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The skin in old age
In Westernized societies, the proportion of people aged over 65 is high and continues to rise. Poor nutrition, lack of self-care and general illness contribute to skin disease in the elderly. Few people die from old skin, but many suffer from it.
Intrinsic ageing of the skin
The changes in aged, sun-protected skin are more subtle than those of photoageing (p. 130) and consist of laxity, fine wrinkling and benign neoplasms. In addition, androgenetic alopecia (p. 84) and greying of the hair are age related.
Histologically, the epidermis is thinned with the loss of the rete ridge pattern and a reduction in the numbers of melanocytes and Langerhans cells. Individual epidermal cells are smaller. The dermis is thinned due, mainly, to loss of proteoglycans. Functionally, the skin is less elastic and has a reduced tensile strength. Resistance to injury, irritants and infection is reduced, and wound healing is slower.
Some inherited disorders, e.g. pseudoxanthoma elasticum (p. 112), show features of aged skin. The misuse of potent topical steroids induces atrophy and purpura (p. 28), signs also seen in old skin.
Dermatoses in the elderly
Few skin conditions are exclusive to old age, but some are seen more frequently ( Table 68.1 ).
Table 68.1
Skin disorders common in the elderly
| The eczemas | Asteatotic/dry skin (p. 53) |
| Seborrhoeic (p. 52) | |
| Contact (p. 48) | |
| Venous (p. 52) | |
| Other eruptions | Psoriasis (p. 38) |
| Drug eruption (p. 106) | |
| Erythema ab igne (p. 88) | |
| Infections | Herpes zoster (p. 69) |
| Candidiasis (p. 72) | |
| Onychomycosis (p. 86) | |
| Scabies (p. 78) | |
| Ulceration | Leg ulcer (p. 90) |
| Pressure ulcer | |
| Autoimmune | Pemphigoid (p. 96) |
| Benign tumours | Seborrhoeic wart (p. 114) |
| Cherry angioma (p. 116) | |
| Skin tag (p. 114) | |
| Chondrodermatitis nodularis | |
| Photodamage | Photoageing (p. 130) |
| Actinic elastosis | |
| Premalignant | Actinic keratosis |
| In situ squamous cell carcinoma (p. 124) | |
| Cancers | Basal cell carcinoma (p. 122) |
| Squamous cell carcinoma (p. 124) | |
| Lentigo malignant melanoma (p. 126) | |
| Cutaneous T-cell lymphoma (p. 128) | |
| Other | Senile pruritus |
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