From the Guidelines
The most common rash in a 60-year-old individual is likely asteatotic eczema, which can be initially managed with emollients and topical steroids for at least 2 weeks. This recommendation is based on the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018 1.
Key Points to Consider
- Asteatotic eczema is a common condition in elderly individuals, characterized by dry, scaly skin, and can be managed with moisturizers and topical corticosteroids.
- Moisturizers with high lipid content may be preferred in the elderly to help manage dry skin and prevent asteatotic eczema 1.
- Patients with pruritus in elderly skin may also benefit from gabapentin, although the strength of recommendation is low 1.
- It is essential to reassess patients who have not responded to initial treatment and consider referral to secondary care if there is diagnostic doubt or if primary care management does not relieve symptoms 1.
Management and Prevention
- Emollients and topical steroids should be used for at least 2 weeks to exclude asteatotic eczema 1.
- Patients should be advised to keep affected areas clean and dry, avoid harsh soaps, and manage stress to help prevent flare-ups.
- If the rash does not improve with these treatments within 2-3 weeks or worsens, medical evaluation is recommended to rule out other conditions.
From the Research
Common Rashes in Older Adults
The most common rashes in older adults can vary, but some studies suggest that:
- Seborrheic dermatitis is a common and chronic skin disease, particularly prevalent in older adults 2
- Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders encountered in geriatric medicine wards 3
- Atopic dermatitis (AD) in older adults has recently emerged as a newly defined subgroup of AD, with various treatment options available 4
- Eczema is one of the most common reasons for consultation in older people, with many differential diagnoses to be considered, including scabies, bullous pemphigoid, and mycosis fungoides 5
Prevalence of Rashes in Older Adults
Studies have shown that:
- Around 70% of older people have a treatable skin condition, with eczema being a common condition that can develop easily in older adults 6
- Age-related changes lead to an increase in skin problems, making it difficult for older people to care for their skin 6
- The increasing number of older adults as a percentage of the population will lead to an even higher prevalence of skin diseases, such as seborrheic dermatitis, in the ensuing decades 2
Types of Rashes in Older Adults
Some common types of rashes in older adults include:
- Seborrheic dermatitis, characterized by the presence of Malassezia yeast colonies and an inflammatory response in the affected individual 2
- Asteatotic eczema, incontinence associated dermatitis, and contact dermatitis, which can be caused by various factors, including chemical exposure and comorbidities 3, 5
- Atopic dermatitis, which can be treated with various options, including topical corticosteroids, calcineurin inhibitors, and oral antihistamines/anti-allergic drugs 4