Abstract
The skin is the barrier between vulnerable internal tissues and a plentitude of environmental factors with the potential to negatively impact those tissues [1]. Degenerative processes inherent to aging produce the characteristic thinning, drying, and sagging of elderly skin [2] as well as a progressive deterioration in skin function [3]. This process is based to some extent on ethnicity and gender [4]. However, most visible changes in aged skin [4] as well as most pathological changes are due to a lifetime of exposure to external environmental insult [1]. Degenerative processes that occur in aging skin and their clinical significance are shown in Table 54.1 .
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References
Marks R. Skin Disease in Old Age, 2nd ed. New York: Taylor & Francis, 1999.
Farage MA, Miller KW, Elsner P, et al. Structural characteristics of the aging skin: a review. Cutan Ocul Toxicol. 2007;26:343–357.
Farage MA, Miller KW, Elsner P, et al. Functional and physiological characteristics of the aging skin. Aging Clin Exp Res. 2008;20:195–200.
Farage MA, Miller KW, Elsner P, et al. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci. 2008;30:87–95.
Gilchrest BA. Geriatric skin problems. Hosp Pract (Off Ed). 1986;21:55, 59–65.
Kligman AM, Koblenzer C. Demographics and psychological implications for the aging population. Dermatol Clin. 1997;15:549–553.
Kligman AM. Psychological aspects of skin disorders in the elderly. Cutis. 1989;43:498–501.
Skin care and repair. www.aarp.org/health/conditions/articles/harvard__skin-care-and-repair_0.html. Accessed February 18, 2009.
Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998;25:153–157.
Gilchrest B, Chiu N. Common skin diseases. http://www.merck.com/pubs/mm_geriatrics/sec15/ch123.htm. Accessed February 18, 2009.
Bleiker TO, Graham-Brown RA. Diagnosing skin disease in the elderly. Practitioner. 2000;244:974–981.
Laube S, Farrell AM. Bacterial skin infections in the elderly: diagnosis and treatment. Drugs Aging. 2002;19:331–342.
Norman RA. Xerosis and pruritus in elderly patients, part 1. Ostomy Wound Manage. 2006;52:12–14.
Wolff K, Johnson R, Suurmond R. 2005.Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 5th ed. McGraw-Hill Professional, New York:
Resnick B. Dermatologic problems in the elderly. Lippincotts Prim Care Pract. 1997;1:14–30, quiz 31–2.
Kleinsmith DM, Perricone NV. Common skin problems in the elderly. Dermatol Clin. 1986;4:485–499.
Peters S. Dermatologic issues in the elderly: examining common problems. Adv Nurse Pract. 1999;7:63–64.
Fitzpatrick JE. Common inflammatory skin diseases of the elderly. Geriatrics. 1989;44:40–46.
Haroun MT. Dry skin in the elderly. Geriatr Aging. 2003;6:41–44.
Shwayder T. Ichthyosis in a nutshell. Pediatr Rev. 1999;20:5–12.
Harding C, Watkinson A, Rawlings A, et al. Dry skin, moisturization and corneodesmoloysis. Int J Cosmet Sci. 2000;22:21–52.
Loden M, Maibach H (eds). Dry Skin and Moisturizers: Chemistry and Function. Boca Raton: CRC Press, 2006.
Leyden JJ, Rawlings AV. Skin Moisturization. New York: Marcel Dekker, 2002.
Jennings MB, Alfieri D, Ward K, et al. Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis. a randomized, double-blind, clinical study. J Am Podiatr Med Assoc. 1998;88:332–336.
Fleischer ABJ. Pruritus in the elderly. Adv Dermatol. 1995;10:41–60.
Waisman M. A clinical look at the aging skin. Postgrad Med. 1979;66:87–93, 96.
Yosipovitch G. Assessment of itch: more to be learned and improvements to be made. J Invest Dermatol. 2003;121:xiv–xv.
Perkins P. The management of eczema in adults (continuing education credit). Nurs Stand. 1996;10:55–6.49–53, quiz
Braun M, Lowitt MH. Pruritus. Adv Dermatol. 2001;17:1–27.
Rogers C. Lichen simplex chronicus. Dermatol Nurs. 2003;15:271.
Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol. 1992;27:560–564.
Lim SPR, Abdullah A. Managing skin disease in elderly patients. Practitioner. 2004;248:100–104, 106, 108–109.
Gupta MA, Gupta AK. Medically unexplained cutaneous sensory symptoms may represent somatoform dissociation: an empirical study. J Psychosom Res. 2006;60:131–136
Shelley WB, Shelley ED. The ten major problems of aging skin. Geriatrics. 1982;37:107–113.
Fleischer ABJ. Pruritus in the elderly: management by senior dermatologists. J Am Acad Dermatol. 1993;28:603–609.
Webster GF. Common skin disorders in the elderly. Clin Cornerstone. 2001;4:39–44.
Tierney L, McPhee S, Papadakis M. Current medical diagnosis and treatment. New York: McGraw Hill, 2006.
DeWitt S. Nursing assessment of the skin and dermatologic lesions. Nurs Clin North Am. 1990;25:235–245.
Marks R. Skin Disease in Old Age. London: Martin Dunitz, 1987.
Habif T. Clinical Dermatology: A Color Guide to Diagnosis and Treatment. St Louis: Mosby, 2004.
Tavadia S, Bianchi J, Dawe RS, et al. Allergic contact dermatitis in venous leg ulcer patients. Contact Derm. 2003;48:261–265.
MacKie R. Clinical Dermatology: An Illustrated Textbook. Oxford, New York: Oxford University Press, 1987.
Hall J. Sauer's Manual of Skin Diseases. Philadelphia: Lippincott, Williams and Wilkins, 2000.
Johnson R, Wolff K, Polano M, et al. Asteatotic dermatitis. In: Fitzpatrick T (ed) Color Atlas and Synopsis of Clinical Dermatology, 3rd ed. New York: McGraw-Hill, 1997.
Norman R (ed). Diagnosis of Aging Skin Diseases. London: Springer Verlag, 2008.
Weismann K, Wadskov S, Mikkelsen HI, et al. Acquired zinc deficiency dermatosis in man. Arch Dermatol. 1978;114:1509–1511.
Akimoto K, Yoshikawa N, Higaki Y, et al. Quantitative analysis of stratum corneum lipids in xerosis and asteatotic eczema. J Dermatol. 1993;20:1–6.
Warin AP. Eczéma craquelé as the presenting feature of myxoedema. Br J Dermatol. 1973;89:289–291.
Guillet MH, Schollhammer M, Sassolas B, et al. Eczema craquelé as a pointer of internal malignancy – A case report. Clin Exp Dermatol. 1996;21:431–433.
van Voorst Vader PC, Folkers E, van Rhenen DJ. Craquelé-like eruption in angioimmunoblastic lymphadenopathy. Arch Dermatol. 1979;115:370.
Sparsa A, Boulinguez S, Liozon E, et al. Predictive clinical features of eczema craquelé associated with internal malignancy. Dermatology (Basel). 2007;215:28–35.
Soter NA. Nummular eczematous dermatitis. In: Freedberg IM, Eisen AZ, Wolff K (eds) Fitzpatrick's Dermatology in General Medicine, 5th ed. New York: McGraw-Hill, 1999.
du Vivier A. Atlas of Clinical Dermatology. Oxford: Churchill Livingston, Kidlington, 2002.
Miller J, Collins K, King L. Nummular dermatitis. http://emedicine.medscape.com/article/1123605-print. Accessed February 18, 2009.
Aoyama H, Tanaka M, Hara M, et al. Nummular eczema: an addition of senile xerosis and unique cutaneous reactivities to environmental aeroallergens. Dermatology (Basel). 1999;199:135–139.
Adachi A, Horikawa T, Takashima T, et al. Mercury-induced nummular dermatitis. J Am Acad Dermatol. 2000;43:383–385.
Le Coz C. Contact nummular (discoid) eczema from depilating cream. Contact Dermatitis. 2002;46:111–112.
Flendrie M, Vissers WHPM, Creemers MCW, et al. Dermatological conditions during tnf-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther. 2005;7:R666–R676.
Shen Y, Pielop J, Hsu S, Generalized nummular eczema secondary to peginterferon alfa-2b and ribavirin combination therapy for hepatitis c infection. Arch Dermatol. 2005;141:102–103.
White JV, Ryjewski C. Chronic venous insufficiency. Perspect Vasc Surg Endovasc Ther. 2005;17:319–327.
Quatresooz P, Henry F, Paquet P, et al. Deciphering the impaired cytokine cascades in chronic leg ulcers (review). Int J Mol Med. 2003;11:411–418.
Leu AJ, Leu HJ, Franzeck UK, et al. Microvascular changes in chronic venous insufficiency – a review. Cardiovasc Surg. 1995;3:237–245.
Coleridge Smith PD. Deleterious effects of white cells in the course of skin damage in CVI. Int Angiol. 2002;21:26–32.
Shai A, Maibach HI. Wound Healing and Ulcers of the Skin: Diagnosis and Therapy – The Practical Approach, New York: Springer, 2005.
Trent JT, Falabella A, Eaglstein WH, et al. Venous ulcers: pathophysiology and treatment options. Ostomy Wound Manage. 2005;51:55–56.38–54, quiz
Herouy Y, Nockowski P, Schöpf E, et al. Lipodermatosclerosis and the significance of proteolytic remodeling in the pathogenesis of venous ulceration (review). Int J Mol Med. 1999;3:511–515.
Buckley C, Rustin MH. Management of irritable skin disorders in the elderly. Br J Hosp Med. 1990;44:24–26, 28, 30–32.
Combemale P, Bousquet M, Kanitakis J, et al. Malignant transformation of leg ulcers: a retrospective study of 85 cases. J Eur Acad Dermatol Venereol. 2007;21:935–941.
Gilchrest B, Krutmann J (eds). Skin Aging. New York: Springer, 2006.
Carter DM, Balin AK. Dermatological aspects of aging. Med Clin North Am. 1983;67:531–543.
Machet L, Couhé C, Perrinaud A, et al. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975–2003 data. Br J Dermatol. 2004;150:929–935.
Smoker A. Skin care in old age. Nurs Stand. 1999;13:47–53.
Chan DCW, Fong DHF, Leung JYY, et al. Maggot debridement therapy in chronic wound care. Hong Kong Med J. 2007;13:382–386.
Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008; Issue 4. Art. No.: CD005083. DOI: 10.1002/14651858.CD005083.pub2.
Coelho S, Amarelo M, Ryan S, et al. Rheumatoid arthritis-associated inflammatory leg ulcers: a new treatment for recalcitrant wounds. Int Wound J. 2004;1:81–84.
Taradaj J, Franek A, Brzezinska-Wcislo L, et al. The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial. Phlebology. 2008;23:178–183.
Körber A, Franckson T, Grabbe S, et al. Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients Dermatology (Basel). 2008;216:250–256.
Kranke P, Bennett M, Roeckl-Wiedmann I, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2004:CD004123.
van Gent WB, Hop WC, van Praag MC, et al. Conservative versus surgical treatment of venous leg ulcers: a prospective, randomized, multicenter trial. J Vasc Surg. 2006;44:563–571.
Beacham BE. Common dermatoses in the elderly. Am Fam Physician. 1993;47:1445–1450.
Piaserico S, Larese F, Recchia GP, et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res. 2004;16:221–225.
Ghadially R, Brown BE, Sequeira-Martin SM, et al. The aged epidermal permeability barrier: Structural, functional, and lipid biochemical abnormalities in humans and a senescent murine model. J Clin Invest. 1995;95:2281–2290.
Goh CL, Ling R. A retrospective epidemiology study of contact eczema among the elderly attending a tertiary dermatology referral centre in Singapore. Singapore Med J. 1998;39:442–446.
Green CM, Holden CR, Gawkrodger DJ. Contact allergy to topical medicaments becomes more common with advancing age: An age-stratified study. Contact Dermatitis. 2007;56:229–231.
Nedorost ST, Stevens SR. Diagnosis and treatment of allergic skin disorders in the elderly. Drugs Aging. 2001;18:827–835.
Mangelsdorf HC, Fleischer AB, Sherertz EF. Patch testing in an aged population without dermatitis: High prevalence of patch test positivity. Am J Contact Dermatitis. 1996;7:155–157.
Spencer SK, Kierland RR. The aging skin: problems and their causes. Geriatrics. 1970;25:81–89.
Chew AL, Maibach HI (eds). Irritant Dermatitis. Berlin/Heidleberg: Springer, 2005.
Levin C, Zhai H, Bashir S, et al. Efficacy of corticosteroids in acute experimental irritant contact dermatitis? Skin Res Technol. 2001;7:214–218.
Levin C, Zhai H, Maibach H. Corticosteroids of clinical value in lipid-soluble-chemical-induced irritation in man? Exogenous Dermatol. 2002;1:97–101.
Sandström Falk MH, Tengvall Linder M, Johansson C, et al. The prevalence of malassezia yeasts in patients with atopic dermatitis, seborrhoeic dermatitis and healthy controls. Acta Derm Venereol. 2005;85:17–23.
Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: An overview. Am Fam Physician. 2006;74:125–130.
Schwartz JR, Cardin CW, Dawson TLJ. Dandruff and seborrheic dermatitis. In: Baran R, Maibach HI (eds). Textbook of Cosmetic Dermatology, 3rd ed. London: Martin Dunitz Ltd., 2004.
Mastrolonardo M, Diaferio A, Logroscino G. Seborrheic dermatitis, increased sebum excretion, and parkinson's disease: a survey of (im)possible links. Med Hypotheses. 2003;60:907–911.
Loo WJ, Burrows NP. Management of autoimmune skin disorders in the elderly. Drugs Aging. 2004;21:767–777.
Bickle K, Roark TR, Hsu S. Autoimmune bullous dermatoses: a review. Am Fam Physician. 2002;65:1861–1870.
Langan SM, Smeeth L, Hubbard R, et al. Bullous pemphigoid and pemphigus vulgaris – incidence and mortality in the UK: population based cohort study. Br Med J. 2008;337:a180.
Walsh SRA, Hogg D, Mydlarski PR. Bullous pemphigoid: from bench to bedside. Drugs. 2005;65:905–926.
American Academy of Dermatology. Bullous disease. http://www.aad.org/public/Publications/pamphlets/bullous.htm. Accessed February 18, 2009.
Stanley J. Bullous pemphigoid. In: Freedberg IM, Eisen AZ, Wolff K, et al (eds) Fitzpatrick's Dermatology in General Medicine, 5th ed. New York: McGraw-Hill, 1999.
Mutasim DF. Autoimmune bullous dermatoses in the elderly: diagnosis and management. Drugs Aging. 2003;20:663–681.
Kjellman P, Eriksson H, Berg P. A retrospective analysis of patients with bullous pemphigoid treated with methotrexate. Arch Dermatol. 2008;144:612–616.
Sollecito TP, Parisi E. Mucous membrane pemphigoid. Dent Clin North Am. 2005;49:91–106, viii.
Laforest C, Huilgol SC, Casson R, et al. Autoimmune bullous diseases: Ocular manifestations and management. Drugs. 2005;65:1767–1779.
Pemphigus vulgaris. http://www.merck.com/mmpe/print/sec10/ch112/ch112f.html. Accessed February 18, 2009.
da Silva AV, Valones MA, Guimaraes RP, et al. Pemphigus vulgaris: A therapeutic option for disease control. Gen Dent. 2008;56:700–703.
Tehranchi-Nia Z, Qureshi TA, Ahmed AR. Pemphigus vulgaris in older adults. J Am Geriatr Soc. 1998;46:92–94.
Chams-Davatchi C, Esmaili N, Daneshpazhooh M, et al. Randomized controlled open-label trial of four treatment regimens for pemphigus vulgaris. J Am Acad Dermatol. 2007;57:622–628.
Zhu X, Zhang B. Paraneoplastic pemphigus. J Dermatol. 2007;34:503–511.
Farage MA, Maibach HI (eds). The Vulva: Anatomy, Physiology, and Pathology, New York: Informa Healthcare, 2006.
Neill SM, Tatnall FM, Cox NH. Guidelines for the management of lichen sclerosus. Br J Dermatol. 2002;147:640–649.
Lorenz B, Kaufman RH, Kutzner SK. Lichen sclerosus: therapy with clobetasol propionate. J Reprod Med. 1998;43:790–794.
Cooper SM, Gao X, Powell JJ, et al. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140:702–706.
Berlowitz DR, Wilking SVB. Pressure ulcers in the nursing home. In: Reubentein L, Wieland D (eds) Improving Care in the Nursing Home: Comprehensive Reviews of Clinical Research. Newbury Park: Sage Publications, 1993.
Edlich RF, Winters KL, Woodard CR, et al. Pressure ulcer prevention. J Long Term Eff Med Implants. 2004;14:285–304.
National Pressure Ulcer Advisory Panel. Pressure ulcers prevalence, cost, and risk assessment: consensus development conference statement. Decubitus. 1989;2:24–28.
Nola GT, Vistnes LM. Differential response of skin and muscle in the experimental production of pressure sores. Plast Reconstr Surg. 1980;66:728–733.
Baranoski S. Skin tears: the enemy of frail skin. Adv Skin Wound Care. 2000;13:123–126.
Baeke JL. Hospital-acquired pressure ulcers: an epidemic. Plast Reconstr Surg. 2000;106:945–946.
Stratton RJ, Ek A, Engfer M, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res. Rev. 2005;4:422–450.
Cohen AF, Tiemstra JD. Diagnosis and treatment of rosacea. J Am Board Fam Pract. 2002;15:214–217.
Diaz C, O'Callaghan CJ, Khan A, et al. Rosacea: a cutaneous marker of Helicobacter pylori infection? Results of a pilot study. Acta Derm Venereol. 2003;83:282–286.
Boixeda de Miquel D, Vázquez Romero M, Vázquez Sequeiros E, et al. Effect of Helicobacter pylori eradication therapy in rosacea patients. Rev Esp Enferm Dig. 2006;98:501–509.
Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. Feb 2009;60(2):270-276, Epub 2008 Nov 25.
Oztas MO, Balk M, Ogüs E, et al. The role of free oxygen radicals in the aetiopathogenesis of rosacea Clin. Exp Dermatol. 2003;28:188–192.
Baz K, Cimen MYB, Kokturk A, et al. Plasma reactive oxygen species activity and antioxidant potential levels in rosacea patients: Correlation with seropositivity to Helicobacter pylori. Int J Dermatol. 2004;43:494–497.
Bakar O, Demirçay Z, Yuksel M, et al. The effect of azithromycin on reactive oxygen species in rosacea Clin. Exp Dermatol. 2007;32:197–200.
Niv D, Maltsman-Tseikhin A, Lang E. Postherpetic neuralgia: What do we know and where are we heading? Pain Physician. 2004;7:239–247.
Johnson R. Herpes zoster – predicting and minimizing the impact of post-herpetic neuralgia. J Antimicrob Chemother. 2001;47(Suppl T1):1–8.
Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–2284.
Koplan JP, Harpaz R. Shingles vaccine: Effective and costly or cost-effective? Ann Intern Med. 2006;145:386–387.
Bachot N, Roujeau J. Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol. 2003;4:561–572.
Liao YH, Chen KH, Tseng MP, et al. Pattern of skin diseases in a geriatric patient group in taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology (Basel). 2001;203:308–313.
Fletcher K. Skin: geriatric self-learning module. Medsurg Nurs. 2005;14:138–142.
Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135:434–440.
Kooken A, Tomecki K. Drug eruptions. http://www.clevelandclinicmeded.com/diseasemanagement/dermatology/drug_eruptions/drug_eruptions1.htm. Accessed February 18, 2009.
Kauppinen K, Alanko K, Hannuksela M, et al. Skin Reactions to Drugs. Boca Raton: CRC Press, 1998.
Kurban RS, Kurban AK. Common skin disorders of aging: diagnosis and treatment. Geriatrics. 1993;48:30–31, 35–36, 39–42.
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Farage, M.A., Miller, K.W., Berardesca, E., Maibach, H.I. (2010). Non-neoplastic Disorders of the Aging Skin. In: Farage, M.A., Miller, K.W., Maibach, H.I. (eds) Textbook of Aging Skin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-89656-2_54
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