Skin Conditions and Older Adults

A stroll through the skin-care aisle might lead you to believe that wrinkles are the most serious skin condition older adults contend with. In fact, wrinkles and sun damage may be the least of them. Some common skin conditions start as nuisances, but they can affect quality of life and lead to more severe problems. Others may look scary or worrisome but are usually benign, and some are extremely dangerous, painful, or both.

Dry, Itchy Skin

Itching affects nearly half of all adults over the age of 60 at one time or another. It may be the result of extremely dry skin; it may also be caused by contact with an irritant or be a symptom of an illness. Dry skin is caused by a lack of moisture (that is, water) in the skin, not lack of oils. It’s more common in winter because cold weather, low humidity, and wind reduce the amount of water in skin.

Treatment:

It’s important to treat itching because scratching can tear skin, and open sores are vulnerable to infection. For severe itching or a rash, see a doctor, who may prescribe an antihistamine to help with itching and will treat the underlying cause.

For dry skin, using a moisturizer will help skin retain water. Oil- and petrolatum-based moisturizers last longer than water-based ones, and they form a barrier on the skin that helps to keep water from evaporating. For best results, use a moisturizer immediately after bathing or showering, while skin is still damp.

If you have sensitive skin, look for lotions and creams that are labeled “fragrance-free.” (“Unscented” products may have chemicals added to mask or neutralize aromas; fragrance-free means that no perfumes or masking agents have been added.)

Purpura

Purpura are small bruises that appear most frequently on older adults’ hands, forearms, and legs. They are extremely common, especially in people who take blood thinners, including aspirin and medications that contain aspirin. They are often caused by pressure (for example, gripping a loved one’s forearms to help them up from a chair) on skin that is tissue-thin and fragile. The bruises disappear in a few weeks, but unlike regular bruises, purpura don’t change color as they fade.

Treatment:

Purpura usually clears up without treatment and most often does not indicate a serious health issue. However, if you see them frequently on your loved one, be sure to rule out causes that require attention, such as problems with balance or elder abuse.

Shingles

If you’ve had chickenpox, you’re at risk for shingles—in fact, about one third of adults who had chickenpox will develop shingles, usually after age 50. Age lowers your ability to fight infection, and so do chronic diseases like cancer or HIV. But even a cold or stress can limit your body’s immune response.

Symptoms start with tingling or burning; after a few days, a red rash may develop (usually on one side of your body, and most often on the trunk, face, or neck).

Treatment:

If you suspect you have shingles, it’s important to see a doctor within three days of developing the rash. There isn’t a cure, but starting treatment as soon as possible can limit the severity and lessen pain. And shingles can be extremely painful—the disease affects your nerves—so the best treatment to prevent the disease if possible. There is a new shingles vaccine available for adults age 50 and older. It reduces the risk of shingles by 90 percent (the older vaccine, available for adults age 60 and older, reduced the risk by 50 percent) and is given in two doses, scheduled a few months apart.

Pressure Ulcers

Pressure ulcers are sometimes called bed sores, because they develop when a person lies in bed (or sits in a chair) without moving or shifting position for an extended time. As bones press against skin, muscle, and other tissues, blood supply to these areas is reduced. Over time, the skin and tissues break down and sores develop. Pressure ulcers most frequently develop on heels, hips, buttocks, elbows, and shoulder blades.

In addition to immobility or the inability to shift position, these factors increase the risk of pressure ulcers:

  • Skin exposed to moisture (such as bladder or bowel incontinence or perspiration)
  • Limited ability to feel pain, respond to discomfort, or communicate discomfort
  • Decreased mental awareness of pressure-related discomfort
  • Poor nutrition or appetite
  • Diabetes

Treatment:

Pressure ulcers are extremely painful and can be difficult to treat, so it’s important to prevent them whenever possible.

For someone in a bed:

  • Follow a written turning schedule if the doctor or home care nurse provided one. Otherwise, turn and reposition every two hours.
  • Keep the head of the bed at or below a 30-degree angle (except during meals) to prevent sliding.
  • Place pillows or foam wedges between legs to keep knees, ankles, and other bony areas from pressing against each other.
  • Position pillows under the calves to raise heels off the bed.
  • Use special mattress support surfaces to redistribute pressure (do not use a donut ring as they can interfere with blood flow).
  • To move the person, use a lifting device like a draw sheet or a trapeze. Avoid dragging, which can tear skin.

For someone in a chair:

  • Shift weight every 15 minutes, or change position every hour.
  • Use special wheelchair cushions to redistribute pressure, but do not use a donut ring as they can interfere with blood flow.

Good skin care habits are an important part of prevention.

  • Keep skin clean and dry.
  • Change underpads or briefs as soon as possible when they become wet or soiled. After each episode, clean and protect skin using a topical barrier ointment (such as petroleum jelly).
  • Clean with a mild soap and warm (not hot) water, or use a no-rinse cleanser.
  • Pat skin dry gently, rather than rubbing or wiping.

Examine the skin from head to toe every day, looking for signs of redness or tenderness and paying close attention to the skin over bones. Call a nurse or doctor right away if you see these changes:

  • A reddened or darker area that does not turn white when pressed; it make feel warm, hard to the touch, swollen, or painful
  • A blister filled with clear fluid or blood
  • An open sore