Dermatological conditions in older adults: clinical overview

The structure of the skin changes with age, and epidermal cell replacement and collagen formation begin to reduce throughout later life, resulting in a more fragile skin, which is thinner and more wrinkled, and therefore more susceptible to breakdown and ulceration (Ersser, 2010). These skin changes that occur in later life lead to conditions such as dermatitis. The term ‘dermatitis’ refers to a range of inflammatory skin conditions that vary in aetiology, with common manifestations including erythema, scaling, vesicles, itching and lichenification where there is chronic inflammation (British Medical Journal, 2018). It can be difficult to differentiate between each type of dermatitis as they can appear similar, but do have distinct signs and symptoms to look out for.

The outer layer of the skin, otherwise known as the stratum corneum, is involved in the skin's barrier function, through its component lipids, namely, cholesterol, free fatty acids, and ceramids (van Smeden and Bouwstra 2016), and this layer is impaired in older people. Therefore, moisture is lost, which leads to dryness. Without barrier lipids to protect the skin's barrier function, the skin becomes dry, scaly and itchy, and its defence against bacteria, chemicals and fungi is hampered (National Eczema Society (NES), 2019). The thin, dry nature of the older person's skin means it is susceptible to tearing, an aspect that needs to be considered carefully when dressing changes for wound care are made, especially in terms of choice, application and removal of the dressing.