Introduction:
Dry, itchy, and inflammatory skin are symptoms of atopic dermatitis, often known as eczema. It can happen at any age, although it is more common in young children. Atopic dermatitis is a chronic condition that occasionally flares up. It is not contagious, although it can be annoying. Food allergies, hay fever, and asthma are all possible side effects for those with atopic dermatitis. In the past, doctors believed that eczema only affected children. However, it affects individuals over 60 almost as frequently as children under 18. It might go away while they are young but return as an adult, or it might persist all their life. Eczema can even strike individuals in their later years. People over 50 are more likely to get adult-onset eczema.
Why Do Older Adults Get Eczema?
Dryer skin from aging can cause irritation and itching. As an individual ages, the barrier that protects the skin from irritants and pathogens may deteriorate. Certain skin changes that occur in women following menopause may increase their susceptibility to eczema. Older adults may be more susceptible to allergies and other triggers, such as chemicals and odors. Additionally, stressful life events like a death in the family or a job loss may cause symptoms.
It is necessary to rule out several differential diagnoses, such as mycosis fungoides, bullous pemphigoid, and scabies. In addition, contact dermatitis is taken into consideration. Elderly patients may get drug-induced eczematous eruptions, primarily from hypertension medications (diuretics, calcium inhibitors). De novo atopic dermatitis in older adults has been reported recently, and pollution has been implicated in these eczemas.
What Are the Common Types of Eczema in the Elderly?
The common types of eczema in the elderly are:
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Atopic Dermatitis - The most prevalent type of eczema, atopic dermatitis, can strike at any age. Dry, itchy, irritated, and red skin are the basic symptoms of eczema caused by an allergic illness. These symptoms typically occur in reaction to environmental triggers.
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Asteatotic Dermatitis - This kind of eczema is also frequent among the elderly and typically affects the shins. The skin may resemble a parched riverbed or flagstone pavement as it becomes dry, rough, and scaly. If an individual keeps their home extremely dry and warm during the winter, they may run the largest danger.
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Dermatitis Due to Varicose - One can develop varicose eczema if they do not move often. Varicose veins, elevated blood pressure, and a prior history of blood clots are further risk factors. This type of eczema causes the skin of the lower leg to deteriorate and become fragile, which increases the risk of ulcers. Additionally, one may develop crusty, leaking sores on their legs.
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Eczema Triggered by Drugs - Drug-induced eczema may be more common in older adults, or it may just be the case that older adults are more inclined to use certain medicines that cause eczema. Certain targeted cancer treatments and biological therapies for arthritis can result in skin reactions that mimic eczema in both appearance and sensation.
What Are the Symptoms of Eczema?
The signs of atopic dermatitis, often known as eczema, can differ greatly from person to person and can occur anywhere on the body. They could consist of:
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Skin that is dry and cracked.
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Pruritus (itchiness).
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Rash on swollen skin that changes color based on the tone of the skin.
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Tiny, raised pimples on skin that are either black or brown.
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Seeping and coating over the skin.
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Skin that is thicker.
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Skin tone darkening, especially around the eyes.
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Raw, delicate skin that emerges on by scratching.
Atopic dermatitis frequently starts before the age of five and can last into adolescence and adulthood. Some patients experience flare-ups followed by periods even in years of clarity. Between the ages of 60 and 90, eczema patients typically have a more severe and active condition. Individuals are more likely to experience symptoms in their arms, legs, and chest, which include more severe itching than in younger individuals. Older adults with eczema frequently experience extreme dryness as well as discolored, inflamed, or differently-textured skin areas.
What Happens When Eczema Is Accompanied by Other Health Conditions in Elderly?
People with eczema may also be more susceptible to some illnesses that are more common in older adults. It is crucial to adhere to the doctor's instructions for any conditions that may arise as an older adult with eczema and maintain a schedule for screenings and other regular preventive care.
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Heart disease, osteoporosis, depression, anxiety, and dementia may be more likely to affect individuals.
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As individuals age, their immune systems naturally deteriorate. This is common among the elderly. The body may find it more difficult to manage inflammation and combat eczema-related infections if it has a compromised immune system.
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It is possible that elderly people with eczema are on medicine for other illnesses. Certain drugs may interfere with eczema treatments or have adverse effects on the skin.
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Eczema can cause pain, discomfort, and sleep disruptions, all of which can significantly lower a person's quality of life.
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Psychological effects can be more noticeable in conjunction with other medical disorders, influencing resilience in general and mental health in particular.
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Skin barrier function may be compromised by aging, leaving the skin more prone to irritation and inflammation. This can make eczema symptoms worse since the skin finds it more difficult to stay moisturized and shield itself from outside allergens.
How Is Eczema Managed in the Elderly?
As with other age groups, treating elderly eczema involves managing the skin barrier with moisturizers and emollients, treating inflammation with topical corticosteroids and topical calcineurin inhibitors, treating allergies with adjunctive oral antihistamines and anti-allergic medications, and recognizing and avoiding exacerbation factors like environmental allergens.
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Avoid aggravating circumstances like exposure to irritants such as chemicals, unsuitable clothing, allergens such as pollen, and foods, as well as pathogens and scratching. One of the things that makes eczema worse is sweat, which contains allergens and irritants.
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Moisturizing is the key. One of the primary signs of eczema in older persons is dry skin or xerosis. It is also a sign of aging skin in this demographic. First-choice medications are topical moisturizers like urea or heparinoids. After taking a bath or shower, these moisturizers should be administered along with topical anti-inflammatory medications as soon as possible, before the skin dries fully.
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Topical corticosteroids are the first-line anti-inflammatory therapy that works well for both active inflammation and disease prevention.
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Topical calcineurin inhibitors, such as Tacrolimus and Pimecrolimus, work by inhibiting the intracellular calcineurin pathway, which prevents T-cells from producing Cytokines. The therapeutic potency of topical corticosteroids of intermediate potency is equal to that of 0.1 % Tacrolimus ointment.
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Other drugs like oral Cyclosporine and immunosuppressive drugs are used. Phototherapy is a choice of treatment in certain cases.
Conclusion:
Though elderly eczema is not a fatal condition, it severely impairs the quality of life for elderly people with atopic dermatitis who are nearing the end of their lives. Individuals' aging processes can have an impact on how the body uses medications and how they react to them. Verifying that new medications will have dangerous interactions with the eczema treatment or other prescriptions is vital. There are risks associated with using over-the-counter medications and natural supplements for those with specific medical conditions or drug usage.It might be difficult to treat eczema in the elderly, but dermocorticosteroids and emollients can assist. However, in this susceptible group, local corticosteroids may have some negative side effects as well, like skin atrophy, hyperglycemia, and hypertension. When feasible, phototherapy and low-dose methotrexate, in particular, can be intriguing therapeutic choices.
