Skin diseases affecting elderly individuals are summarised in Table 29.1. Elderly patients may present with multiple skin lesions, either benign, malignant or a combination (Figure 29.1).

Attitudes to Skin Diseases in the Elderly

Some elderly patients ‘put up’ with skin diseases that they consider non-life-threatening. Patients may delay seeking medical attention until the rash or lesion becomes symptomatic (e.g. bleeding basal cell carcinoma or squamous cell carcinoma) (Figure 29.2).

Co-Morbidities Impacting on Skin Disease in the Elderly

Co-morbidities may be the primary cause, contribute to the skin disease or impact on its management (e.g. impaired mobility due to arthritis may result in stasis eczema or chronic venous leg ulceration) (Figure 29.3).

Memory or visual impairment can also delay presentation until the rash or tumour is more extensive or advanced (Figure 29.4).

Elderly individuals are often on multiple systemic medications, some of which may cause skin diseases (e.g. peri-anal ulceration due to nicorandil). Potential interactions with other medications and exacerbation of other co-morbidities should be borne in mind when starting elderly individuals on systemic treatment for their skin disease (e.g. worsening diabetes with the use of oral steroids).

Factors to Consider When Managing Elderly People with Skin Diseases

Practicalities of applying topical treatment: elderly patients living alone or those with co-morbidities such as arthritis or poor vision may not be able to apply topical treatments to difficult to reach and/or see body sites (e.g. back) (Figure 29.5). Family members or carers may need to be involved and educated about the topical treatment.

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