregulation of the NF-kB/Snail/RKIP/PTEN Circuit. Genes Cancer. 2010;1(5):409–20.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Goldringer SM, Murer C, Sieger P, Dummer R. Targeted therapy in melanoma-the role of BRAF, RAS and KIT mutations. Eur J Cancer Suppl. 2013;11(2):92–6.CrossRefGoogle Scholar
  41. 41.
    Saldanha G, Potter L, Dafomo P, Pringle JH. Cutaneous melanoma subtypes show different BRAF and NRAS mutation frequencies. Clin Cancer Res. 2006;12(15):4499–505 (abstract).CrossRefPubMedGoogle Scholar
  42. 42.
    Flaherty KT, Puzanov I, Kim KB, Ribas A, McArthur GA, Sosman JA, et al. Inhibition of mutated activated BRAF in metastatic melanoma. N Engl J Med. 2010;363:809–19.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Menzies AM, Haydu LE, Visintin L, Carlino MS, Howele JR, Thompson JF, et al. Distinguishing clinicopathological features of patients with V6000E and V600K BRAF-mutant metastatic melanoma. Clin Cancer Res. 2012;18:3242–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Kelleher FC, McArthur GA. Targeting NRAS in melanoma. Cancer J. 2012;18(2):132–6 (abstract).CrossRefPubMedGoogle Scholar
  45. 45.
    Macdonald JB, Dueck AC, Gray RJ, Wasif N, Swanson DL, Sekulic A, et al. Malignant melanoma in the elderly: different regional disease and poorer diagnosis. J Cancer. 2011;2:538–43.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Beacham BE. Common dermatoses in the elderly. Am Fam Physician. 1993;47(6):1445–50 (abstract).PubMedGoogle Scholar
  47. 47.
    Yaar M, Gilchrest BA. Skin aging: postulated mechanisms and consequent changes in structure and function. Clin Geriatr Med. 2001;17:617.CrossRefPubMedGoogle Scholar
  48. 48.
    Loo WJ, Burrows NP. Management of autoimmune skin disorders in the elderly. Drugs Aging. 2004;21(12):767–77 (abstract).CrossRefPubMedGoogle Scholar
  49. 49.
    Mutasim DF. Autoimmune bullous dermatoses in the elderly: an update on pathophysiology diagnosis and management. Drugs Aging. 2010;27(1):1–19 (abstract).CrossRefPubMedGoogle Scholar
  50. 50.
    Scheinfeld NS. Skin disorders in older adults: papulosquamous and bullous diseases, Part 2. Consultant. 2011; 168. http://www.consultant360.com/content/skin-disorderes-older-adults-papulosquamous-a. Retrieved 28 Mar 2015.
  51. 51.
    Greaves MW. Recent trends in pathophysiology and current management of itch. Ann Acad Med Singapore. 2007;31:788–92.Google Scholar
  52. 52.
    Inoue K, Koizumi S, Fuzuwara S, Denda S, Inoue K, Denda M, et al. Functional vanilloid receptors in cultured normal human epidermal keratinocytes. Biochem Biophys Res Commun. 2002;291:128–9.Google Scholar
  53. 53.
    Stander S, Raap U, Weisshaar E, Schmelz M, Mettang T, Handwerker H, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9(6):456–63 (abstract).PubMedGoogle Scholar
  54. 54.
    Rukweid R, Lischetzki G, McGlove F, Heyer G, Schmelz M. Mast cell mediators other than histamine induce pruritus in atopic dermatitis patients. A dermal microdialysis study. Br J Dermatol. 2000;42:1114–20.CrossRefGoogle Scholar
  55. 55.
    Greaves MW, McDonald-Gibson W. Itch: role of prostaglandins. Br Med J. 1973;3:608–9.PubMedCentralCrossRefPubMedGoogle Scholar
  56. 56.
    Raap U, Sttander S, Metz M. Pathophysiology of itch and new treatments. Curr Opin Allergy Clin Immunol. 2011;11(5):420–7 (abstract).CrossRefPubMedGoogle Scholar
  57. 57.
    Yosipovitch G, Fleischer A. Itch associated with skin disease: advances in pathophysiology and emerging therapies. Am J Dermatopathol. 2003;4(19):617–22.Google Scholar
  58. 58.
    Greaves MW, Wall PB. Pathophysiology of itching. Lancet. 1996;348:938–40.CrossRefPubMedGoogle Scholar
  59. 59.
    Burns DA. Itching-physiology, causes, management. Curr Paediatr. 1991;1(3):142–4.CrossRefGoogle Scholar
  60. 60.
    Potenzier C, Undem BJ. Basic mechanisms of itch. Clin Exp Allergy. 2012;42(1):8–9 (abstract).CrossRefGoogle Scholar
  61. 61.
    Stander S, Setinhoff M, Schmeltz M. Neurophysiology of pruritus. Arch Dermatol. 2003;139:1463–6.CrossRefPubMedGoogle Scholar
  62. 62.
    Shanley K. Pathophysiology of pruritus. Vet Clin North Am Small Anim Pract. 1988;18:971–81.CrossRefPubMedGoogle Scholar
  63. 63.
    Bernhard J. Itch & pruritus. What are they, how should itches be classified. Dermatol Ther. 2005;18:288–91.CrossRefPubMedGoogle Scholar
  64. 64.
    Reich A, Stander S, Szepietowski J. Pruritus on the elderly. Clin Dermatol. 2011;29:15–23.CrossRefPubMedGoogle Scholar
  65. 65.
    Waller JM, Monbach HI. Age and skin structure and function: a quantitative approach II Protein, glycosaminoglycan, water and lipid content and structure. Skin Res Technol. 2006;12(3):145–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 2
  • Gary Cheuk
    • 3
  1. 1.Sydney Medical School (Westmead)The University of SydneyNorth RocksAustralia
  2. 2.Norwest Specialist Medical GroupBella VistaAustralia
  3. 3.Blacktown-Mt Druitt HospitalBlacktownAustralia

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