|Year : 2020 | Volume
| Issue : 1 | Page : 38-44
Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients
Mohammed Abu El-Hamd1, Wafaa M Abd-Elmaged1, Nesreen A Mohammed2
1 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
2 Department of Public health, Faculty of Medicine, Sohag University, Sohag, Egypt
|Date of Submission||30-Apr-2019|
|Date of Acceptance||01-Oct-2019|
|Date of Web Publication||6-Jan-2020|
MD Mohammed Abu El-Hamd
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag 82524
Source of Support: None, Conflict of Interest: None
Background Geriatric health care has increased rapidly worldwide. The frequency of skin diseases is rising among elderly patients.
Objectives This study aimed to evaluate demographic features and pattern and frequency of skin disorders among elderly patients attending dermatology clinics.
Patients and methods This was a cross-sectional clinical hospital-based study that included all patients aged more than or equal to 60 years old who attended the Outpatient Clinics of Dermatology, Sohag University, Upper Egypt. All the patients were subjected to a detailed medical history and complete general and dermatological examination.
Results This study included 808 elderly patients, with a mean age of 70.21±7.51 years. A total of 434 (53.7%) patients were females and 374 (46.3%) were males. Among the patients, 264 (32.7%) were living in urban areas. Overall, 188 (23.3%) patients were smokers. Among patients, 268 (33.1%) had low education levels and 450 (53.2%) patients had a previous history of manual work. The most common comorbidities were diabetes mellitus, seen in 270 (33.41%) patients, and hypertension, seen in 64 (7.92%) patients. Of 808 elderly patients, 188 (23.7%) had infectious skin diseases, 162 (20%) had allergic and eczematous diseases, 98 (12.1%) had senile pruritus, 78 (9.7) had xerosis, 48 (5.9%) had papulosquamous diseases, 32 (4%) had cutaneous tumors, 30 (3.7%) had vesiculobullous diseases, 28 (3.5%) had pigmentary skin diseases, and 18 (2.3%) had vascular disorders.
Conclusion Skin diseases are common among elderly patients. Infectious skin diseases, allergic and eczematous diseases, senile pruritus, and xerosis are the most common skin diseases among elderly patients.
Keywords: demography, elderly, geriatric health, skin disorders
|How to cite this article:|
El-Hamd MA, Abd-Elmaged WM, Mohammed NA. Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients. Egypt J Dermatol Venerol 2020;40:38-44
|How to cite this URL:|
El-Hamd MA, Abd-Elmaged WM, Mohammed NA. Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients. Egypt J Dermatol Venerol [serial online] 2020 [cited 2021 Feb 25];40:38-44. Available from: http://www.ejdv.eg.net/text.asp?2020/40/1/38/275178
| Introduction|| |
The proportion of people more than or equal to 60 years old is increasing rapidly worldwide. This may be related to longer life expectancy . According to the World Health Organization, the global population of people aged more than or equal to 60 years old will reach two billions in 2050 . In Egypt, over the past few decades, there is a gradual increase in the absolute and relative numbers of elderly population. The percentage was 6.9% in 2015 and is expected to rise to 9.2% in 2021, and it is expected to reach 20.8% in 2050. Approximately 20 million Egyptians will be categorized as elderly by that time .
Aging processes result in several changes in the structure and function of multiple human organs, including the skin. The skin undergoes intrinsic and extrinsic aging .
Intrinsic skin aging is related to physiological metabolic changes, affects all persons, and is inevitable . It is characterized by the thinning of the upper layers of the skin, reduction in the amount of lipids, decreased blood flow, and collagen fragmentation. This presents with dry, pale skin with fine wrinkles. Extrinsic skin aging is also known as photoaging as it is mainly related to exposure to ultraviolet radiation. It results in the accumulation of abnormal elastin and the disintegration of collagen fibrils. This presents by deep wrinkles, skin laxity, hyperpigmentation, senile lentigines, and a leathery skin appearance .
Geriatric health care has increased rapidly worldwide, but few statistical studies were carried out about skin disorders in the elderly. The American HANES survey reported that the frequency of skin diseases increases with age so that at the age of 70 years old, 70% had significant skin diseases and many others had multiple skin disorders .
So, this study aimed to evaluate demographic features and pattern and frequency of skin disorders among elderly patients attending dermatology clinics at Sohag University Hospitals, Sohag Governorate, Upper Egypt.
| Patients and methods|| |
This was a cross-sectional clinical hospital-based study including all patients aged more than or equal to 60 years old who attended the Outpatient Clinics of Dermatology at Sohag University Hospitals, Sohag Governorate, Upper Egypt, between January 2018 and January 2019. Informed consents were obtained from all included patients. The current study was reviewed and approved by the Ethical and Scientific Committee, Faculty of Medicine, Sohag University.
All the patients underwent a detailed medical history, including demographic data, history of present illness, and history of associated medical disease. All patients underwent complete general and dermatological examinations, including skin, mucous membrane, hair, and nail.
Diagnosis of skin diseases in the elderly was based on the clinical presentations.
The skin diseases in the elderly patients were categorized into infectious diseases (bacterial, viral, parasitic, and fungus), allergic and eczematous diseases, senile pruritus, xerosis, papulosquamous diseases, cutaneous tumors, vesiculobullous diseases, pigmentary diseases, vascular disorders, and others.
Punch biopsy (3 mm) and histopathological confirmation were done for the required lesions.
Sample size calculation was done by using WHO software for sample size evaluation, where level of significance α=0.5, 1−β=90, test value of population proportion Po=0.40, anticipated value of population proportion=0.50, and sample size=210.
Statistical analysis has been performed using the Statistical Package for Social Sciences, version 20 (SPSS Inc., Chicago, Illinois, USA). Quantitative variables were presented as the mean±SD, and qualitative variables were presented as frequency and percentages.
| Results|| |
This study included 808 elderly patients [9.3% in relation to all examined patients (n=11 520)] with a mean age 70.21±7.51 years. Overall, 434 (53.7%) were females and 374 (46.3%) were males.
Of the elderly patients, 264 (32.7%) were living in urban and 370 (45.8) were living in suburban areas. Moreover, 620 (76.7%) were nonsmokers and 188 (23.3%) were smokers. Concerning education, 268 (33.1) of the patients had low education levels, 244 (30.2) had medium education levels, and 208 (25.7) were illiterate. Other information gathered shows that 430 (53.2) patients had a previous history of manual work and 378 (46.8) had a previous history of intellectual work. Among patients, 450 (55.7) had no comorbidities and 358 (44.3%) had comorbidities. The most common comorbidities were diabetes mellitus in 270 (33.41%) patients and 64 (7.92%) patients had hypertension ([Table 1]).
|Table 1 Distribution of the patients according to sociodemographic criteria (n=808)|
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Of 404 elderly patients, 188 (23.7%) had infectious skin diseases [52 (6.4%) bacterial, 50 (6.2%) viral, 44 (5.4%) parasitic, and 42 (5.2%) fungal], 162 (20%) had allergic and eczematous diseases, 98 (12.1%) had senile pruritus, 78 (9.7%) had xerosis, 48 (5.9%) had papulosquamous diseases, 32 (4%) had cutaneous tumors, 30 (3.7%) had vesiculobullous diseases, 28 (3.5%) had pigmentary skin diseases, and 18 (2.3%) had vascular disorders ([Table 2], [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6]).
|Table 2 Frequency of skin diseases among the studied elderly patients (N=808)|
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Of 808 elderly patients, 98 (12.1%) had senile pruritus, 78 (9.7%) had xerosis, 54 (6.7%) had chilblains, 34 (4.2%) had wrinkles, 32 (4%) had psoriasis, 28 (3.5%) had multiple boils, 28 (3.5%) had scabies, 26 (3.2%) had herpes zoster, 24 (3%) had asteatotic eczema, 24 (3%) had vitiligo, 22 (2.7%) had papular urticaria, 20 (2.5%) had postherpetic neuralgia, 18 (2.2%) had seborrheic dermatitis, 16 (2%) had pemphigus vulgaris, eight (2%) had lichen planus, 16 (2%) had contact dermatitis, 16 (2%) had pediculosis, 16 (2%) had common warts, and 16 (2%) had tinea pedis ([Table 2], [Figure 1],[Figure 2],[Figure 3],[Figure 4]).
| Discussion|| |
This cross-sectional clinical hospital-based study aimed to evaluate demographic features and pattern and frequency of skin disorders among elderly patients attending dermatology clinics at Sohag University Hospitals, Sohag Governorate, Upper Egypt.
The demographic data obtained from the present study were relatively in agreement with Reszke et al.  who found that the mean age of the elderly patients was 76.1±6.7 years; moreover, 59.1% of the patients were females, 74.7% of the patients were living in urban and suburban areas, 49% of the patients were smokers, and 51.5% of the patients had a previous history of manual work.
This study found that the most common comorbidities of elderly patients included the following: 270 (33.41%) patients with diabetes mellitus and 64 (7.92%) patients with hypertension. Darjani et al.  showed that the most common comorbidities of elderly patients were hypertension (87%) and diabetes mellitus (18%).
This study found that infectious disorders were the most common group of skin diseases in elderly. These findings were in agreement with Abd El-Aziz et al.  who reported that the most common dermatological disorders of elderly patients were skin infections (68.6%). Moreover, Raveendra  reported that skin infections and infestations were seen in 32% of elderly patients.
Skin infections formed the largest group of skin disorders seen in elderly. In elderly people, decreases in personal care, epidermal turnover, and immunologic functions were reported, possibly responsible for the high prevalence rate of fungal infections . Decreased immune surveillance in the elderly may be related to aging and systemic diseases, providing more opportunity for the increased prevalence rate of bacterial and viral infections in the elderly patients . In addition, the current study reported that diabetes mellitus was presented in 270 (33.41%) of the elderly patients and 188 (23.3%) of the patients were smokers.
The second most common group of skin diseases in elderly was allergic and eczematous diseases.
Eczematous diseases in elderly have shown different rates from 1.5 to 58.7% in different studies ,,,,,. In addition, Reszke et al.  reported that eczematous lesions were present in 27.3% of elderly patients. These lesions were presented as atopic dermatitis, asteatotic eczema stasis dermatitis, and photosensitive eczema .
The third common group of skin diseases in elderly was senile pruritus that affected 98 (12.1%) patients. The prevalence of the senile pruritus has been cited in different studies of elderly patients, for example its prevalence was 6.4% in Tunisia , 8.8–11.5% in Turkey , 14.2% in Taiwan , 18.9% in Italy , and 49.6% in India . The actual pathogenesis of senile pruritus is poorly understood. Age-related changes in the nerves leading to increased touch and pain thresholds, possibly owing to subclinical neuropathy, have been suggested .
This study reported that xerosis was present in 78 (9.7%) elderly patients. Xerosis was reported as 1.5% in Japan , 5.4% in Turkey , 18.2% in Hong Kong , 28% in Tehran , 29.5% in Australia , and 58.3% in Taiwan . Differences in humidity and lifestyle can explain the wide difference of prevalence of xerosis in the elderly patients. Moreover, decreased sebaceous and sweat gland activity associated with impaired skin permeability leads to xerosis, which is extremely common in elderly patients .
This study reported that papulosquamous disorders were present in 48 (5.9%) of elderly patients [32 (4%) psoriasis and 16 (2%) lichen planus]. The prevalence of psoriasis in elderly ranged from 1 to 11.2% in several studies ,,,,. The prevalence of lichen planus was 5% in elderly patients in many previous studies ,.
This study reported that cutaneous tumors were present in 32 (4%) elderly patients [eight (1%) basal cell carcinoma, eight (1%) seborrheic keratosis, six (0.7%) senile lentigines, two (0.5%) hidrocystoma, two (0.2%) dermatofibroma, two (0.2%) leukoplakia of vulva, and two (0.2%) multiple keloids].
Darjani et al.  reported that in elderly patients, basal cell carcinoma was presented in 8.8% of elderly patients. Basal cell carcinoma was the most common skin cancer (>75%) and is related to chronic ultraviolet light exposure. In addition, seborrheic keratosis (8%) was the most prevalent benign neoplasm in elderly populations . Low prevalence rate of cutaneous tumors in the present study may be because 78.5% of the patients were from urban and suburban areas with less sun exposure.
This study found that pigmentary skin diseases were present in 28 (3.5%) elderly patients [24 (3%) vitiligo and four (0.5%) idiopathic guttate hypomelanosis]. Raveendra  reported that pigmentary disorders in elderly were seen in 14% of patients, vitiligo was seen in 8% of patients, melasma in 5% of patients, and ashy dermatosis in 1% of patients. In addition, several studies cited that the incidence of vitiligo was between 1.2 and 19% of elderly patients ,,.
This study found that vesiculobullous diseases were reported in 30 (3.7%) elderly patients [16 (2%) pemphigus vulgaris and 14 (1.7%) bullous pemphigoid]. In several studies, the incidence of vesiculobullous diseases ranged from 0.5 to 4.4% of elderly patients ,,.
This study found that chilblain was found in 54 (6.7%) elderly patients. This high prevalence rate of chilblain in this study may be because 33.41% of the patients had diabetes mellitus and 23.3% of the patients were smokers. This was in agreement with Eraso et al.  who found that smoking and diabetes mellitus were major risk factors for peripheral arterial disease. These risk factors might be associated with increased prevalence rate of chilblain in elderly patients.
This study found that wrinkles were reported in 34 (4.2%) elderly patient. Wrinkles were present on sun-exposed areas such as face, neck, forearms, and dorsa of hands. Tindall and Smith , Beauregard and Gilchrest , and Durai et al.  cited that wrinkling was found in 94, 95.6, and 99% of patients, respectively. Moreover, wrinkles seen in the previous studies were on sun-exposed areas such as face, neck, forearms, and dorsa of hands ,,. Low prevalence rate of wrinkling in the present study may be because 78.5% of the patients were from urban and suburban areas with less sun exposure. In addition, 76.7% of the patients were nonsmokers. Elderly patients of our country did not consider wrinkling as an essential complaint.
This study found that postherpetic neuralgia was found in 20 (2.5%) elderly patients. The increased risk and severity of herpes zoster and postherpetic neuralgia with advancing age are associated with an age-related decline in varicella zoster virus-specific T-cells .
This study concluded that skin diseases are common among elderly patients. Infectious skin diseases, allergic and eczematous diseases, senile pruritus, and xerosis are the most common skin diseases among elderly patients. Awareness of geriatric skin care is required.
The authors are grateful to all the faculty and postgraduate students in our scientific departments for their invaluable help in conducting this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sweed HS. Population ageing-Egypt Report. ME-JAA 2016; 13:10–17.
Jafferany M, Huynh TV, Silverman MA, Zaidi Z. Geriatric dermatoses: a clinical review of skin diseases in an aging population. Int J Dermatol 2012; 51:509–522.
Hashizume H. Skin aging and dry skin. J Dermatol 2004; 31:603–609.
Fisher GJ, Wang ZQ, Datta SC, Varani J, Kang S, Voorhees JJ. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 1997; 337:1419–1428.
Marks R. Skin disease in the elderly. Eur J Dermatol 2006; 16:460–461.
Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. Int J Dermatol 2015; 54:e332–e338.
Darjani A, Mohtasham-Amiri Z, Mohammad AK, Golchai J, Sadre-Eshkevari S, Alizade N. Skin disorders among elder patients in a referral center in Northern Iran. Dermatol Res Pract 2013; 2013:193–205.
Abd El-Aziz GA, Ahmed NA, El Khouli MA. Pattern of skin diseases in elderly. AAMJ 2009; 7:199–213.
Raveendra L. A clinical study of geriatric dermatoses. Our Dermatol Online 2014; 5:235–239.
Havlik NL, Fitzpatrick TB, Kligman AM, Kligman LH. Geriatric dermatology. In Freedberg IM, Eisen AZ, Wolff K et al.
, eds. Fittzpattrick’s dermatology in general medicine. 6th ed. New York: Mc Graw-Hill 1999. 1707–1724
Elgart ML. Skin infections and infestations in geriatric patients. Clin Geriatr Med 2002; 18:89–101.
Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol 2006; 45:672–676.
Bilgili SG, Karadag AS, Ozkol HU, Calka O, Akdeniz N. The prevalence of skin diseases among the geriatric patients in Eastern Turkey. J Pak Med Assoc 2012; 62:535–539.
Durai PC, Thappa DM, Kumari R, Malathi M. Aging in elderly: chronological versus photoaging. Indian J Dermatol 2012; 57:343–352.
] [Full text]
Smith DR, Atkinson R, Tang S, Yamagata Z. A survey of skin disease among patients in an Australian nursing home. J Epidemiol 2002; 12:336–340.
Smith DR, Sheu HM, Hsieh FS, Lee YL, Chang SJ, Guo YL. Prevalence of skin disease among nursing home patients in southern Taiwan. Int J Dermatol 2002; 41:754–759.
Weismann K, Krakauer R, Wanscher B. Prevalence of skin diseases in old age. Acta Derm Venereol 1980; 60:352–353.
Souissi A, Zeglaoui F, El Fekih N, Fazaa B, Zouari B, Kamoun MR. Skin diseases in the elderly: a multicentre Tunisian study. Ann Dermatol Venereol 2006; 133:231–234.
Liao YH, Chen KH, Tseng MP, Sun CC. Pattern of skin diseases in a geriatric patient group in Taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology 2001; 203:308–313.
Rubegni P, Poggiali S, Nami N, Rubegni M, Fimiani M. Skin diseases in geriatric patients: our experience from a public skin outpatient clinic in Siena. G Ital Dermatol Venereol 2012; 147:631–636.
Nusbaun NJ. Aging and sensory senescence. South Med J 1999; 92:267–275.
Smith DR, Kubo H, Tang S, Yamagata Z. Skin disease among staff in a Japanese nursing home. J Occup Health 2003; 45:60–62.
Chan SW. Prevalence of skin problems in elderly homes residents in Hong Kong. Hong Kong J Dermatol Venereol 2006; 14:66–70.
Roodsari MR, Malekzad F. The prevalence of skin diseases among nursing-home patients in North Tehran. Clin Dermatol 2008; 24:43–45.
Choi EH, Man MQ, Xu P, Xin S, Liu Z, Crumrine DA et al.
Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol 2007; 127:2847–2856.
Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol 1987; 123:1638–1643.
Sahoo A, Singh PC, Pattnaik S, Panigrahi RK. Geriatric dermatoses in Southern Orissa. Indian J Dermatol 2000; 45:66–68.
Tindall JP, Smith JG. Skin lesions of the aged and their association with internal changes. JAMA 1963; 186:1039–1042.
McFadden N, Hande KO. A survey of elderly new patients at a dermatology outpatient clinic. Acta Derm Venereol 1989; 69:260–262.
Patange VS, Fernandez RJ. A study of geriatric dermatoses. Indian J Dermatol Venerol Leprol 1995; 61:206–208.
Eraso LH, Fukaya E, Mohler ER, Xie D, Sha D, Berger JS. Peripheral arterial disease, prevalence and cumulative risk factor profile analysis. Eur J Prev Cardiol 2014; 21:704–711.
Schmader K. Herpes zoster in older adults. Clin Infect Dis 2001; 32:1481–1486.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]