Dry skin in the elderly: complexities of a common problem.

Dry skin, or xerosis, is a common skin condition in older adults, but it is not a normal part of aging. The geriatric patient may have several incurable, but treatable, chronic diseases that affect their skin. Xerosis in older adults is multifactorial: intrinsic changes in keratinization and lipid content, use of diuretics and similar medications, and overuse of heaters or air conditioners all contribute. Xerosis causes pruritus, which then leads to excoriations and risk of skin infections. Patients can minimize the effect of xerosis by increasing the ambient humidity, modifying their bathing technique and products, and using emollients to replace the lipid components of the skin. Care should be made to avoid skin sensitizers, such as lanolin, aloe vera, and parabens, that are commonly found in emollients. These may lead to a delayed hypersensitivity reaction. This contribution reviews the intrinsic and extrinsic aging processes of skin aging and advises practical changes in environment and emollient application that can be distributed to patients.

[1]  H. Williams,et al.  Management of atopic eczema. Joint Workshop of the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London. , 1995, BMJ.

[2]  A. Kılıç,et al.  Dermatological findings in the senior population of nursing homes in Turkey. , 2008, Archives of gerontology and geriatrics.

[3]  P. Stephens.  Aging of the Skin , 2003 .

[4]  P. Elias,et al.  The aged epidermal permeability barrier: basis for functional abnormalities. , 2002, Clinics in geriatric medicine.

[5]  B. Reisberg,et al.  Temporal Order of Cognitive and Functional Loss in a Nursing Home Population , 1995, Journal of the American Geriatrics Society.

[6]  D. Krasner,et al.  Chronic Wound Care: A Clinical Source Book for Healthcare Professionals , 1990 .

[7]  B. Resnick.  Dermatologic problems in the elderly. , 1997, Lippincott's primary care practice.

[8]  M. Gajić,et al.  Contact sensitivity in patients with venous leg ulcers in Serbia: comparison with contact dermatitis patients and relationship to ulcer duration , 2007, Contact dermatitis.

[9]  M. Lóden.  Role of Topical Emollients and Moisturizers in the Treatment of Dry Skin Barrier Disorders , 2003, American journal of clinical dermatology.

[10]  Jiska Cohen-Mansfield,et al.  The Preference and Importance of Bathing, Toileting and Mouth Care Habits in Older Persons , 2005, Gerontology.

[11]  H. Tagami,et al.  Biophysical Assessment of Persistent Effects of Moisturizers after Their Daily Applications: Evaluation of Corneotherapy , 2000, Dermatology.

[12]  Derek R. Smith,et al.  A survey of skin disease among patients in an Australian nursing home. , 2002, Journal of epidemiology.

[13]  H. Maibach,et al.  Racial (Ethnic) Differences in Skin Properties , 2003 .

[14]  A. Pons-Guiraud.  Dry skin in dermatology: a complex physiopathology , 2007, Journal of the European Academy of Dermatology and Venereology : JEADV.

[15]  H. Williams,et al.  Systematic review of treatments for atopic eczema. , 2000, Health technology assessment.

[16]  Section for Enhancing Geriatric Understanding,et al.  Retooling for an Aging America: Building the Healthcare Workforce , 2011, Journal of the American Geriatrics Society.

[17]  W. Hazzard,et al.  Principles of Geriatric Medicine and Gerontology , 2003 .

[18]  A. Fleischer.  Pruritus in the elderly: management by senior dermatologists. , 1993, Journal of the American Academy of Dermatology.

[19]  B. Hodgkinson,et al.  A systematic review of topical skin care in aged care facilities. , 2007, Journal of clinical nursing.

[20]  M. Hardy.  What can you do about your patient's dry skin? , 1996, Journal of gerontological nursing.

[21]  E. Campion.  The oldest old. , 1994, The New England journal of medicine.

[22]  H. Tagami,et al.  Stratum corneum hydration and amino acid content in xerotic skin , 1989, The British journal of dermatology.

[23]  Y. Thaipisuttikul.  Pruritic Skin Diseases in the Elderly , 1998, The Journal of dermatology.

[24]  Smith Derek Richard,et al.  Prevalence of skin disease among nursing home patients in southern Taiwan , 2002 .

[25]  Motoji Takahashi,et al.  Effect of exposure of human skin to a dry environment , 2002, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[26]  R. Norman.  Xerosis and pruritus in the elderly: recognition and management. , 2003, Dermatologic therapy.

[27]  J. English,et al.  Advised best practice for the use of emollients in eczema and other dry skin conditions , 2002, The Journal of dermatological treatment.

[28]  L. Vaillant,et al.  A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta‐analysis of 1975–2003 data , 2004, The British journal of dermatology.