Perawatan dermatologis usia lanjut

Skin layers

Layers of the epidermis

Geriatric dermatology is a specialty that will receive particular attention. Since the human population is living longer, chronic diseases will become more prevalent, as will diseases of the skin.
Norman, R.A.; Geriatric dermatology. Dermatologic Therapy; Vol. 16, 2003; 260-268

 Intrinsic aging Extrinsic aging

Epidermal Changes Melanocytes* Approximately 15% decline per decade.* Density doubles on sunexposedskin.* Increased lentigines. Langerhans' cells* Decreased density.* Decreased responsiveness.

Dermal Changes -Decreased collagen -Decreased density -relatively acellular, avascular, and less dense with the loss of functional elastic tissue

Skin Changes in Aging * Loss of elasticity.* Thinning of the skin.* Clinical -- xerosis, laxity, wrinkling,uneven pigmentation,easy tearing, traumatic purpura,neoplasia.* Histology -- dermal atrophy,progressive loss of elastic tissuein the papillary dermis.
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Moist skin

Moist deficient skin

Layers are not able to maintain the moisture due to lack of NMF, so the skin becomes dry and rough

Moist skin is a state in which the stratum corneum is regularly arranged with the right balance between NMF and Epidermal Lipids

Hair color change graying is caused by follicle produces less melanin, begins in the 30s-40s Graying is genetically determined. Nutritional supplements, vitamins, and other products will not stop or decrease the rate of graying

Hair color is caused by a pigment (melanin) that is produced by the hair follicle. With aging, the follicle produces less melanin

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Aged hair follicles are no longer as prepared for new hair growth
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The nails change with aging, growing more slowly, dull & brittle Color change translucent to yellowed & opaque Nails, especially toenails hard & thick and ingrown toenails more common Tips of the fingernails may fragment

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 Xerosis is characterized by pruritic, dry,

cracked, & fissured skin with scaling

Xerosis due to decreased sebaceous & sweat gland activity; this reduced activity predisposes the aged skin to moisture depletion

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Pre-existing situations : radiation, end-stage renal disease, nutritional deficiency (especially zinc and essential fatty acids), thyroid disease & neurological disorders with decreased sweating, antiandrogen medications, diuretic therapy, & malignancies
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Deficits in both skin hydration and lipid content play a key role in xerosis The xerotic vicious cycle needs to be broken to disable the process and prevent complications. To achieve this goal, keratolytics, moisturizers, and steroids are the primary components of xerosis treatment. use of moisturizers reduce scaling and enhance the corneodesmosome degradation process

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Preventing xerosis involves three key elements: keeping the environment amply humidified, which includes not keeping the temperature excessively high; making sure residents have good fluid intake, which should already be part of the care routine; and moisturizing the skin daily.

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Additional management:
Reduced frequency of bathing Minimal use of a irritant soap Avoidance of harsh skin cleansers Application of moisturizer of choice directly on skin that is still damp Avoidance of friction from washcloths, rough clothing, and abrasives Use of air humidification in dry environments
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Pruritus

Characteristic features of pruritis include scratching and inflammation underlying diseases Underlying metabolic conditions that can produce pruritus include renal failure, HIV, diabetes mellitus, thyroid disease, parathyroid disease, hypervitaminosis A, iron-deficiency anemia, neuropathy, hepatic disease, malignancy, and drugs Itching evokes the desire to scratch produces an immunology-based inflammatory response
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The goal of pruritis therapy is to optimize treatment efficacy by tailoring the treatment to the underlying etiology Avoidance of fragrance soap, irritating chemicals, and hot water help reduce pruritus, especially in elderly patients who have the xerotic changes of aging
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Purpura Purpura can be defined as any of a group of conditions characterized by ecchymoses or other small hemorrhages in the skin, mucous membranes, or serosal surfaces. Purpura may be caused by decreased platelet counts (thrombocytopenia), platelet abnormalities, vascular defects, trauma, or drug reactions
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Elderly persons are especially susceptible to hemorrhage into the skin. Aging causes a gradual reduction in the number of blood vessels and elastic fibers, as well as losses in dermal collagen and fat, causing a thinning of the skin and reduced protection from external trauma

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Treatment should focus on the underlying cause Administration of oral glucocorticoids & immunoglobulins , If platelet counts are extremely low (< 10,000/cubic mm), platelet transfusion may be needed Skin tears most often result from a purpura torn open by inadvertent trauma Important measures include skin protectors and designing living environments to prevent injuries.
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Keep indoor temperatures Too much heat is extremely drying Drink at least eight glasses of water a day. Water helps lubricate the system and prevents dehydration Use a moisturizer: emollient petroleum jelly or mineral oil forms an oily barrier on the skin, which seals in moisture and blocks its evaporation humectant glycerin, sorbitol, or urea attracts and holds water on the surface of the skin To prevent chapped lips, use lip balms, petroleum jelly, or lipstick.

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Avoid long, hot showers or baths washes away natural oils & often leads to itching. Water can be very drying when used to excess. Take short tiped baths or showers. Bathe less often in cold weather

Use a mild soap with moisturizers or extra oil. Avoid harsh deodorant soaps. Soap can be drying and should be used judiciously Pat dry after bathing, rather than rubbing hard with a towel. Rubbing may initiate itching. Apply a bland emollient (moisturizer) immediately after drying
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Try not to scratch when your skin is itchy. Use moisturizers or mild cortisone lotions if necessary. Apply cool compresses on trigger spots Use a cool-moist humidifier to combat dry indoor air very high humidity promotes the growth of bacteria, molds, and fungi, which can elicit allergies in sensitive people.
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Wrinkles & elastosis problems for most of old ages Management skin care before aging esp topical retinoid Chemical peels, collagen implant, facelift operation

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Sunprotection : sun block SPF > 30, anatoher vehicle such as hat, umbrella, sun glasses Electrocauterization Comedos extraction

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Nails Nails develop pits, ridges, lines, changed shape, or other changes. These can be related to iron deficiency, kidney disease, and nutritional deficiencies Cutting nails regularly, moisturizer

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