From the Guidelines
Pruritic rash of aging, often called senile pruritus or aging-associated pruritus, typically presents with intense itching accompanied by dry, flaky skin, and is commonly associated with dry skin or xerosis, as noted in the British Association of Dermatologists' guidelines 1.
Symptoms and Presentation
The symptoms of pruritic rash of aging include:
- Persistent scratching
- Redness
- Scaling
- Small bumps or lesions on the skin
- Excoriations from scratching, which can lead to secondary infections
- Thinner, less elastic skin with signs of lichenification (thickening) in areas of chronic scratching The rash frequently appears on the back, arms, legs, and lower extremities, with itching that may worsen at night or in low-humidity environments.
Causes and Exacerbating Factors
This condition results from age-related changes including:
- Decreased skin barrier function
- Reduced natural oil production
- Diminished skin cell turnover
- Neurological changes affecting itch perception Dehydration, certain medications, and underlying conditions like diabetes or kidney disease can exacerbate symptoms, as mentioned in the guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1.
Impact on Quality of Life
While not life-threatening, pruritic rash of aging significantly impacts quality of life through:
- Sleep disturbance
- Anxiety
- Discomfort Making proper identification and management essential for older adults, as emphasized in the British Association of Dermatologists' guidelines 1.
Management and Treatment
Patients with pruritus in elderly skin should initially receive emollients and topical steroids for at least 2 weeks to exclude asteatotic eczema, and may benefit from gabapentin, as recommended in the guidelines 1.
From the Research
Symptoms of Pruritic Rash of Aging
The symptoms of pruritic rash of aging can be potentially debilitating and have a significant impact on elderly patients by impairing their quality of life 2.
- Pruritus is the most common skin complaint in patients over the age of 65 years 2
- Itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes 3
- Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people 3
- Atopic dermatitis is a chronic relapsing and remitting inflammatory skin disease that can cause intensely pruritic skin lesions 4
- Repeated scratching can trigger a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life 4
Classification and Diagnosis
- Cutaneous pruritus can be classified into two categories based on its distribution: localized cutaneous pruritus and generalized cutaneous pruritus 5
- Localized cutaneous pruritus is indicative of a neuropathic cause, whereas generalized cutaneous pruritus suggests underlying systemic disease(s), drug-induced itch, psychogenic itch, or chronic pruritus of unknown origin (CPUO) 5
- Systemic diseases associated with cutaneous pruritus include disorders of iron metabolism, chronic kidney disease, chronic liver disease, endocrine/metabolic diseases, hematological disorders, and malignant solid tumors 5
Treatment Options
- Topical glucocorticoids are commonly the first-line therapy in the management of atopic dermatitis and psoriasis patients 6
- Topical antipruritics, oral antihistamines, topical corticosteroids, and phototherapy may prove useful in the treatment of pruritus 2
- Device-based physical therapies and medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain are available for cutaneous pruritus 5