Rashes in Older People

Skin changes are one of the most visible and significant signs of ageing and help to determine a person's age. Features include wrinkles, sagging and paper-thin skin, vulnerable to damage.

Prevention of skin breakdown in elderly patients can be crucial in preventing skin disease and morbidity, such as irritant dermatitis or infection

Older skin is more vulnerable to a number of dermatological conditions, particularly dry skin with associated itching and eczema; irritant and contact dermatitis; and skin breakdown associated with pressure

Basic skin-care needs of older people can be neglected or dealt with only when major skin breakdown occurs.

While there are many different types, rashes can basically be divided into two types: infectious or noninfectious.

Noninfectious rashes include eczema, contact dermatitis, psoriasis, seborrheic dermatitis, drug eruptions, hives and allergic dermatitis to name a few.

Infection-associated rashes, such as ringworm, impetigo, staphylococcus, scabies, herpes, chicken pox and shingles, are treated by treating the underlying cause.

Infectious agents that can cause a rash include viruses, bacteria, fungi and parasites.

A rash can be a helpful guide to the likely differential diagnosis.  Infectious disease and drug reactions give a short history whereas psoriasis and eczema may have been present for longer.

Any unusual skin lesions that appear and do not spontaneously resolve should be reported to a dermatology specialist. Cancerous skin conditions, require referral.

Other lesion changes that occur with age include cherry angiomas (small, red, benign tumours), moles, skin tags (fleshy, pedunculated warts in areas of friction) and liver spots. Bruising is related to the loss of subcutaneous tissue supporting the skin's capillaries.  These can be caused by minor trauma, especially on the extensor surface of the forearm. In some cases, this can be an indicator of elder abuse. These lesions can generally be left alone as long as they do not cause distress or present a danger to the individual.

In addition, one of the most common complaints among the elderly is Pruritus, which is a generalised itch and is usually caused by dry skin.  This is easily treated by avoiding soap products.  It is critical however, to distinguish cases of widespread itch with skin diseases (which are typically inflammatory) from those caused by trauma from chronic scratching.

To help ease dry skin an emollient will be needed, these include by are not limited to

Aveeno

Balneum

Cetraben

Doublebase gel (Dermal)

E45

Hydromol cream or ointment

Dermatologists (skin specialists) are best equipped to diagnose and treat most rashes, especially those that require biopsy or special tests.  Additionally, if you are unsure of the rash or unable to arrange an appointment, you can speak directly to your pharmacist who will be able to advise on what emollient to use or whether a Dr is required to diagnose.