Skin Problems in the Elderly

The skin is constantly renewing itself. New cells are formed on the lower layer of skin and slowly move upward. By the time they reach the skin's surface, these cells are dead and are removed daily. With ageing, this process of cell renewal slows down. The "dead cell" layer remains longer on the skin's surface, giving the skin a dull look. This skin feels rough and scaly—the supporting structures and elasticity decrease with age, leading to sagging skin and wrinkles. 

Skin disorders in the elderly come in a number of guises.

Appearance and Texture Changes

Senile Purpura 

The skin of an aged person is thinner and easily disrupted. Blood vessels, too, are easily disrupted, resulting in bruises called senile purpura (Figure 1). Senile purpura is commonly seen on the forearms. Its presence does not indicate vitamin deficiency or a bleeding disorder. The skin heals slowly following injury.

Xerosis/Asteatotic Eczema 

The skin becomes dry and flakes easily as the oil content of the skin decreases with age. Dry skin becomes itchy, and sensations of dryness and tautness are familiar.

Dry skin has a rough and finely flaking or scaly surface. These are seen in the upper back and the limbs, especially the shins. Sometimes asteatotic eczema (Figure 2) occurs in areas of dry skin in the elderly. These are seen as poorly demarcated, scaly, round red patches. Sometimes, distinctive red scaly fissures in an irregular netlike pattern resembling cracked porcelain appear.

Skin Infections/Infestations 

Skin Conditions Caused by Bacterial Infection

The fissures/cracks on dry skin make it possible for bacteria to enter the skin and cause superficial infection. 

Scabies (Figure 3) is an infectious, very itchy skin infestation caused by a mite. The infestation spreads frequently among elderly people living in crowded homes. Sometimes, crusting and scaling can cover the whole body (Norwegian scabies).

Ringworm Infections

The elderly often have ringworm infections of the nails and skin, especially on the feet. Ringworm infection of the nails appears as discoloured and thickened nails. Ringworm infection of the feet might show redness and blisters in addition to scaling.

Pigmentary Changes 

Senile Freckles

Brown spots that look like freckles (Figure 4) are one of the facial skin problems in old age. Sometimes called “senile freckles”, these are larger and more irregular than freckles. They are the result of skin damage from the sunlight. If the freckles become larger or thicker or develop a crust, you should consult a doctor to check for cancer. Senile freckles can be removed easily by freezing, electrosurgery or the application of certain chemicals.

The pigment cells in the skin of the elderly also become less active, and the skin may look sallow.

Blistering Disorders

Blistering Eruptions 

The elderly can develop blistering disorders from different causes. A common blistering disorder is herpes zoster, also known as shingles (Figure 5), a reactivation of the chickenpox that the sufferer had when young. This appears as a band of blisters on one side of the head or body or along one limb and can be extremely painful.

Bullous Pemphigoid

Blistering problems can also be due to an immune disturbance. A common condition in this group of disorders is bullous pemphigoid (Figure 6), in which an individual develops many large blisters arising from red or normal skin. This condition usually requires potent medications to suppress the blisters.

Skin Growths 

The elderly may be prone to skin growths, too. Benign skin growths do not need treatment, but cancerous growth should be removed early to prevent spreading to other parts of the body. If in doubt, always consult a doctor. Your dermatologist can advise you whether your skin growths are likely to be benign or cancerous.

Non-cancerous Skin Growths

The elderly can develop many benign skin growths of different types. These include seborrheic keratoses (Figure 7), which are rough, brownish-black spots; cherry angiomas (smooth reddish bumps); and sebaceous hyperplasia (yellow bumps consisting of oil glands).

Figure 7 Seborrheic keratoses 

Cancerous Skin Growths

Elderly people who have had extensive sun exposure earlier in their life may develop pre-cancerous skin growths called solar keratoses (Figure 8) and skin cancers like basal cell carcinomas and squamous cell carcinomas.

Basal cell carcinomas and squamous cell carcinomas most commonly appear on the face and are some of the more serious facial skin problems in old age. They start as small bumps and gradually enlarge until they ulcerate. They can be pink or black in colour. See your doctor if you have any enlarging skin growths or a non-healing sore.

The most common type of skin cancer is called basal cell carcinoma (Figure 9), which appears as a small shiny growth with a central ulcer or depression. This is a slow-growing cancer. 

Another type of skin cancer is squamous cell carcinoma (Figure 10). They appear as red, scaly patches or pinkish growths. Sometimes they can be very large and raised.

Cancerous moles are less common, but they tend to spread quickly if not treated. They appear as moles with irregular borders, irregular colours and lopsided shapes.

If you are not sure whether the growths are skin cancers, see your doctor. All cancers must be removed.

Adverse Drug Reaction 

As the elderly tend to be receiving multiple drugs for various medical problems, they are more likely to develop adverse reactions to drugs (Figure 11). The most common adverse reaction to drugs is seen in the skin, where it can present as red, itchy rashes or blisters. Such rashes must be recognised early so that the offending drug can be discontinued, thereby preventing the damage caused by the drug from becoming too serious. It is important to keep a record of the medications, prescribed or not, that you take. Be sure to bring all medicines when you consult your doctor.

Figure 11 Adverse reaction to drugs

Stasis Dermatitis

Some elderly persons have poor blood circulation in the legs, leading to rashes around the ankles called stasis dermatitis (Figure 12). Untreated, this might lead to skin ulcers.

Figure 12 Stasis dermatitis

Special Skin Care for the Elderly

The elderly require special skincare because their skin is thin and dry, and bacteria can enter. Care must be taken to prevent the skin from becoming too dry, so hot baths should be avoided, as should frequent baths/showers. Avoid soap or use just mild soap. If the skin is dry, moisturisers should be applied after a bath.

People who are bedridden need to avoid prolonged pressure on the ankles, heels and buttocks as too much pressure can tear the thin skin and lead to bedsores.