Elderly Skin Research Articles

Correção: Cuidados de enfermagem na prevenção de quebras de pele no idoso: revisão integrativa da literatura

Introduction Skin tears are considered injuries of traumatic etiology that can result from a variety of mechanical forces, such as shear or friction forces, blunt trauma, falls, improper handling, injury caused by equipment or removal of adherent dressings. These are acute wounds that have a high probability of becoming complex chronic wounds. They cause pain, increase healthcare costs, reduce quality of life and are a source of stress for the person. They lengthen hospital stay and increase the risk of morbidities. Skin Tears are a growing problem, making it crucial to invest in this topic in order to promote their prevention and proper treatment. Objective To identify nursing care and strategies to prevent skin tears in the elderly. Methods A bibliographic survey of publications was carried out in the EBSCOhost search engine, which incorporates the CINAHL Complete, MEDLINE Complete and Cochrane Database of Systematic Reviews databases and in the PubMed database, carried out in June 2022. 26 records were returned, five meeting the inclusion criteria. The included studies (n=5) were carried out between 2012 and 2022. Results In the sample of articles, it was possible to identify the benefits of twice-daily application of topical products, moisturizing creams and emollients, and the relevance of oral administration for 8 weeks of an oral nutritional supplement in the hydration of the stratum corneum and in the elasticity of the skin, as well as the importance of primary prevention and the promotion of health education in elderly skin care. Conclusion Preventive care to avoid skin tears in the elderly focuses on the daily topical application of moisturizing creams and emollients, nutrition (administration of oral nutritional supplements with 10g of collagen peptides) and adequate hydration; to prevent cutaneous traumas by providing a safe environment with adequate devices, and through the promotion of health education.

Pruritus in elderly: Classification and management

Pruritus is majority complaint that is often encountered in dermatology. The diagnosis and management of pruritus still became important health problem in elderly. It is estimated that one fifth of the world’s population experience chronic pruritus which can affect their quality of life. The lifetime prevalence of chronic pruritus in the general population was 22%. In the elderly, two thirds of the population are reported to experience pruritus. Based on the onset of symptom, pruritus is divided into acute pruritus and chronic pruritus. While based on clinical complaints, pruritus is divided into pruritus originating from the skin, neuropathic pruritus, neurogenic pruritus, and psychogenic pruritus. Elderly skin is sensitive skin, which often gives complaints of itching. Pruritus, especially in elderly, requires treatment that must be adapted to the pathophysiology. Treatment of pruritus in the elderly can include topical therapy, systemic therapy and phototherapy. The management approach to pruritus consists of 4 important pillars, namely basic therapy, targeted therapy, symptomatic therapy, and therapy for accompanying diseases.

Comparison of breast skin resistance against protease digestion between young and elderly individual based on attenuation-of-sound values

The skin is a gateway through which bacteria can establish infection. Evidence has shown that the components of the skin change with age, with elderly individuals exhibiting fewer epidermal rete ridges, dermal collagen, and elastic fibers. In the present study, paraffin sections of breast skin were digested with proteolytic enzymes of bacterial origin, after which skin fragility was assessed by observing attenuation-of-sound (AOS) images over time. Accordingly, studies have shown that AOS values are correlated with tissue viscosity and can serve as a numerical indicator of protein density. Breast skin sections were digested using two types of collagenases and actinase E, a broader peptidase. Notably, our results showed that skin sections from young and elderly patients showed resistance to digestion with the two types of collagenases. However, the epidermis and dermis were successfully digested using actinase over time. All layers of the epidermis, except for the keratin layer, were digested, whereas collagen and elastic fibers in the dermis were broken down, along with a decrease in AOS levels. Although actinase affected both young and aged skin, elderly skin showed much lower AOS values given its naturally reduced thickness and density due to aging. This finding suggests that older patients experience greater damage from proteolytic enzymes. AOS is an excellent approach to visualizing the process of protease digestion over time and statistically comparing proteolytic damage.The skin is a gateway through which bacteria can establish infection. Evidence has shown that the components of the skin change with age, with elderly individuals exhibiting fewer epidermal rete ridges, dermal collagen, and elastic fibers. In the present study, paraffin sections of breast skin were digested with proteolytic enzymes of bacterial origin, after which skin fragility was assessed by observing attenuation-of-sound (AOS) images over time. Accordingly, studies have shown that AOS values are correlated with tissue viscosity and can serve as a numerical indicator of protein density. Breast skin sections were digested using two types of collagenases and actinase E, a broader peptidase. Notably, our results showed that skin sections from young and elderly patients showed resistance to digestion with the two types of collagenases. However, the epidermis and dermis were successfully digested using actinase over time. All layers of the epidermis, except for the keratin layer, were digested, whereas collagen and elastic fibers in the dermis were broken down, along with a decrease in AOS levels. Although actinase affected both young and aged skin, elderly skin showed much lower AOS values given its naturally reduced thickness and density due to aging. This finding suggests that older patients experience greater damage from proteolytic enzymes. AOS is an excellent approach to visualizing the process of protease digestion over time and statistically comparing proteolytic damage.

Expression of p53, p63, p16, Ki67, Cyclin D, Bcl-2, and CD31 Markers in Actinic Keratosis, In Situ Squamous Cell Carcinoma and Normal Sun-Exposed Skin of Elderly Patients

Background: Age and cumulative exposure to ultraviolet (UV) light are primary contributors to skin cancer development. Regulatory proteins within the cell cycle are essential for the homeostasis of squamous epithelium. Methods: This study assessed the expression of immunohistochemical markers p53, p63, p16, Ki67, Cyclin D, Bcl-2, and CD31 in keratinocyte intraepithelial neoplasia (actinic keratosis and squamous cell carcinoma in situ) compared to normal skin. The objective was to distinguish disease-specific changes from those attributable to ageing and sun exposure in elderly skin. Results. Analysis included 22 actinic keratoses (AK), 7 in situ squamous cell carcinomas (SCC), and 8 normal skin biopsies. The mean age was 78.1 years for the AK/SCC group and 73.8 years for controls, with no significant age difference noted between the groups. The AK/SCC group exhibited a higher occurrence of amorphous masses, higher intensity of p53, lower Bcl-2 expression in the epidermis, higher Bcl-2 expression in the dermis, and higher CD31 expression in the dermis, all of which were statistically significant (p < 0.05). Conclusions: The study identifies distinct differences in the presence of amorphous masses and the expression levels of p53, Bcl-2, and CD31 between sun-exposed skin and in situ cutaneous squamous cell carcinomas, including actinic keratoses.

Pelatihan Kader Kesehatan dalam Perawatan Kulit Lansia

Introduction: Elderly is an age group that is at risk of experiencing disturbances in body tissues, one of which is skin tissue. The structure of the elderly's skin changes, including dry skin, wrinkles, and itching. The Sukoharjo Village, which is under the auspices of the Bareng Health Center, only has 16 health cadres and functions as an informal caregiver to care for the elderly indirectly. Informal caregivers do not have a formal educational background in terms of skin care, causing problems related to their competence. Objective: The purpose of this service was to improve the ability and skills of health cadres in elderly skin care. Method: This public service was conducted by lectured, discussion, and demonstration. The approach taken is to provide education about long-term care and skin care as well as training in elderly skin care through bathing the elderly. Result: The activity partners were 16 health cadres in RW 1 and 2, Sukoharjo Village. The results of the activity showed an increase in knowledge of 40% of cadres who had good knowledge, while 73% of health cadres had good skills in providing skin care to the elderly. Conclusion: Health cadres who are given training on elderly skin care are expected to be able to transfer the knowledge that has been given to caregivers who are in RW 1 and RW 2 for the sake of improving the quality of life of the elderly.

Cuidados de enfermagem na prevenção de quebras de pele no idoso: revisão integrativa da literatura

Introduction Skin tears are considered injuries of traumatic etiology that can result from a variety of mechanical forces, such as shear or friction forces, blunt trauma, falls, improper handling, injury caused by equipment or removal of adherent dressings. These are acute wounds that have a high probability of becoming complex chronic wounds. They cause pain, increase healthcare costs, reduce quality of life and are a source of stress for the person. They lengthen hospital stay and increase the risk of morbidities. Skin Tears are a growing problem, making it crucial to invest in this topic in order to promote their prevention and proper treatment. Objective To identify nursing care and strategies to prevent skin tears in the elderly. Methods A bibliographic survey of publications was carried out in the EBSCOhost search engine, which incorporates the CINAHL Complete, MEDLINE Complete and Cochrane Database of Systematic Reviews databases and in the PubMed database, carried out in June 2022. 26 records were returned, five meeting the inclusion criteria. The included studies (n=5) were carried out between 2012 and 2022. Results In the sample of articles, it was possible to identify the benefits of twice-daily application of topical products, moisturizing creams and emollients, and the relevance of oral administration for 8 weeks of an oral nutritional supplement in the hydration of the stratum corneum and in the elasticity of the skin, as well as the importance of primary prevention and the promotion of health education in elderly skin care. Conclusion Preventive care to avoid skin tears in the elderly focuses on the daily topical application of moisturizing creams and emollients, nutrition (administration of oral nutritional supplements with 10g of collagen peptides) and adequate hydration; to prevent cutaneous traumas by providing a safe environment with adequate devices, and through the promotion of health education.

Increased production of natural moisturizing factors and bleomycin hydrolase activity in elderly human skin

BackgroundBleomycin hydrolase (BH), which is expressed in the stratum granulosum and lower stratum corneum (SC), is involved in final filaggrin degradation. Furthermore, BH plays an essential role in producing free amino acids, which constitute the majority of natural moisturizing factors (NMF). However, the effects of BH expression and protease activity on human skin aging remain unclear. ObjectiveThis study was designed to evaluate the activity and expression patterns of BH in SC extracts from healthy young and elderly individuals. MethodsSC samples were collected by tape stripping. BH activity was assessed by measuring the citrulline aminopeptidase activity. BH expression was determined by Western blotting, and NMF was quantified by liquid chromatography/mass spectrometry. Skin barrier function was determined by measuring SC hydration, transepidermal water loss (TEWL), and skin pH. ResultsThe activity and expression of BH were higher in the elderly skin than in young skin, and BH activity was correlated with BH expression levels. Evaluation of the NMF showed that the levels of total amino acids, such as glycine, serine, aspartic acid, citrulline, pyrrolidone carboxylic acid (a metabolite of glutamic acid), and trans-urocanic acid (a metabolite of histidine), were significantly higher in elderly skin than in young skin. Moreover, SC hydration and TEWL were significantly lower in elderly, indicating dry skin, and pH was significantly higher in elderly, indicating greater skin alkalinization. ConclusionThese results suggest that BH activity and expression, as well as NMF amino acids, increase in elderly people as compensatory mechanisms against dry skin.

Evaluation of Clinical Knowledge Regarding Geriatric Skin Conditions among Thai Physicians

Objective: Assess the knowledge of common geriatric skin conditions in Thai physicians.Materials and Methods: This retrospective study was conducted among Thai physicians attending annual dermatology courses by the Dermatological Society of Thailand from 2016 to 2019. Data was assessed based on knowledge of diagnosis and management of common geriatric skin conditions.Results: A total of 197 participants, mainly general practitioners, were included. The highest percentage of correct diagnoses were benign erythematous, eczematous lesions (35.5%, senile purpura; 36.0%, xerotic eczema), and malignant diseases (35.5%, basal cell carcinoma; 27.4%, squamous cell carcinoma; 11.7%, subungual melanoma; 24.4%, acral lentiginous melanoma). In contrasts, the lowest percentage of correct diagnosis were premalignant diseases (0.5%, arsenical keratosis; 4.6%, actinic keratosis; 1.0% Bowen’s disease) and benign hypopigmented lesion (0.5%, stellate pseudoscar; 7.6%, idiopathic guttate hypomelanosis). Harmful treatment with systemic antifungal therapy was used in subungual melanoma (58.0%). Harmful management of senile comedone, subungual melanoma and acral lentiginous melanoma was significantly found in physicians given the incorrect diagnosis. (p = 0.027, p <0.001, p = 0.014, respectively).Conclusion: Most physicians recognized malignant lesions, benign erythematous or eczematous diseases in elderly skin. Surprisingly, almost all physicians couldn’t diagnose premalignant lesions and benign hypopigmented lesions.

The Role of Essential Oils on Improving Elderly Skin Hydration

Skin hydration has an important role in various diseases of the elderly. Skin hydration is determined by two factors, namely the ability of the stratum corneum (SC) to retain water due to natural moisturizing factors and the barrier function of the intercellular lipid lamellar structure and tight junctions. Several parameters are usually used for skin hydration, such as surface water content (SWC) and trans-epidermal water loss (TEWL). With age, several changes in the skin affect hydration, including changes in the cellular and intercellular lipid matrix, skin pH, SC protease enzymes, decreased sebaceous and sweat gland activity, and decreased estrogen levels in women. Therefore, a moisturizer is needed to minimize the unwanted effects of some of these changes. Selection of the type of moisturizer is very important for the elderly, especially moisturizers with antiseptic, antibacterial, and antioxidant effects are highly recommended. The ability of essential oils as components of moisturizers has been proven in various studies. Essential oils can improve the function of the epidermal barrier and help prevent transepidermal water loss. Therefore, this literature review discusses the role of various essential oils, namely green tea oils (Camellia sinensis or Camellia assamica), virgin coconut oils (Cocos nucifera L.), evening primrose oils (Oenothera paradoxa), grape seed oils (Vitis vinifera L.) .), rosemary oils (Rosmarinus officinalis L.), immortelle oils (Helichrysum italicum), and cannabis seeds oils (Cannabis sativa L.) on improving skin hydration in the elderly.

The comprehensive assessment of epigenetics changes during skin development

Epigenetic regulation is critical to multiple physiological and pathological processes. However, little is known regarding the epigenetic changes during neonatal skin development and skin aging, and in response to ultraviolet (UV) exposure. The transcriptomes of human skin samples from different ages or irradiated with different types and doses of UV light were analyzed using R (version 4.0.3) software. The epigenetic landscape of the skin, including histone modifications, genetic imprinting and m6A modification, which are mainly involved in collagen formation, extracellular matrix organization, immune function and keratinization, underwent significant changes during neonatal to adult development. Epigenetic effectors such as IGF2BP2, GATA2, GATA3, CPA4 and CDK1 were significantly correlated with extracellular matrix organization, and VEGFA, CDK1 and PRKCB with skin immune function. The m6A readers such as IGF2BP2, IGF2BP3, HNRNPA2B1 and EIF3G showed significant correlation with extracellular matrix organization, metabolism, or antigen processing and presentation. Small doses of UV exposure only induced changes in the expression levels of some epigenetic effectors, without any significant effect on the overall epigenetic landscape. However, the minimal erythema dose of UV exposure altered multiple epigenetic effectors regulating extracellular matrix organization, cell-matrix adhesion, innate immune response, mitochondrial function and mRNA processing. In addition, epigenetic changes following UV exposure were more pronounced in the elderly skin compared to the younger skin. In conclusion, histone modifications, genetic imprinting and m6A modification play critical roles during skin development, and a large dose of UV exposure can significantly change the expression of multiple epigenetic effectors.

Blood donation improves skin aging through the reduction of iron deposits and the increase of TGF-β1 in elderly skin

Skin aging is characterized by a wide range of physiological and structural changes, including wrinkling, dyschromia, and roughness, as well as the reduction of dermal thickness and collagen content. Here, we showed that blood donation increased dermal thickness and collagen content and decreased the number of senescent cells in old mice. Transcriptomic and metabolomic studies revealed blood donation significantly altered aging-related pathways in the skin of old mice. Molecular genes analysis indicated blood donation decreased the expression of genes associated with inflammation such as Fols1, Cox-2, and IL-1β, and increased the expression of collagen-associated genes including TGF-β1, TGF-β2, and Col3a1. The improvement of skin aging by blood donation was associated with the reduction of iron deposits and the increase of TGF-β1 in elderly skin. Our results suggested that appropriate blood donation could promote collagen re-synthesis and improve skin aging.

Local Response and Barrier Recovery in Elderly Skin Following the Application of High-Density Microarray Patches.

The high-density microneedle array patch (HD-MAP) is a promising alternative vaccine delivery system device with broad application in disease, including SARS-CoV-2. Skin reactivity to HD-MAP applications has been extensively studied in young individuals, but not in the >65 years population, a risk group often requiring higher dose vaccines to produce protective immune responses. The primary aims of the present study were to characterise local inflammatory responses and barrier recovery to HD-MAPs in elderly skin. In twelve volunteers aged 69–84 years, HD-MAPs were applied to the forearm and deltoid regions. Measurements of transepidermal water loss (TEWL), dielectric permittivity and erythema were performed before and after HD-MAP application at t = 10 min, 30 min, 48 h, and 7 days. At all sites, TEWL (barrier damage), dielectric permittivity (superficial water);, and erythema measurements rapidly increased after HD-MAP application. After 7 days, the mean measures had recovered toward pre-application values. The fact that the degree and chronology of skin reactivity and recovery after HD-MAP was similar in elderly skin to that previously reported in younger adults suggests that the reactivity basis for physical immune enhancement observed in younger adults will also be achievable in the older population.

Oligomeric α-Synuclein induces skin degeneration in reconstructed human epidermis

Aged and photoaged skin exhibit fine wrinkles that are signs of epidermal inflammation and degeneration. It has been shown that healthy elderly skin expresses amyloidogenic proteins, including α-Synuclein, which are known to oligomerize and trigger inflammation and neurodegeneration. However, little is known about their putative role in skin physiology and sensitivity. To unravel this possible role, we investigated the impact of oligomeric α-Synuclein (Oα-Syn) in 2D and 3D keratinocyte human models. Exogenous Oα-Syn caused degeneration of reconstructed human epidermis (RHE) by diminishing proliferation and thickness of the stratum basale. Oα-Syn also increased NF-kB nuclear translocation in keratinocytes and triggered inflammation in the RHE, by increasing expression of interleukin-1β and tumor necrosis factor-alpha, and the release of tumor necrosis factor-alpha in a time-dependent manner. Dexamethasone and an IL-1β inhibitor partially diminished RHE degeneration caused by Oα-Syn. These findings suggest that Oα-Syn induces epidermal inflammation and decreases keratinocyte proliferation, and therefore might contribute to epidermal degeneration observed in human skin aging.

Newborn and elderly skin: two fragile skins at higher risk of pressure injury.

Skin is a key organ maintaining internal homeostasis by performing many functions such as water loss prevention, body temperature regulation and protection from noxious substance absorption, microorganism intrusion and physical trauma. Skin ageing has been well studied and it is well known that physiological changes in the elderly result in higher skin fragility favouring the onset of skin diseases. For example, prolonged and/or high-intensity pressure may suppress local blood flow more easily, disturbing cell metabolism and inducing pressure injury (PI) formation. Pressure injuries (PIs) represent a significant problem worldwide and their prevalence remains too high. A higher PI prevalence is correlated with an elderly population. Newborn skin evolution has been less studied, but some data also report a higher PI prevalence in this population compared to older children, and several authors also consider this skin as physiologically fragile. In this review, we compare the characteristics of newborn and elderly skin in order to determine common features that may explain their fragility, especially regarding PI risk. We show that, despite differences in appearance, they share many common features leading to higher fragility to shear and pressure forces, not only at the structural level but also at the cellular and molecular level and in terms of physiology. Both newborn and elderly skin have: (i) a thinner epidermis; (ii) a thinner dermis containing a less-resistant collagen network, a higher collagen III:collagen I ratio and less elastin; (iii) a flatter dermal-epidermal junction (DEJ) with lower anchoring systems; and (iv) a thinner hypodermis, resulting in lower mechanical resistance to skin damage when pressure or shear forces are applied. At the molecular level, reduced expression of transforming growth factor β (TGFβ) and its receptor TGFβ receptor II (TβRII) is involved in the decreased production and/or increased degradation of various dermal extracellular matrix (ECM) components. Epidermal fragility also involves a higher skin pH which decreases the activity of key enzymes inducing ceramide deficiency and reduced barrier protection. This seems to be correlated with higher PI prevalence in some situations. Some data also suggest that stratum corneum (SC) dryness, which may disturb cell metabolism, also increases the risk of PI formation. Besides this structural fragility, several skin functions are also less efficient. Low applied pressures induce skin vessel vasodilation via a mechanism called pressure-induced vasodilation (PIV). Individuals lacking a normal PIV response show an early decrease in cutaneous blood flow in response to the application of very low pressures, reflecting vascular fragility of the skin that increases the risk of ulceration. Due to changes in endothelial function, skin PIV ability decreases during skin ageing, putting it at higher risk of PI formation. In newborns, some data lead us to hypothesize that the nitric oxide (NO) pathway is not fully functional at birth, which may partly explain the higher risk of PI formation in newborns. In the elderly, a lower PIV ability results from impaired functionality of skin innervation, in particular that of C-fibres which are involved in both touch and pain sensation and the PIV mechanism. In newborns, skin sensitivity differs from adults due to nerve system immaturity, but the role of this in PIV remains to be determined.

Time-Resolved Extracellular Matrix Atlas of the Developing Human Skin Dermis.

Skin aging is a physiological issue that is still relatively poorly understood. Studies have demonstrated that the dermal extracellular matrix (ECM) plays important roles in skin aging. However, the roles of the changes in ECM characteristics and the molecules that are secreted to the extracellular space and are involved in the formation of the dermal matrix from birth to old age remain unclear. To explore the way in which the ECM microenvironment supports the functions of skin development across different age groups is also poorly understood, we used a decellularization method and matrisome analysis to compare the composition, expression, and function of the dermal ECM in toddler, teenager, adult, and elderly skin. We found that the collagens, glycoproteins, proteoglycans, and regulatory factors that support skin development and interact with these core ECM proteins were differentially expressed at different ages. ECM expression markers occurring during the process of skin development were identified. In addition, our results elucidated the characteristics of ECM synthesis, response to skin development, and the features of the ECM that support epidermal stem cell growth via the basement membrane during skin aging.

The role of mast cells in accelerating our skin aging

Everyone wishes to appear younger. Actually, women spend a lot of efforts and money to fight aging appearance of skin. In the recent decade, skin aging has become an annoying social and medical problem at the levels of modern societies. Unfortunately, up to now, scientists have not discovered an effective treatment to overcome the appearance of the elderly skin. Although, researchers try hard to discover the main causes and mechanisms of getting skin more aged to earn a youthful look for skin appearance, some researchers suggested that mast cells (MCSs) were scarcely found neither in fetus dermis nor the youth while they are clearly detected in dermis of senile people which proposes the function of these cells in controlling the process of skin caducity. Researchers have taken into consideration the beneficial effect of MCS in controlling skin caducity. Recently, MCS is considered as an effective route in treatment elderly skin. Non-synthetic products can inhibit MCS activation so considered as a good functional ingredient fighting skin aging process as this cell implicated in skin damage and aging; degranulation of papillary dermal MCS might result in inflammation, reconstruction of extracellular matrix and angiogenesis with subsequently induced skin caducity. This mini review summarizes the crucial role of activated MCS in the dermal aging process. Keywords: skin; aging; mast cell.

Reflectance Confocal Microscopy of Aging Skin and Skin Cancer.

Skin aging is a complex process that causes morphologic variations. Some of these variations have been hypothesized to be involved in skin cancer development. This paper reviews current knowledge of the features of aged skin as seen with reflectance confocal microscopy (RCM). Basic principles of the technique are described, and the RCM features of healthy skin and skin cancer are briefly discussed. Moreover, the RCM features at different layers of young and elderly skin are described, as are the variations that occur with passing years and in relation to sun exposure that contribute to photoaging and the development of skin cancer. RCM enables the noninvasive evaluation, at quasi-histologic resolution, of aging-related skin changes, some of which are shared with skin cancer; this ability helps avoid skin biopsy. Further research is needed to understand the relation between skin aging and skin cancer development.

English

BACKGROUND Geriatric dermatoses are a common group of conditions seen frequently in the daily out-patient clinic. The process of ageing plays an important role in the physiological and pathological changes of the skin in old age. With the presence of long-term systemic comorbidities, the incidence of pathological conditions also increases. Only a few studies have been conducted in India about geriatric dermatoses. We wanted to study the prevalence of physiological and pathological skin changes in the elderly population. METHODS It was a cross sectional observational study and 300 patients aged more than 60 years attending the outpatient clinic of dermatology at UPUMS, Saifai were enrolled in the study. Detailed history of cutaneous complaints, past and present medical conditions was taken. Complete general physical and dermatological examination was done. The physiological and pathological skin changes in the cases were noted. RESULTS Out of 300 patients, 70.67 % were males and 29.33 % were females. 72 % belonged to the age group of 60 - 69 years. 88.33 % complained about pruritus. Wrinkles and xerosis were the most common physiological cutaneous manifestations. Benign growths like seborrheic keratosis, dermatosis papulosa nigra, and acrochordons were observed in most of the patients. Eczema and fungal infections were the most common pathological conditions in the study. 25 % had pre-existing systemic conditions with diabetes and hypertension being the commonest. 88 % had greying of hair and 45.67 % had nail changes. CONCLUSIONS India is an ageing nation. In the elderly, both physiological and pathological skin changes are common. Geriatric dermatology is becoming an important aspect of dermatology. Our study helps in providing a better understanding about the patterns of geriatric dermatoses and emphasizes the need to focus on healthcare needs of the elderly. KEYWORDS Geriatric, Ageing, Eczema, Wrinkling, Xerosis

SKIN TEARS IN THE ELDERLY

Objectives: to identify in the scientific literature the knowledge produced about skin tears injuries in the elderly. Methods: it is an integrative literature review (2014-2019), carried out by searching the databases/platforms National Library of Medicine, Biomedical Answers and Biblioteca Virtual em Saúde, with descriptors and the Boolean operators “and” and “or ”. Results: from the bibliographic search, selection and analysis, eight articles made up the sample. For skin tears injuries in the elderly, four pillars of care emerged: maintenance of organic and tissue homeostasis with a focus on proper nutrition and hydration; avoid trauma to senile skin, providing a safe environment with suitable devices; and the systematization of health care and education for elderly skin care. Conclusion: as prevention mechanisms, primary prevention is achieved through a unique care plan and health education activities, focused on risk factors and vulnerabilities, minimizing damage and complications.

Dermatoses among patients aged 60 years and above attending a tertiary referral center: A cross-sectional study from North Kerala

Objectives: With the rise in life expectancy at birth, geriatric population contributes to a significant proportion of those seeking medical aid. Skin problems in the elderly are very common and vary according to region and ethnicity. It is essential for dermatologists to have a better understanding of the pathophysiology of geriatric skin disorders to formulate quality management guidelines. This study was undertaken to document the frequency and the clinical pattern of various physiological and pathological changes in the elderly skin. Materials and Methods: A cross-sectional study was carried out in 200 consecutive patients aged 60 years and above and who attended the Dermatology outpatient clinic of a tertiary referral center in North Kerala. A pre-set pro forma was used to document the patient characteristics, the comorbidities, the medications used, and the clinical findings. Results: All the study participants (100%) had one or more dermatoses. The age of the study population ranged from 60 to 89 years (mean 67.7 ± 6.2 years). This was a female preponderant study with a female to male ratio of 1.4:1. Hypertension (36%), hyperlipidemia (27%) and diabetes mellitus (26%) were the common comorbidities observed. Graying of hair was the most common physiological change, followed by wrinkling. Pruritus was the most common presenting complaint (136, 68%). Statistically significant association was noted between xerosis and generalized pruritus. Fungal infections (30.5%) outnumbered other infections and infestations. Changes of severe photoaging were less frequent. One patient had skin malignancy (basal cell carcinoma). Significant association was noted between photoaging and male sex, smoking, and sun exposure. Limitations: Study conducted in a tertiary referral center not reflecting the status in the community was the major limitation. Conclusion: Photoaging and skin cancers are less frequent in darker skin type. Healthy lifestyle, nutritious diet, frequent application of emollient, better skin care, and judicious use of sunscreen can delay the process of cutaneous aging. More prospective studies in different population groups may go a long way in improving the current knowledge about the less known aspects of geriatric dermatoses.