Source of Data

Following approval from the Institutional Ethics Committee, consecutive patients aged 60 and older who visited the dermatology and geriatrics outpatient departments (OPDs) of a tertiary care hospital were included in the study. Recruitment continued until a sample size of 375 participants was achieved.

Sample Size

The study conducted by Chopra et al. revealed that nearly 50% of the patients had xerosis, while an almost similar proportion had pathological conditions such as eczema and seborrheic keratosis. Sample size for the present study was estimated based on the frequency of xerosis, which is the commonest complaint that the elderly present with, with a relative precision of 10% and a desired confidence level of 95%.

Method of Data Collection

Patients aged 60 years and above presenting to the dermatology OPD and the geriatric OPD were recruited for the study. A predesigned proforma including demographics, detailed history, clinical examination, and relevant laboratory investigations were used for the patients recruited.

Type of Study

Cross-sectional study design.

Statistical Analysis

Statistical analysis in this study was performed using the following methods. Continuous data was expressed as means ± standard deviations, while dichotomous data was represented as numbers and percentages. Proportions were compared using the chi-squared test of significance. A p value of less than 0.05 was considered statistically significant. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) software.

Ethics Statement

Institutional ethics committee approval was obtained.

Age Distribution

The majority of the patients in the present study were in the age group of 60–69 years (n = 220), out of the total 375 patients enrolled in the study (58.7%). Our data with respect to age distribution was in line with the previous studies (Table 1).

Table 1: Age distribution.

Sex Distribution

Out of the 375 patients studied, the number of male patients was 218 (58.1%) and the number of female patients was 157 (41.9%). This finding was similar to all previous reference studies with a male preponderance (Table 2).

Table 2: Sex distribution.

Physiological Skin Manifestations

In our study, the following were considered physiological changes: xerosis, wrinkling, actinic elastosis, senile lentigenes, senile comedones, cherry angioma, venous lakes, senile purpura, idiopathic guttate hypomelanosis, asteatotic eczema, achrochordons/dermatosis papulosa nigricans, nail dystrophy, nail pigmentation, mucosal pigmentation, with most of the elderly having wrinkling (74.7%), followed by xerosis (73.3%).

The findings were comparable to studies done by Chopra et al. [7] and Pavithra et al. [14] yet contrasted with studies done by Sahoo et al. [13] and Darjani et al. [15]. These differences might have been due to the different geographical locations (Table 3).

Table 3: Physiological skin manifestations in the elderly.

In a study by Dhumale SB, Khyalappa R, fungal infections were predominantly found, 21% had Tinea and 16.5% had candida infections totalling to 37.5% of the total dermatoses in the elderly [10].

Abrupt changes in environmental temperature (e.g., cold or heat shock) and chemical or physical assaults (e.g., exposure to irritants) were identified as significant stressors affecting the skin.

Many environmental factors can also affect the physiological changes, leading to differences with rest to the geographical locations as also studied in a study by Martini L, Solime R et al [16].

Pathological Skin Changes

The pathological changes were classified into infections and infestations, papulo-squamous disorders, vesiculobullous disorders, drug rash, and miscellaneous conditions. Among the infections and infestations, there were 23 patients (6.13%) with fungal infections, 17 (4.53%) with viral infections, 10 (2.67%) with bacterial infections, and 3 (0.8%) with parasitic infestations.

Among the fungal infections, dermatophytosis was the most common, accounting for 16 of 23 patients with fungal infections. Among viral infections, 14 patients were diagnosed with herpes zoster. Seven out of 10 patients had folliculitis/furuncles, and we had 3 patients with Hansen’s disease. We encountered three elderly patients with scabies. Among the papulosquamous disorders, there were 27 patients with eczema, 22 with psoriasis, 4 with lichen planus, and 3 with erythroderma. Five cases, each with bullous pemphigoid and pemphigus vulgaris and one case of dermatitis herpetiformis, were encountered during the study period. We came across two patients with drug rash, one to salbutamol and the other to anticonvulsants.

In the study done by Chopra et al., the prevalence of skin disorders were as follows: atopic dermatitis in 40 (18.6%), LSC in 29 (13.5%), post-herpetic neuralgia in 22 (10.3%), psoriasis 12 in (5.6%), fungal infections in 12 (5.6%), PMLE in 12 (5.6%), bacterial infection in 10 (4.7%), eczema in 6 (2.8%), delusional parasitophobia in 6 (2.8%), erythroderma in 5 (2.3%), senile pruritus in 5 (2.3%), bullous pemphigoid, varicose dermatitis in 4 (1.8%), pemphigus vulgaris in 4 (1.8%), vitiligo in 2 (0.95), herpes zoster in 2 (0.9%), actinic reticuloid in 1 (0.5%), xanthelasma in 1 (0.5%), and malignant melanoma in 1 (0.5%) [7].

In the study done by Patange et al., the infective dermatoses constituted 34.5% of the total. Fungal infections (17.5%) were the most common, followed by bacterial (8.5%) and viral (5%) infections [11].

In a study done by Yalcin et al., the five most frequently encountered diseases in elderly patients were eczematous dermatitis, fungal infections, pruritus, and bacterial and viral infections [12].

In the study by Sahoo et al., most of the dermatoses encountered were of an infectious nature (30%) [13].

In the study by Pavithra et al., fungal infections (20.7%), eczemas (19.2%), papulosquamous disorders (12.3%), leg ulcers (6.6%), pigmentory disorders (5.8%), infestation (4.9%), vesiculobullous disorders (4.4%), and malignant cases (0.7%) were reported [14].

In comparison with the above studies, the most common pathological manifestation was of eczematous dermatitis in our study. This was similar to the study by Yalcin et al. [12] and Pavithra et al. [14]. Among the infectious conditions fungal infections were common in our study, as were in all the above-mentioned studies. There were no patients with malignancies encountered during the study period.

Limitations

The study was done in a particular geographical area and the majority of the study participants were from the lower economic strata. The findings of the study need to be compared, keeping in mind these differences and further large-scale studies. Many geographical locations and all strata of the society need to be taken into account to generalize the results thus obtained.

Statement of Human and Animal Rights

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 2008 revision of the Declaration of Helsinki of 1975.

Statement of Informed Consent

Informed consent for participation in this study was obtained from all patients.

Comment

The present study offers a comprehensive overview of cutaneous manifestations in the elderly, distinguishing between physiological changes such as xerosis and wrinkling, and pathological dermatoses including eczema, fungal infections, and psoriasis. The results emphasize the importance of comprehensive dermatological assessment in elderly patients, as clinical presentations may be atypical or masked by coexisting age-related changes. The integration of dermatologic evaluation into routine geriatric care is essential for early diagnosis and effective management.