From the Guidelines
Senile rash, also known as senile purpura, should be managed by protecting the skin from injury, applying moisturizer daily, and considering topical retinoids and vitamin C serums under medical guidance, as the condition is generally harmless and resolves on its own within 1-3 weeks. The condition is characterized by purple or red flat spots that appear on the skin, particularly on the forearms, hands, and legs, due to fragile blood vessels leaking blood into the skin after minor trauma. According to the British Association of Dermatologists' guidelines 1, pruritus in elderly skin should initially be treated with emollients and topical steroids for at least 2 weeks to exclude asteatotic eczema.
Some key points to consider in managing senile rash include:
- Protecting the skin from injury by wearing long sleeves and pants when doing activities that might cause bumps or scrapes
- Applying moisturizer daily to keep skin hydrated and strengthen the skin barrier
- Considering topical retinoids to improve skin thickness and vitamin C serums to strengthen blood vessels, though these should be used under medical guidance
- Taking oral supplements like vitamin C (500mg daily) and bioflavonoids may help strengthen blood vessels from within
- Referring patients to secondary care if there is diagnostic doubt, or if primary care management does not relieve symptoms, as recommended by the British Association of Dermatologists' guidelines 1.
It is also important to note that pruritus in the elderly can be associated with dry skin or xerosis, and other factors such as generalized pruritus of unknown origin (GPUO), malignancy, ageing in nerve fibre bundles, and drug-induced pruritus, as mentioned in the guidelines 1. Therefore, a thorough evaluation and reassessment of the patient's condition is necessary to provide appropriate management and referral to secondary care if needed.
From the Research
Definition and Prevalence of Senile Rash
- Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people 2.
- Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly 2.
- Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old 2.
Causes and Classification of Senile Rash
- 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 2.
- When a rash is present it could suggest an underlying primary dermatosis 3.
- Pruritus in the elderly population remains both a diagnostic and therapeutic challenge 3.
Treatment Options for Senile Rash
- Various therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments 2.
- Apart from lifestyle modifications, emollients, topical antipruritics, oral antihistamines, topical corticosteroids and phototherapy may prove useful 3.
- For moderate-to-severe cases and/or in those with a decreased ability to use topical treatments, powerful anti-inflammatory treatments may become necessary as additional treatment options 4.
- Dupilumab therapy markedly improves skin lesions and itch in older patients with AD, with a rapid response and non-serious adverse effects 4.
Safety Considerations for Treatment
- Antihistamine safety in older adult dermatologic patients is a concern, and dermatologists may be less familiar with age-associated adverse effects of common dermatologic medications 5.
- The risks of antihistamines, anticholinergic burden and polypharmacy, pertinent preexisting medical conditions, and safe alternatives for aging adult patients should be considered 5.
- Low-dose oral corticosteroids may be useful for cases of elderly AD, but careful attention should be paid to adverse effects 4.