Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-04-30T15:37:56.298Z Has data issue: false hasContentIssue false

Chapter 38 - Dermatologic Conditions

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Frank Lacy ,
Maria del Mar Melendez-Gonzalez  and
Christopher J. Sayed
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Skin conditions affect patients of all ages, but there are unique considerations in the geriatric population. The structure and function of the skin evolve over time in ways that alter the risk of developing many skin diseases as well as the appearance of both normal and abnormal skin findings. It is important to recognize normal skin changes such as seborrheic keratosis and actinic purpura and to be able to distinguish them from more concerning changes such as skin cancers or infections that are more likely to occur in elderly patients. In this chapter, we review the typical effects of aging on the skin and the important neoplastic, inflammatory, infectious, and other processes.

Keywords

geriatricsdermatologyskin cancerpsoriasisphotoaginginfection
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 457 - 476
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bonté, F, Girard, D, Archambault, JC, Desmoulière, A. Skin changes during ageing. Subcell Biochem. 2019; 91:249–280.Google Scholar
Vukmanovic-Stejic, M, Rustin, MH, Nikolich-Zugich, J, Akbar, AN. Immune responses in the skin in old age. Curr Opin Immunol. 2011 (Aug.); 23(4):525–531.CrossRefGoogle ScholarPubMed
Vandergriff, T, Bergstresser, P. Anatomy and physiology. In: Bolognia, J, Jorrizo, J, Schaffer, J, eds. Dermatology, 3rd edition. Philadelphia, PA: Saunders, 2012, pp. 43–54.Google Scholar
Gilchrest, BA, Chiu, N. Aging and the skin. In: Beers, MH, Ber, R, eds. The Merck Manual of Geriatrics, 3rd edition. Whitehouse Station, NJ: Merck and Co, Inc, 2000.Google Scholar
Balin, AK. Skin disease. In: Evans, JG, Williams, TF, Beattie, BL, Michel, J-P, Wilcock, GK, eds. Oxford Textbook of Geriatric Medicine, 2nd edition. Oxford: Oxford University Press, 2012.Google Scholar
Fisher, GJ, Varani, J, Voorhees, JJ. Looking older: Fibroblast collapse and therapeutic implications. Arch Dermatol. 2008 (May); 144(5):666–672.Google Scholar
Xu, YP, Qi, RQ, Chen, W, Shi, Y, Cui, ZZ, Gao, XH, Chen, HD, Zhou, L, Mi, QS. Aging affects epidermal Langerhans cell development and function and alters their miRNA gene expression profile. Aging (Albany NY). 2012 (Nov.); 4(11):742–754.CrossRefGoogle ScholarPubMed
Laube, S. Skin infections and ageing. Ageing Res Rev. 2004 (Jan.); 3(1):69–89.Google Scholar
Victorelli, S, Lagnado, A, Halim, J, et al. Senescent human melanocytes drive skin ageing via paracrine telomere dysfunction. EMBO J. 2019 (Dec. 2); 38(23):e101982.Google Scholar
Fenske, NA, Lober, CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986; 15:571–585.Google Scholar
Kim, DJ, Mustoe, T, Clark, RA. Cutaneous wound healing in aging small mammals: A systematic review. Wound Repair Regen. 2015 (May–Jun.); 23(3):318–339.CrossRefGoogle ScholarPubMed
Bergan, JJ, Schmid-Schönbein, GW, Smith, PD, Nicolaides, AN, Boisseau, MR, Eklof, B. Chronic venous disease. N Engl J Med. 2006 (Aug. 3); 355(5):488–498.Google Scholar
Olsen, EA, Katz, HI, Levine, N, Nigra, TP, Pochi, PE, Savin, RC, Shupack, J, Weinstein, GD, Lufrano, L, Perry, BH. Tretinoin emollient cream for photodamaged skin: Results of 48-week, multicenter, double-blind studies. J Am Acad Dermatol. 1997 (Aug.); 37(2 Pt 1):217–226.Google Scholar
Piraccini, BM, Alessandrini, A. Androgenetic alopecia. G Ital Dermatol Venereol. 2014 (Feb.); 149(1):15–24.Google Scholar
Zouboulis, CC, Boschnakow, A. Chronological ageing and photoageing of the human sebaceous gland. Clin Exp Dermatol. 2001 (Oct.); 26(7):600–607.Google Scholar
Akpinar, F, Dervis, E. Association between acrochordons and the components of metabolic syndrome. Eur J Dermatol. 2012 (Jan.–Feb.); 22(1):106–110.Google Scholar
Derancourt, C, Bourdon-Lanoy, E, Grob, JJ, Guillaume, JC, Bernard, P, Bastuji-Garin, S. Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: A case-control study. Dermatology. 2007; 214(1):25–31.CrossRefGoogle Scholar
Lopes Mattos e Dinato, SL, de Oliva, R, e Dinato, MM, Macedo-Soares, A, Bernardo, WM. Prevalence of dermatoses in residents of institutions for the elderly. Rev Assoc Med Bras. 2008 (Nov.–Dec.); 54(6):543–547.Google Scholar
Rogers, HW, Weinstock, MA, Feldman, SR, Coldiron, BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol. 2015 (Oct.); 151(10):1081–1086.Google Scholar
Studdiford, J, Salzman, B, Tully, A. Geriatric dermatology. In: Arenson, C, Busby-Whitehead, J, Brummel-Smith, K, O’Brien James, G, Palmer, M, Reichel, W, eds. Reichel’s Care of the Elderly: Clinical Aspects of Aging, 6th edition. New York: Cambridge University Press, 2009, pp. 345–368.Google Scholar
Mancebo, SE, Hu, JY, Wang, SQ. Sunscreens: A review of health benefits, regulations, and controversies. Dermatol Clin. 2014 (Jul.); 32(3):427–438, x.CrossRefGoogle ScholarPubMed
Stern, RS. Prevalence of a history of skin cancer in 2007: Results of an incidence-based model. Arch Dermatol. 2010 (Mar.); 146(3):279–282.Google Scholar
Youssef, KK, Van Keymeulen, A, Lapouge, G, Beck, B, Michaux, C, Achouri, Y, Sotiropoulou, PA, Blanpain, C. Identification of the cell lineage at the origin of basal cell carcinoma. Nat Cell Biol. 2010 (Mar.); 12(3):299–305.CrossRefGoogle ScholarPubMed
Soyer, HP, Rigel, D, Wurm, E. Actinic keratosis, basal cell carcinoma, and squamous cell carcinoma. In: Bolognia, J, Jorrizo, J, Schaffer, J, eds. Dermatology, 3rd edition. Philadelphia, PA. Saunders, 2012, pp. 1773–1794.Google Scholar
Peris, K, Fargnoli, MC, Garbe, C, et al; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. Eur J Cancer. 2019 (Sep.); 118:10–34.Google Scholar
Jansen, MHE, Kessels, JPHM, Nelemans, PJ, Kouloubis, N, Arits, AHMM, van Pelt, HPA, Quaedvlieg, PJF, Essers, BAB, Steijlen, PM, Kelleners-Smeets, NWJ, Mosterd, K. Randomized trial of four treatment approaches for actinic keratosis. N Engl J Med. 2019 (Mar. 7); 380(10):935–946.Google Scholar
Work Group; Invited Reviewers, Kim, JYS, Kozlow, JH, Mittal, B, Moyer, J, Olenecki, T, Rodgers, P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018 (Mar.); 78(3):560–578.Google Scholar
Marcil, I, Stern, RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: A critical review of the literature and meta-analysis. Arch Dermatol. 2000 (Dec.); 136(12):1524–1530.Google Scholar
Cancer.org. American Cancer Society. Cancer Facts and Figures, 2014. www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index.Google Scholar
Cancer.org. American Cancer Society. Cancer Facts and Figures, 2020 [cited June 2020]. www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html.Google Scholar
Scope, A, Dusza, SW, Halpern, AC, Rabinovitz, H, Braun, RP, Zalaudek, I, Argenziano, G, Marghoob, AA. The “ugly duckling” sign: Agreement between observers. Arch Dermatol. 2008 (Jan.); 144(1):58–64.Google Scholar
Wee, E, Wolfe, R, Mclean, C, Kelly, JW, Pan, Y. Clinically amelanotic or hypomelanotic melanoma: Anatomic distribution, risk factors, and survival. J Am Acad Dermatol. 2018 (Oct.); 79(4):645–651.CrossRefGoogle ScholarPubMed
Garbe, C, Bauer, J. Melanoma In: Bolognia, J, Jorrizo, J, Schaffer, J, eds. Dermatology, 3rd edition. Philadelphia, PA: Saunders, 2012, pp. 1914–1885.Google Scholar
Zitelli, JA, Brown, C, Hanusa, BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. 1997 (Aug.); 37(2 Pt 1):236–245.Google Scholar
Leiter, U, Stadler, R, Mauch, C, et al.; German Dermatologic Cooperative Oncology Group (DeCOG). Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): A multicentre, randomised, phase 3 trial. Lancet Oncol. 2016 (Jun.); 17(6):757–767.Google Scholar
Wright, FC, Souter, LH, Kellett, S, Easson, A, Murray, C, Toye, J, McCready, D, Nessim, C, Ghazarian, D, Hong, NJL, Johnson, S, Goldstein, DP, Petrella, T; Melanoma Disease Site Group. Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: A clinical practice guideline. Curr Oncol. 2019 (Aug.); 26(4):e541–e550.Google Scholar
Chapman, PB, Hauschild, A, Robert, C, et al.; BRIM-3 Study Group. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011 (Jun. 30); 364(26):2507–2516.Google Scholar
Rotte, A. Combination of CTLA-4 and PD-1 blockers for treatment of cancer. J Exp Clin Cancer Res. 2019 (Jun. 13); 38(1):255. doi: 10.1186/s13046-019-1259-z. PMID: 31196207; PMCID: PMC6567914.Google Scholar
Elewski, BE, Draelos, Z, Dréno, B, Jansen, T, Layton, A, Picardo, M. Rosacea – global diversity and optimized outcome: Proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011 (Feb.); 25(2):188–200.Google Scholar
Wilkin, J, Dahl, M, Detmar, M, Drake, L, Feinstein, A, Odom, R, Powell, F. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002 (Apr.); 46(4):584–587.CrossRefGoogle ScholarPubMed
Zhao, YE, Wu, LP, Peng, Y, Cheng, H. Retrospective analysis of the association between Demodex infestation and rosacea. Arch Dermatol. 2010 (Aug.); 146(8):896–902.Google Scholar
Yang, X. Relationship between Helicobacter pylori and Rosacea: Review and discussion. BMC Infect Dis. 2018 (Jul. 11); 18(1):318.Google Scholar
Kastarinen, H, Oksanen, T, Okokon, EO, Kiviniemi, VV, Airola, K, Jyrkkä, J, Oravilahti, T, Rannanheimo, PK, Verbeek, JH. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database Syst Rev. 2014 (May 19); 2014(5):CD009446.Google Scholar
Potts, GA, Hurley, MY. Psoriasis in the geriatric population. Clin Geriatr Med. 2013 (May); 29(2):373–395.Google Scholar
Eder, L, Chandran, V, Shen, H, Cook, RJ, Shanmugarajah, S, Rosen, CF, Gladman, DD. Incidence of arthritis in a prospective cohort of psoriasis patients. Arthritis Care Res (Hoboken). 2011 (Apr.); 63(4):619–622.Google Scholar
Dregan, A, Charlton, J, Chowienczyk, P, Gulliford, MC. Chronic inflammatory disorders and risk of type 2 diabetes mellitus, coronary heart disease, and stroke: A population-based cohort study. Circulation. 2014 (Sep. 2); 130(10):837–844.Google Scholar
van der Voort, EA, Koehler, EM, Dowlatshahi, EA, Hofman, A, Stricker, BH, Janssen, HL, Schouten, JN, Nijsten, T. Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: Results from a population-based study. J Am Acad Dermatol. 2014 (Mar.); 70(3):517–524.Google Scholar
Balato, N, Patruno, C, Napolitano, M, Patrì, A, Ayala, F, Scarpa, R. Managing moderate-to-severe psoriasis in the elderly. Drugs Aging. 2014 (Apr.); 31(4):233–238.Google Scholar
Menter, A, Gelfand, JM, Connor, C, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020 (Jun.); 82(6):1445–1486.Google Scholar
Kalb, RE, Fiorentino, DF, Lebwohl, MG, Toole, J, Poulin, Y, Cohen, AD, Goyal, K, Fakharzadeh, S, Calabro, S, Chevrier, M, Langholff, W, You, Y, Leonardi, CL. Risk of serious infection with biologic and systemic treatment of psoriasis: Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015 (Sep.); 151(9):961–969.Google Scholar
Baumrin, E, Van Voorhees, A, Garg, A, Feldman, SR, Merola, JF. A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2019 (Jul.); 81(1):102–110.Google Scholar
Vakharia, PP, Silverberg, JI. Adult-onset atopic dermatitis: Characteristics and management. Am J Clin Dermatol. 2019 (Dec.); 20(6):771–779.Google Scholar
Ozkaya, E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005 (Apr.); 52(4):579–582.Google Scholar
Bonamonte, D, Foti, C, Vestita, M, Ranieri, LD, Angelini, G. Nummular eczema and contact allergy: A retrospective study. Dermatitis. 2012 (Jul.–Aug.); 23(4):153–157.Google Scholar
Blauvelt, A, de Bruin-Weller, M, Gooderham, M, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): A 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017 (Jun. 10); 389(10086):2287–2303.Google Scholar
Berger, TG, Shive, M, Harper, GM. Pruritus in the older patient: A clinical review. JAMA. 2013 (Dec. 11); 310(22):2443–2450.Google Scholar
Yalçin, B, Tamer, E, Toy, GG, Oztaş, P, Hayran, M, Alli, N. The prevalence of skin diseases in the elderly: Analysis of 4099 geriatric patients. Int J Dermatol. 2006 (Jun.); 45(6):672–676.Google Scholar
Erfurt-Berge, C, Geier, J, Mahler, V. The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis: New data from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis. 2017; 77(3):151–158.CrossRefGoogle ScholarPubMed
Hammers, CM, Stanley, JR. Mechanisms of disease: Pemphigus and bullous pemphigoid. Annu Rev Pathol. 2016; 11:175–197.Google Scholar
Schmidt, E, Kasperkiewicz, M, Joly, P. Pemphigus. Lancet. 2019 (Sep. 7); 394(10201):882–894.Google Scholar
Joly, P, Roujeau, JC, Benichou, J, Picard, C, Dreno, B, Delaporte, E, Vaillant, L, D’Incan, M, Plantin, P, Bedane, C, Young, P, Bernard, P; Bullous Diseases French Study Group. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. 2002 (Jan. 31); 346(5):321–327.Google Scholar
Polansky, M, Eisenstadt, R, DeGrazia, T, Zhao, X, Liu, Y, Feldman, R. Rituximab therapy in patients with bullous pemphigoid: A retrospective study of 20 patients. J Am Acad Dermatol. 2019; 81(1):179–186.Google Scholar
Dupuy, A, Benchikhi, H, Roujeau, JC, Bernard, P, Vaillant, L, Chosidow, O, Sassolas, B, Guillaume, JC, Grob, JJ, Bastuji-Garin, S. Risk factors for erysipelas of the leg (cellulitis): Case-control study. BMJ. 1999 (Jun. 12); 318(7198):1591–1594.Google Scholar
McNamara, DR, Tleyjeh, IM, Berbari, EF, Lahr, BD, Martinez, JW, Mirzoyev, SA, Baddour, LM. Incidence of lower-extremity cellulitis: A population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 2007 (Jul.); 82(7):817–821.Google Scholar
Perl, B, Gottehrer, NP, Raveh, D, Schlesinger, Y, Rudensky, B, Yinnon, AM. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis. 1999 (Dec.); 29(6):1483–1488.Google Scholar
Yawn, BP, Saddier, P, Wollan, PC, St Sauver, JL, Kurland, MJ, Sy, LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007 (Nov.); 82(11):1341–1349.Google Scholar
Zhang, JX, Joesoef, RM, Bialek, S, Wang, C, Harpaz, R. Association of physical trauma with risk of herpes zoster among Medicare beneficiaries in the United States. J Infect Dis. 2013 (Mar. 15); 207(6):1007–1011.Google Scholar
Kost, RG, Straus, SE. Postherpetic neuralgia: Pathogenesis, treatment, and prevention. N Engl J Med. 1996; 335(1):32–42.Google Scholar
Gnann, JW Jr. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002 (Oct. 15); 186 (Suppl 1):S91–98.Google Scholar
Choo, PW, Galil, K, Donahue, JG, Walker, AM, Spiegelman, D, Platt, R. Risk factors for postherpetic neuralgia. Arch Intern Med. 1997 (Jun. 9); 157(11):1217–1224.Google Scholar
Dooling, KL, Guo, A, Patel, M, Lee, GM, Moore, K, Belongia, EA, Harpaz, R. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep. 2018 (Jan. 26); 67(3):103–108.Google Scholar
Cunningham, AL, Lal, H, Kovac, M, Chlibek, R, et al.; ZOE-70 Study Group. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016 (Sep. 15); 375(11):1019–1032.Google Scholar
Arlian, LG, Runyan, RA, Achar, S, Estes, SA. Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis. J Am Acad Dermatol. 1984 (Aug.); 11(2 Pt 1):210–215.Google Scholar
Currie, BJ, McCarthy, JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010 (Feb. 25); 362(8):717–725.Google Scholar
Raffi, J, Suresh, R, Butler, DC. Review of scabies in the elderly. Dermatol Ther (Heidelb). 2019 (Dec.); 9(4):623–630.Google Scholar
Usha, V, Gopalakrishnan Nair, TV. A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies. J Am Acad Dermatol. 2000; 42(2 Pt 1):236–240.Google Scholar
Lipner, SR, Scher, RK. Onychomycosis: Clinical overview and diagnosis. J Am Acad Dermatol. 2019 (Apr.); 80(4):835–851.CrossRefGoogle ScholarPubMed
Gupta, AK, Versteeg, SG, Shear, NH. Onychomycosis in the 21st century: An update on diagnosis, epidemiology, and treatment. J Cutan Med Surg. 2017 (Nov./Dec.); 21(6):525–539.Google Scholar
Lipner, SR, Scher, RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019 (Apr.); 80(4):853–867.CrossRefGoogle ScholarPubMed
Kalra, MG, Higgins, KE, Kinney, BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014 (Apr.); 89(7):569–573.Google Scholar
Yosipovitch, G, DeVore, A, Dawn, A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007 (Jun.); 56(6):901–916.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×