Main skin diseases of the elderly

Abstract

Due to the increasing life expectancy, the geriatric der­ma­tology has become more important and more common in the daily medical practice. A correct diagnosis and a proper management can reduce the morbidity and improve the quality of life. With age, the structure and functions of the skin are continuously changing. The factors which promote the aging of the skin are divided into two categories: in­trin­sical and extrinsical factors. The intrinsical factors are re­presented by the physiological processes of the aging of the skin, which are genetically determined, like wrinkles and loss of elasticity. Sun exposure, smoking, stress and other environmental factors are parts of the extrinsical group. The pathology of the elderly can be divided into four large groups: inflammatory dermatoses, skin infections, vascular pathologies and neoplasms. The main inflammatory der­ma­toses, which are most likely to be found in the elderly, are: asteatotic eczema, contact dermatitis, nummular ec­zema and drug eruptions. The skin infections which are most commonly found in older patients have various etiologies, for example bacterian (Staphylococcus aureus) fungal (Trichophyton rubrum, Candida albicans etc.) or viral (herpes zoster). These infections need a specific treatment, always taking into consideration the other comorbidities of the patients and the eventual drug interactions. With age, the density of the blood vessels and the cutaneous blood flow are decreasing. Due to the loss of elasticity and the impairment of the immune response, the aged skin is more susceptible to different agressions and has a delayed response to them. As a result, the most common vascular pathologies of the elderly are: senile purpura, stasis dermatitis, ulcers, bedsores and chronic venous insuf­ficiency. Of high importance are also the neoplasms of the elderly. The benign neoplasms are: solar lentigos, actinic keratoses (these two types of lesions suggest an increased sun exposure throughout the entire life and indicate a high risk of developing a malignant neoplasm), seborrheic keratoses, angiomas and fibroepithelial polyps. The most common malignant tumors found at older ages are: basal cell carcinoma, scuamous cell carcinoma and melanoma, all of them being related to increased sun exposure. In conclusion, the spectrum of pathologies of the elderly is very broad, and their treatment requires an important amount of attention, because the patients usualy associate multiple comorbidities and present a high risk of complications.