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GERIATRIC DERMATOSIS the Professional Medical Journal ORIGINAL PROF-0-4050 GERIATRIC DERMATOSIS The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-0-4050 https://doi.org/10.29309/TPMJ/2020.27.11.4050 Geriatric dermatosis; the concerns of aging skin. Furquana Niaz1, Nadia Shams2, Sadaf Asim3, Humera Maryum4, Arshad Ali5, Naresh Kumar Seetlani6 1. MBBS, FCPS (Dermatology) D-DERM (UK) ABSTRACT… Objectives: To study the cutaneous manifestations in elderly and their Associate Professor and Head association with gender. Study Design: Cross Sectional study. Setting: Sir Syed Hospital Dermatology Karachi. Period: Jan 2016 to Jan 2018. Material & Methods: Total 217 geriatric cases (>60 Karachi Institute of Medical Sciences, Karachi. years; both genders) were included from outdoor dermatology clinic. The previous pregnancy, 2. MBBS, FCPS Medicine lactation, severe systemic disease and drug induced skin changes were excluded. Results: Associate Professor Medicine Among 217 cases, there were 126(58%) females and 91(42%) males. Mean age was 69.3+4.99 Rawal Institute of Health Sciences years. Wrinkling was seen in 92%, dryness (65%), skin laxity in 54.8%, xerosis (43%), dryness Islamabad. 3. MBBS, FCPS (Derma) D-DERM (65%), sagging (46%), pigmentation (37%), eczema (25%), sparse hair (21%), skin atrophy (UK) (19%), tinea (13%) and LSC (10%). While herpes zoster, psoriasis, onychomycosis, tinea Assistant Professor & HOD corporis ,asteotic eczema in 7%. Folliculitis 6%, scabies and bullous pemphigoid seen in 5%, Dermatology Dow University, Ojha Campus while lichen planus, actinic elastosis, BCC, Prurigo nodularis in 3%. Cellulitis, pediculosis, Karachi. Seborrheic Dermatitis and contact dermatitis were seen in 2% followed by 1% cases of warts, 4. MBBS, FCPS (Skin) candidiasis, photodermatosis and SCC seen in our study. Folliculitis (6%) was the most frequent Associate Professor Dermatology bacterial infection followed by impetigo (0.9%). Herpes zoster (6.5%) was frequent among viral Hamdard Medical University Karachi. infections followed by warts (0.9%) and HSV-1 (0.9%). Tinea (13.4%) was most frequent fungal 5. MBBS, MD (Medicine). infection followed by onychomycosis (7%) and candidiasis (0.9%). Scabies was most common Associate Professor Medicine parasitic infection (4.6%) followed by pediculosis (2.3%). Eczema seen in 24.8%. The benign Karachi Institute of Medical Sciences, Karachi. dermatosis, Actinic elastosis was frequent (3.2%), stucco keratosis 4(1.8%), Keratoacanthoma 6. MBBS, FCPS Medicine (0.9%). Amongst malignancies, BCC was common (3.2%), followed by SCC (1.4%). 5% Bullous Assistant Professor Medicine Pemphigoid cases were found. The psychocutaneous disorder included LSC (10%), prurigo Civil Hospital Karachi. nodularis (2.8%) and neurotic excoriation (0.9%). Wrinkling, sagging, dryness of skin, actinic Correspondence Address: keratosis, actinic elastosis was found to be associated with female gender, however cellulitis, Dr. Furquana Niaz squamous cell carcinoma and asteatotic eczema with male gender. Conclusion: Geriatric Associate Professor & Head of population is facing multiple dermatological concerns. Contributory factors being the natural Dermatology H# B, 196 Block-15, Gulistan-e- aging process, exposure to UV radiation, pathogens, dryness, humidity, temperature and Jouhar, Karachi. chemical irritants. Female geriatrics are prone to wrinkling, sagging, dryness of skin and male [email protected] geriatrics to basal cell carcinoma. There is need to address the skin problems in elderly for better quality of life in geriatrics. Article received on: 16/08/2019 Accepted for publication: Key words: Dermatosis, Geriatric, UV Radiation. 25/01/2020 Article Citation: Niaz F, Shams N, Asim S, Maryum H, Ali A, Seetlani NA. Geriatric Dermatosis; the Concerns of Aging Skin. Professional Med J 2020; 27(11):2445-2452. https://doi.org/10.29309/TPMJ/2020.27.11.4050 INTRODUCTION estimated 524 million people aged 65 or above in Old age has been defined by the United Nations 2010 to approximately 1.5 billion in 2050 with the as above 60 years of age to be eligible for old age greatest increase in developing countries.2 benefits without any standard criterion. Average life expectancy for global population according With the increasing age, there is increase in the WHO was 71.4 years in 2015 with 79.3 years problems of chronic and degenerative diseases in USA, 81.2 years in UK and 66.4 years in i.e. Diabetes, IHD, Cancers, Dementia, etc. This Pakistan.1 results in significant rise in disease burden. Among the wide array of chronic and degenerative With the gradual decline in communicable diseases Geriatric dermatoses is an important diseases life expectancy is growing globally, with problem with significant effects on health and Professional Med J 2020;27(11):2445-2452. www.theprofesional.com 2445 GERIATRIC DERMATOSIS 2 quality of life. Very little data is available especially Complete blood counts, urine routine examination, in our region to understand the skin problems random blood sugars, chest x ray was advised faced by the elderly and their management. in each case as per indications. Skin scrapings, nail clipping for fungus, Tzanck smear and skin Aging leads to degeneration of skin that causes biopsy were performed as per indication in each metabolic changes that affects the barrier case. function, sensory perception, wound healing, immune response, DNA repair, elastic tissue Data was analyzed by SPSS-21. Frequencies and collagen bundles decrease in sweat and calculated for qualitative variables (cutaneous sebaceous glands as well as the vascularity, and manifestations, gender), mean and standard hyper proliferative disorders.3 deviation for quantitative variables (age). Chi- square test was applied to study association of Aging can occur due to intrinsic factors i.e. skin manifestation with gender with significant normal maturity and extrinsic factors i.e. changes p-value < 0.05. Data presented in the form of due to UV light exposure, smoking and other tbales and bar graph. environmental factors.4 Skin changes that occur with age include xerosis, eczematous reactions, RESULTS infections, infestations, photodermatoses, 217 patients were enrolled amongst which neoplasias, immunological disorders, 126(58%) were females and 91(42%) were males. vascular changes, nutritional dermatoses, Mean age was 69.3+4.99 (65-91) years, 31(1.4%) psychodermatoses and pressure sores etc. were divorced, 195(90%) married, 9(04%) were unmarried and 10 (4.6%) were widow. In this study we aim to determine the prevalence of skin diseases in elderly patients, gender Out of 217 cases, 200 patients were having a preponderance and comparison between wrinkling followed by laxity of skin 119(54.8%), infections and non-infectious diseases so that xerosis 93 (42.9%) , dryness 65%, sagging 46%, disease trends can be monitored and relevant pigmentation 37%, eczema 25%, sparse hairs health care programs can be designed in the 21%, skin atrophy 19%, tinea 13%, LSC 10%,, future. while herpes zoster, psoriasis, onychomycosis, Tinea corporis ,asteotic eczema were seen in 7%, MATERIAL & METHODS cases. This descriptive cross sectional study was conducted over 2 years duration at Sir Syed Folliculitis 6%, scabies, bullous pemphigoid in Hospital Karachi from Jan 2016-Jan 2018 after 5%, cases while lichen planus, actinic elastosis, ethical approval. Total 217 patients with age >60 BCC, Prurigo nodularis were seen in 3% cases. years (both the genders) presenting to outdoor dermatology clinic were selected by consecutive Cellulitis, pediculosis, Seborrheic Dermatitis and sampling. Informed consent was obtained from contact dermatitis were seen in 2% followed by 1% each patient. Patients having skin changes cases of warts, candidiasis, photodermatosis and secondary to past pregnancy, lactation, systemic SCC seen in our study. Among bacterial infection, illness and drugs were also excluded. folliculitis 13(6%) was the most common infection followed by impetigo 2(0.9%). A detailed history of cutaneous complaints, present and past medical illness was documented. Among viral infection Herpes zoster 14(6.5%) The complete general physical examination and was the most common dermatosis of the old systemic examination was carried out. Detailed age group followed by warts 2(0.9%), HSV 1 dermatological examination was performed (2(0.9%) and no cases was found for Molluscum and positive findings were documented in a contigiosum. predesigned proforma. 2446 www.theprofesional.com Professional Med J 2020;27(11):2445-2452. GERIATRIC DERMATOSIS 3 In Fungal infections tinea 29(13.4%) was the most was the most common dermatosis followed by commonly seen followed by onychomycosis prurigo of nodularis 6(2.8%), Neurotic excoriation 15(7%), candidiasis 2(0.9%). 2(0.9%) were found.There was no case of delusion of parasitosis in our study. Scabies was the most common parasitic infection 10(4.6%) followed by pediculosis 5 (2.3%). As per association with gender; wrinkling, sagging, dryness of skin, actinic keratosis, Among papulosquamous lesions eczema actinic elastosis was found to be associated with was found to be in 54(24.8%)asteotic eczema female gender, however cellulitis, squamous cell 14(6.4%), Nummular eczema (0%), varicose carcinoma and asteatotic eczema was associated eczema 1.8%) were seen. with male gender (p < 0.05; Table-I). Among benign Dermatosis, Actinic elastosis was DISCUSSION found to be most common dermatosis followed Skin diseases are an important health problem by stucco keratosis 4(1.8%), Keratoacanthoma affecting geriatric population.
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