9: Geriatric Skin Disorders - Mahoney Flashcards
decrease in skin lipids –>
dryness
decreased cell replacement –>
roughness, delayed healing
decreased DNA repair –>
increased malignancies
fragmentation of collagen/elastin –>
wrinkles, increase in ulcers
reduced connective tissue support of blood vessels –>
increased purpura
decreased sensation –>
increased injury
impaired thermoregulation –>
vulnerable to heat and cold
reduced function of sebaceous glands –>
decreased lipids
reduced function of sweat glands –>
risk of overheating
decreased langerhans cells –>
delayed healing and increase in infection
reduced subq fat –>
increased risk of injury
flattening of DE junction –>
increased risk of skin tears and blisters
reduced linear nail growth –>
onychogryphosis, longitudinal striations, brittle nails
decreased melanocytes –>
increase in malignancies
extrinsic changes to skin with aging
pruritus
spider veins
age spots
easy bruising and skin breaks
ulcer over bony prominences
pressure over time leads to ischemia and tissue damage
decubitus ulcer
NPUAP stages I-IV
I: non-blanchable erythema
II: necrosis with superficial to partial thickness skin loss
III: necrosis with full-thickness skin loss to fascia
IV: extensive necrosis into m and bone
tx decubitus ulcer
- change position
- better mattress
- keep ulcer dry
- nutritional consult
- infection control measure
why xerosis?
due to decrease in lipids combined with impaired epidermal barrier function (greater loss of water from skin)
asteatotic eczema =
xerosis
pruritus is most commonly caused by…
xerosis
leads to local excoriations
PHILL is itchy
polycythemia vera HIV iron deficiency anemia liver and renal dysfuntion lymphoma
venous hypertension leads to inflammatory rxn accompanied by leukocye activation and release or red cells into tissue which break down into hemosiderin depositions
stasis dermatitis
infection of subQ fat
cellulitis
- deeper than erysipelas and does not have a distinct border
infection of dermis and upper subQ tissue
erysipelas
diagnosis of herpes simplex
tzanck smear
- positive result is finding of multinucleate giant cells
common cause of plantar xerosis in elderly, especially resistant to routine moisturization
tinea pedis
- diagnosis confirmed with KOH
4 types of onychomycosis
- distal subungual
- proximal subungual
- total subungual
- superficial white
staining for onychomycosis
sabouraud’s medium or PAS staining
pathology of onychomycosis
fungus produces keratinase which destroys nail and leads to the thickening, discoloration and loosening with accumulation of subungual debris
oral terbinafine for onychomycosis produces a complete cure ….
1/3 of time
- primary manifestation is burrow found between fingers
- highly pruritic and wil lhave overlapping signs of scratching which can hide diagnosis and be attributed to simply itchy skin in elderly
scabies
- diagnosed by microscopic identification
- treat with promethrin
pt complains of intense itching and you worry about systeic cause … what screening tests are appropriate?
CBC ALT and AST Creatinine HIV screening Check for interdigital papules or blisters
nummular eczema
similar to all forms of eczema which will have an inflammatory phase with vesicles and oozing, followed by a dry, crusty phase
- appears as dry, cracking skin on plantar surface of foot or toes
- pts will have some type of allergic hx, usually hayfever or environmental allergens
atopic eczema
in elderly, due to decreased ability to mount a delayed hypersensitivity reaction due to reduced number of langerhands cells and tcells and to diminished vascular reactivity
eczema contact dermatitis
- shoes, nickel, fragrances, baslam of peru are common sources
tx psychodermatological disorder
topical steroids and anti-anxiety medications
FIEF drugs cause …
furosemide
ibuprofen
enalapril
flu vaccine
bullous pemphigoid
tx is topical steroids and tacrolimus along with DMARDs
hyperkeratosis that looks like it has been stuck onto the skin
seborrheic keratosis
*sudden appearance of multiple lesions may signal internal malignancy known as leser-trelat syndrome
erythematous, dome-shaped, 1-10 cm nodule iwth keratin plug in center
keratoacantoma
