Geriatric dermatoses refer to skin conditions that are commonly seen in elderly individuals, Aged skin undergoes progressive structural and functional degeneration that leaves it prone to a variety of bothersome and even fatal conditions and diseases.¹ Due to the degenerative and metabolic changes occurring throughout the skin layers during the aging process, elderly people are vulnerable to a wide variety of dermatological conditions. Neurological and systemic diseases, health and hygiene, socioeconomic status, climate, color of skin, gender, nutrition, culture, and personal habits, such as smoking, drinking, etc., may also contribute a role in the genesis of cutaneous conditions in the elderly population.² The clinical manifestation of skin disorders may differ and may not present as classically as they do in younger populations.³ Two types of skin aging have been described: chronological skin aging and photoaging. Both have different clinical and histological features. Chronological skin aging is characterized by physiological alteration in skin function. Photoaging results from ultraviolet radiations, and the effects are more prominent on exposed parts of skin.⁴ Skin changes in elderly population take the form of either intrinsic or extrinsic changes. Intrinsic changes are changes due to skin’s natural metabolic aging process. These include thinning of the skin’s upper layer, diminishing blood flow and compromising the skin’s inherent ability to nourish and repair cells. Extrinsic changes may result from factors, such as UV light exposure and environmental pollutants such as smoking.⁵ Most of the geriatric population have atleast one skin disorder, and many have two or more. The aim of our study was to evaluate the prevalence and pattern of physiological and pathological skin changes in geriatric population.

This was a hospital based, cross sectional study. The study was undertaken from May 2024 to November 2024. Two hundred patients above the age of 60 years, attending Dermatology OPD at a Teritiary Hospital located in south India were enrolled in the study. Severely ill patients and diseases of nail, hair and mucosa were not included in the study.

A detailed clinical history including demographic details, family history, drug history, previous history of skin diseases, were recorded in a proforma after obtaining informed consent from each individual patient. A detailed physical examination and dermatological examination was done and findings recorded. Relevant investigations like complete haemogram, diabetic profile, KOH mount, culture & sensitivity, wood s lamp examination, biopsy and immunofluorescence was done when indicated.

Data was compiled in Microsoft Excel and analyzed with SPSS 21 version software. Qualitative data was represented by frequencies and proportions and analyzed.

In our study, we included two hundred patients above the age of 60 years. Out of 200 patients, 116 (58%) were males and 84 (n=42) were females. The male to female ratio was 1.38 : 1.

In our study, age group varied from 60 to 91 years. Maximum number of patients were in the age group of 60-69 years(n=95), followed by age group of 70-79 years(n=67) (Fig 1).

                                                Fig 1: Age distribution of patients

All patients had one or more physiological and degenerative skin changes, the commonest was wrinkling present in 140 (70%) patients followed by xerosis in 135(67.5%) and idiopathic guttate hypomelanosis in 62 (31%) patients (Table 1).

Table 1: Physiological and Degenerative skin changes

Among the Benign tumors, the most common was seborrheic keratosis seen in 55(27.5%) patients, followed by acrochordan in 45(22.5%) and dermatosis papulose nigra in 41(20%) patients.  Basal cell carcinoma was seen in one patient (Fig 2).

Fig 2: Benign and malignant tumors of the skin

Infections and infestations were seen in 81(40.5%) patients, of which fungal infection being the commonest, seen in 41(20.5%) patients, followed by bacterial in 20 (10%) and viral infection in 15(7.5%) patients (Table 2). Among the fungal infections, dermatophytosis was seen in 30(15%) and candidiasis was reported in 11 (5.5%) patients. Among bacterial infections, cellulitis was seen in 7(3.5%), folliculitis in 6(3%), furunculosis in 4(2%), carbuncle in 2(1%) patients and leprosy was seen in 1(0.5%) patient. Of the various viral infections, herpes zoster was seen in 10(5%), verruca vulgaris was seen in 4(2%) patients and molluscum contagiosum seen in 1(0.5%) patient. Scabies was seen in 5(2.5%) patients.

Table 2: Infectious dermatoses

In our study, eczema was present in 65(32.5%) patients. Among the various types of eczema, asteatotic eczema was the commonest seen in 24(12%) patients, 12(6%) patients had irritant contact dermatitis,8(4%) patients had stasis eczema (Fig 3). Allergic contact dermatitis was present in 7(3.5%) patients, seborrheic dermatitis was seen in 6(3%) patients, phytophodermatitis was seen in 3(1.5%)patients.

                           Fig 3: Eczematous dermatoses

 Papulosquamous disorders were seen in 16(8%) patients,11(5.5%) patients had psoriasis  and 5(2.5%) patients had lichen planus. Among the bullous disorders, bullous pemphigoid was seen in 3(1.5%) patients and pemphigus vulgaris in 2 (1%) patients. Among other dermatoses, amyloidosis was seen in 8(4%) patients, vitiligo was present in 7(3.5%) patients, urticaria was documented in 5(2.5%) patients, 3(1.5%) patients had acquired perforating dermatosis, lichen sclerosus et atrophicus and pigmented purpuric dermatoses were seen in 2(1%) patients each (Table 3).

                                                     Table 3: Non infectious dermatoses

Fig 4: Xerosis

Fig 5: Senile lentigo

Fig 6: Idiopathic guttate hypomelanosis

Fig 7: Wrinkling

Fig 8: Senile comedones

Fig 9: Seborrheic keratosis

Fig 10: Cherry angioma

Fig 11: Asteatotic eczema

Fig 12: Dermatophytosis

Fig 13: Psoriasis in an elderly patient

Fig 14: Pigmented purpuric dermatoses

Fig 15: Candidal intertrigo

The process of ageing affects the skin in multiple ways. The effects of skin ageing, both internal and external have the potential to produce significant morbidity.

We included 200 patients above the age of 60 years. Males constituted majority of our study group of about 58% and females constituted 42% with male to female ratio of 1.38:1. Similar male preponderance was observed in studies by Yalcin et al, Patange et al and Chopra et al.^3,6,7 In our study, maximum number (47.5%) of patients were in the age group of 60-69 years and in a study done by Darjani et al 57% of patients were in the age group of 60-69 years.⁸

In our study, the most common physiological change was wrinkling seen in 70% of patients followed by xerosis in 67.5% patients. Wrinkling was the commonest physiological finding in studies by Chopra et al, Kumar et al and Grover et al.^7,9,10Whereas xerosis was the most common physiological change noted by Durai et al and Raveendra et al.^11,12 Wrinkling of the skin in old age is due to changes in the dermis where collagen bundles and elastic fibers are fragmented and disoriented. Decrease in skin lipids and barrier function causes xerosis, affected skin becomes rough and scaly and can be exacerbated by harsh soap, hot water, and low indoor humidity.²

Other physiological changes observed in our study were idiopathic guttate hypomelanosis in 31%, senile purpura in 15.5%, senile lentigenes in 13% and senile comedones in 6.5% of patients, which is in concordance with the findings of various studies.^9,10,13 A variety of skin changes have been seen in aged skin due to prolonged exposure to sun. Sun exposure contributes to a decline in dermatological integrity, leading to skin that easily sags, breaks, bruises, and itches. Senile purpura is due to lack of support of vasculature by collagen tissue and reduced perivascular veil cells.^1,2

Among the Benign tumors, the most common was seborrheic keratosis seen in 27.5% patients, followed by acrochordan in 22.5% and dermatosis papulose nigra in 20% of patients. Seborrheic keratosis was the commonest benign tumor noted in studies by Durai et al (50.6%) and Simin et al (54.5%).¹⁴ Cherry angioma was seen in 19% patients in the present study, while Agarwal et al noted cherry angiomas in 91.8% patients.¹⁵

Most common dermatoses in the present study were infections (40.5%) followed by eczema (32.5%), which is in concordance with the study by Kumar et al.⁹

Infections and infestations were seen in 81(40.5%) patients, of which fungal infection being the commonest, seen in 41(20.5%) patients, followed by bacterial in 20 (10%) and viral infection in 15(7.5%) patients. Higher incidence of fungal infection was seen in studies by Patange et al (17.5%), Raveendra et al (11%).^6,12 Among the fungal infections, dermatophytosis was seen in 30(15%) and candidiasis was reported in 11 (5.5%) patients. Among bacterial infections, cellulitis was seen in 7(3.5%), folliculitis in 6(3%), furunculosis in 4(2%), carbuncle in 2(1%) patients and leprosy was seen in 1(0.5%) patient. Of the various viral infections, herpes zoster was seen in 10(5%), verruca vulgaris was seen in 4(2%) patients and molluscum contagiosum seen in 1(0.5%) patient. Scabies was seen in 5(2.5%) patients.

A variety of infections including bacterial, viral, and fungal may occur commonly in the elderly population. Infections are seen frequently due to alteration in skin architecture and loss of barrier function caused by various physical factors, malnourishment, and nutritional deficiencies.

In our study, eczema was present in 65(32.5%) patients. The incidence of eczema was 29.6%, 39% and 58% in studies by Kumar et al, Grover et al, and Liao et al. ^9,10,16Among the various types of eczema, asteatotic eczema was the commonest seen in 24(12%) patients, 12(6%) patients had irritant contact dermatitis,8(4%) patients had stasis eczema. Kumar et al observed in their study that the commonest eczema was allergic contact dermatitis (10%) followed by stasis dermatitis 4.4%.⁹ Agarwal et al reported allergic contact dermatitis in 30.6 %, followed by irritant contact dermatitis in 11.2 %, and asteatotic eczema in 10.8 % of cases.¹⁵

Asteatotic eczema (eczema craquele) is an eczematous eruption common in the elderly. Asteatotic eczema is characterized by dry, cracked, and fissured patches on the limbs. It is common in winter. Asteatotic eczema is seen secondary to epidermal lipid and free fatty acid depletion. Extensive or generalized eczema craquele should be investigated for internal malignancy, such as malignant lymphoma.¹⁷ Stasis dermatitis (hypostatic eczema) occurs on the lower legs because of underlying insufficient venous drainage. Varicose veins are often present, and chronic pruritic dermatitis develops with periods of exacerbations. The dermatitis may be   dry, scaly or lichenified. Secondary bacterial infection may lead to cellulitis and lymphangitis.¹⁸

Allergic contact dermatitis was present in 7(3.5%) patients, seborrheic dermatitis was seen in 6(3%) patients, phytophoto dermatitis was seen in 3(1.5%) patients in the present study.

In our study papulosquamous disorders were seen in 16(8%) patients,11(5.5%) patients had psoriasis and 5(2.5%) patients had lichen planus. Similar observation was made by kumar et al where the incidence of papulosquamous disease was 18.4%, commonest being psoriasis 9.2%, followed by lichen planus 2.4%.

Among the bullous disorders, bullous pemphigoid was seen in 3(1.5%) patients and pemphigus vulgaris in 2 (1%) patients, which was in corcordance with the study by Kumar et al.⁹ Bullous pemphigoid is a disease found primarily in the elderly population at age 60 years and over. It is a chronic autoimmune disease characterized by bullous eruption on normal skin or on an urticarial base.¹⁹

Among other dermatoses, amyloidosis was seen in 8(4%) patients, vitiligo was present in 7(3.5%) patients, urticaria was documented in 5(2.5%) patients, 3(1.5%) patients had acquired perforating dermatosis, lichen sclerosus et atrophicus and pigmented purpuric dermatoses were seen in 2(1%) patients each.

Dermatological disorders in geriatric population are very common. Skin wrinkling, senile xerosis and idiopathic guttate melanosis were the most common physiological and degenerative skin changes seen in our study population. The most common pathological dermatoses being cutaneous infections, eczematous dermatitis and benign tumors as seen in our study and previous studies. Recognition and management of these conditions is important in improving the quality of life and avoiding serious adverse effects in elderly patients.

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