- Geriatric Dermatology, An Issue of Clinics in Geriatric Medicine, Volume 29-2
- Table of Contents
- Practical Dermatology
An epidemiological analysis in — reported that 3. Dermatophagoides species , followed by pollens e. Japanese cedar and grass pollen. Positive rates were as follows: Dermatophagoides farinae , Skin manifestations in elderly AD basically match those of adult AD, but the reverse sign of lichenified eczema around unaffected folds of the elbows and knees is more common than the classic sign of localized lichenification at those folds. Other stigmata of AD, such as facial erythema atopic red face and pallor, Hertoghe's sign loss of the lateral eyebrows , Dennie—Morgan infraorbital folds, dirty neck and follicular lichenified papules might also be observed in elderly AD Fig.
Skin manifestations of elderly atopic dermatitis. The pathogenesis of AD is complex. In addition, For elderly patients with AD, intriguing characteristics might be obtained from our retrospective analysis.
Geriatric Dermatology, An Issue of Clinics in Geriatric Medicine, Volume 29-2
For each clinical type, only the incidence of malignancy 2. The majority of elderly AD patients achieve amelioration of the skin manifestations once they receive suitable management in later life. Using standard treatments e. In our clinical study of elderly patients with moderate to severe AD, 27 patients received oral corticosteroids.
However, complete remission outgrowth, a condition without any need for treatment rarely arises in elderly AD. Most elderly AD patients will reach the end of life with AD.
A possible pathomechanism of elderly AD is shown in the scheme Fig. A possible pathomechanism of elderly atopic dermatitis AD. Activity develops in the childhood phase, peaks in puberty and declines gradually thereafter. Th17 cells into Treg cells.
Sex hormones appear to influence the immune system in humans. That study showed that average serum levels of testosterone in men and estradiol in women were significantly lower in older adults than in younger adults, and interestingly, average serum levels of estradiol were clearly lower in older women than in older men. Dysfunctions of the physiological, biochemical and immunological chiefly innate immunity barriers, not only in the skin, but also in the gut, might be involved in the pathogenesis of AD.
Dry skin is common in infants and children as part of the normal skin physiology before puberty, although genetic predispositions, such as mutation of FLG and other candidate genes involved in skin barrier function, seem to influence disease severity. Barrier impairment under dry skin conditions might thus be thought to represent a major cause of infantile and childhood AD, and even for the start of atopic march in association with complicating allergic respiratory diseases.
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Barrier defects in dry skin facilitate the entry of irritants e. Sweat is one factor exacerbating AD. In contrast, regional sweating in older adults decreases with age.
Table of Contents
Indeed, a positive relationship between a lower level of activities of daily living and higher probability of asteatosis dry skin condition has been reported among elderly residents in care institutions. This might complicate the diagnosis of elderly AD. Even now, definitive clinical, histopathological and laboratory diagnostic markers are lacking. In general, management of AD is carried out in accordance with the standardized guidelines of practice for AD.
Management of elderly AD should basically conform to this concept. In older patients, avoiding trigger factors in the environment and applying sufficient topical medication is difficult, because of the decreased activities of daily living with aging and lifestyle e. Therefore, for moderate to severe cases, oral corticosteroid therapy can be used with the aforementioned standard treatments.
However, this requires appropriate monitoring and prevention of adverse events, such as hypertension, peptic ulcer, cataract, osteoporosis, diabetes mellitus and steroid purpura. As other adjunctive treatments, oral cyclosporine is very effective for the treatment of severe cases of elderly AD, but clinicians must pay attention to the increased risk of malignancy and organ toxicity e.
In the near future, AD will become an ordinary disease of elderly individuals in an aging society. The natural lifetime courses of AD in accordance with the genetic background, environmental stimuli and heterogeneous clinical phenotypes will become apparent. Genetic and biological research will inevitably bring further insights into the pathophysiology of AD and advances in the diagnosis of AD. Further investigation of a large cohort of elderly patients with AD is warranted.
AD in older adults represents a new subgroup of AD. Most elderly patients with AD reach the end of life with AD, which should now be considered a lifelong allergy disease. Volume 16 , Issue S1. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.
Email: rtanei aol. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Evidence-based prescribing in older patients is then explained, and the evidence relating to treatments for psoriasis, reviewed.
Further chapters in Geriatric Dermatology address non-surgical treatment options for basal cell carcinoma, the increase in and management of sexually transmitted diseases in older dermatology patients, and cutaneous signs of elder mistreatment. Case vignettes and informative illustrations assist the reader in quickly grasping the connection between an age-related process and its clinical impact.
Geriatric Dermatology is written for dermatologists, research scientists with translational interest, geriatricians, and gerontologists. Here at Walmart. Your email address will never be sold or distributed to a third party for any reason.
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