Skin disorders among elderly patients: clinicodemographic characteristics of 808

Egyptian patients

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 2020 Jan 28];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 [1]. 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 [2]. 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 [3].

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 [4].

Intrinsic skin aging is related to physiological metabolic changes, affects all persons, and is inevitable
[5]. 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 [6].

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 [7].

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

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)

Click here to view

Figure 1 A 73-year-old male patient with xerosis.

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 Figure 2 A 66-year-old female patient with herpes zoster.

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Figure 3 A 77-year-old female patient with facial wrinkles.

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Figure 4 A 72-year-old male patient with vitiligo.

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Figure 5 A 68-year-old female patient with basal cell carcinoma.

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 Figure 6 A 70-year-old female patient with hidrocystoma.

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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.
[8] 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. [9]
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. [10] who reported that the most common
dermatological disorders of elderly patients were skin infections (68.6%). Moreover, Raveendra [11]
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 [12]. 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 [13]. 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 [14],
[15],[16],[17],[18],[19]. In addition, Reszke et al. [8] 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 [8].

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 [20], 8.8–11.5% in Turkey [15], 14.2% in Taiwan [21],
18.9% in Italy [22], and 49.6% in India [16]. 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 [23].

This study reported that xerosis was present in 78 (9.7%) elderly patients. Xerosis was reported as
1.5% in Japan [24], 5.4% in Turkey [15], 18.2% in Hong Kong [25], 28% in Tehran [26], 29.5% in
Australia [17], and 58.3% in Taiwan [18]. 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 [27].

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 [9],[28],[29],[30],[31]. The prevalence of lichen planus was 5% in elderly
patients in many previous studies [11],[29].

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. [9] 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 [9]. 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 [11] 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 [19],[29],[32].

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 [14],[16],[28].

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. [33] 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 [30],
Beauregard and Gilchrest [28], and Durai et al. [16] 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 [16],[28],[30]. 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 [34].
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.

Acknowledgements

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

Nil.

Conflicts of interest

There are no conflicts of interest.