Population ageing is emerging as a major public health concern worldwide, including in India. The proportion of elderly individuals has been steadily increasing, and by 2050, people aged 65 years and above are expected to constitute approximately 20.8% of the Indian population, reflecting a significant demographic transition.1,2 As a result, elderly patients represent an increasing proportion of dermatology outpatient visits, highlighting the need to understand the spectrum of skin disorders affecting this age group.3

Geriatric dermatoses constitute a substantial share of dermatological conditions encountered in clinical practice.4,5 Ageing is associated with progressive structural and functional changes in the skin resulting from both intrinsic and extrinsic factors. Intrinsic ageing is a genetically determined process characterized by thinning of the skin, dryness, fine wrinkling, and dermal atrophy, whereas extrinsic ageing is largely influenced by environmental factors such as ultraviolet (UV) radiation, smoking, air pollution, and nutritional deficiencies.6,7 Chronic exposure to UV radiation is considered the principal cause of photoageing and contributes significantly to cutaneous damage in the elderly.7

In addition to physiological ageing, older adults frequently experience multimorbidity and polypharmacy, both of which increase their susceptibility to dermatological disorders.8 Systemic diseases such as diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disorders, and other chronic illnesses can adversely affect skin integrity, impair wound healing, and predispose individuals to infections and various cutaneous manifestations.9,10 Furthermore, environmental exposures and lifestyle factors may aggravate existing skin conditions and contribute to the development of new dermatoses.11

The clinical presentation of skin diseases in the elderly is often influenced by multiple factors, including age-related skin changes, systemic comorbidities, nutritional status, personal habits, hygiene, climate, and socioeconomic conditions.4,5 Consequently, the diagnosis and management of geriatric dermatoses pose unique challenges for healthcare providers.

Given the growing elderly population and the limited data available from Central India, the present study was undertaken to evaluate the prevalence and pattern of geriatric dermatoses in patients attending a tertiary care hospital and to assess their association with systemic comorbidities.

A cross-sectional observational study was conducted in the Department of Dermatology, Venereology and Leprosy, People's College of Medical Sciences, Bhopal, over a period of 1.5 years. The study population comprised patients aged 60 years and above who attended the Dermatology Outpatient Department (OPD) of People's Hospital, associated with People's College of Medical Sciences and Research Centre (PCMS & RC).

The study was conducted after obtaining approval from the Institutional Ethics Committee of People's College of Medical Sciences and Research Centre (PCMS & RC). All participants were informed about the nature and purpose of the study, and written informed consent was obtained before enrolment. Written informed consent for publication of clinical photographs was also obtained from all participants. Confidentiality of all patient information and clinical data was maintained throughout the study.

Sample Size

The sample size was calculated using Yamane's formula:

n=N1+Ne2n = \frac{N}{1 + Ne^2}n=1+Ne2N​

Where:

• n = Sample size
• N = Population size
• e = Margin of error (5%)

Based on this formula, a total of 300 patients aged 60 years and above attending the Dermatology OPD at PCMS & RC were included in the study.

Inclusion Criteria

1. All new and follow-up cases diagnosed with various geriatric dermatoses.
2. Patients aged 60 years and above, with or without underlying systemic illnesses.

Exclusion Criteria

1. Patients below 60 years of age.
2. Patients who did not provide informed consent to participate in the study.
3. Patients with delirium, Alzheimer's disease, or other conditions that prevented them from providing a reliable clinical history.

Data Collection Procedure

Patients fulfilling the inclusion criteria and providing informed consent were enrolled in the study. Each participant underwent a detailed clinical evaluation in the Dermatology OPD of PCMS & RC.

The following information was recorded for each participant:

• Demographic variables: Age, gender, and socioeconomic status (assessed using the BG Prasad Scale).
• Clinical variables: Type of dermatological disease, extent of disease involvement, duration of illness, and associated systemic comorbidities.

Dermatoses were classified according to commonly accepted clinical and dermatological classification systems. Data from both outpatient and inpatient departments were included.

A detailed clinical history, thorough dermatological examination, and photographic documentation of skin lesions were performed for every participant. All findings were recorded in a pre-designed proforma. The collected data were compiled, organized, and prepared for statistical analysis.

Statistical Analysis

Data were analyzed using the trial version of the Statistical Package for the Social Sciences (SPSS) software. Appropriate descriptive and inferential statistical methods were applied for data analysis and interpretation of the results.

Among the 300 elderly patients included in the study, the majority belonged to the 60–69 years age group (57.7%), followed by those aged 70–79 years (36.3%) and ≥80 years (6.0%). Males constituted 60.7% of the study population. Housewives (32.0%) and retired individuals (18.0%) represented the largest occupational groups, while 53.3% of participants were married. Itching was the predominant presenting complaint (72.3%), followed by pain (16.0%), whereas only 9.0% of patients were asymptomatic (table 1).

Table 1: Demographic and Clinical Characteristics of the Study Population (n=300)

Plaques were the most common morphological lesion observed (46.7%), followed by scales (8.7%), excoriations (7.3%), papules (6.7%), and vesicles (6.3%). Other lesion types occurred less frequently. Among physiological skin changes, wrinkling (23.7%) and xerosis (20.7%) were the most frequent age-related findings, followed by senile lentigines (15.3%), cherry angioma (12.0%), idiopathic guttate hypomelanosis (12.0%), and acrochordons (7.3%). No physiological skin changes were observed in 26.7% of participants (table 2).

Table 2: Clinical Morphology and Physiological Skin Changes

Fungal infections were the most common dermatological disorder, accounting for 22.7% of all diagnoses, followed by eczematous disorders (12.7%), generalized pruritus (11.3%), and papulosquamous disorders (9.0%). Viral infections (6.7%), infestations (5.0%), tumors and malignancies (4.0%), bacterial infections (3.3%), urticaria (3.0%), and psychocutaneous disorders (3.0%) were less frequent, while other conditions each accounted for less than 2% of cases. Miscellaneous conditions were seen in 22 patients (7.3%). Post-herpetic neuralgia was the most common (6 patients, 2%), followed by amyloidosis, callosity, senile comedones, and sebaceous cysts (2 patients each, 0.7%). Other conditions such as lichen sclerosus, keloid, zoon’s balanitis, reactive perforating collagenosis, twenty nail dystrophy, and xanthelasma were each seen in 1 patient (0.3%). This reflects a wide variety of less common dermatological conditions (table 3).

Table 3: Spectrum and Frequency of Dermatological Disorders

Among fungal infections, Tinea cruris et corporis was the most common subtype, followed by Tinea corporis and candidal intertrigo. Asteatotic eczema was the predominant eczematous disorder, while generalized pruritus was most frequently associated with xerosis. Herpes zoster was the leading viral infection, and psoriasis vulgaris represented the most common papulosquamous disorder. These findings demonstrate the predominance of chronic inflammatory dermatoses and superficial fungal infections among elderly patients (table 4).

Table 4: Clinical Pattern of Major Dermatological Disorders

Fungal infections remained the most common diagnosis across all age groups, with the highest proportion observed in patients aged 70–79 years. Eczematous disorders were relatively more frequent among patients aged ≥80 years, whereas generalized pruritus showed a comparable distribution across age groups.

The association between age group and dermatological diagnosis was not statistically significant (χ² = 36.18, p = 0.553) as shown in table 5.

Table 5: Association Between Age Group and Dermatological Disorders

Fungal infections were the most common diagnosis in both males and females. Eczematous disorders and generalized pruritus were also frequently encountered in both sexes. Tumors/malignancies, vascular disorders, and infestations were relatively more common among males, whereas papulosquamous and psychocutaneous disorders showed slightly higher frequencies among females. However, no statistically significant association was observed between gender and the distribution of dermatological disorders (χ² = 18.09, p = 0.516) as shown in table 6.

Table 6: Association Between Gender and Dermatological Disorders

Hypertension (23.3%) and type 2 diabetes mellitus (21.7%) were the most common systemic comorbidities among study participants, although 40.7% had no associated systemic illness. Diabetes mellitus was most frequently associated with fungal infections and generalized pruritus, while hypertension showed a strong association with eczematous and vascular disorders. Psychocutaneous disorders were commonly associated with underlying psychiatric illness, whereas most patients with viral infections and tumors had no associated systemic comorbidity (table 7).

Table 7: Systemic Comorbidities and Their Association with Dermatological Disorders

T2DM: Type 2 Diabetes Mellitus, HTN: Hypertension, CAD: Coronary Artery Disease, BPH: Benign Prostatic Hyperplasia, CKD: Chronic Kidney Disease, CVA: Cerebrovascular Accident, PTB: Pulmonary Tuberculosis

A positive family history was most frequently reported in patients with psoriasis (20%), followed by eczema (15%), chronic urticaria (12%), and lichen planus (10%). Smoking, tobacco chewing, and alcohol consumption were reported by 18%, 10%, and 12% of participants, respectively. Most patients reported adequate sleep (58%) and were independently mobile (88%), while only 2% were bedridden. The majority maintained an adequate diet, although reduced appetite was noted in a small proportion of elderly individuals (table 8).

Table 8: Other Clinical Characteristics

The present study was carried to evaluate the prevalence of dermatological disorders in the geriatric population and correlate them with the underlying systemic disorders. The findings demonstrated that dermatological disorders are highly prevalent among the geriatric population, with infections (particularly fungal infections), eczematous disorders, and generalized pruritus being the most common conditions. A significant association was observed between skin diseases and underlying systemic disorders, especially hypertension and type 2 diabetes mellitus.

In the present study, the majority of patients (57.7%) belonged to the 60–69 years age group, followed by 36.3% in the 70–79 years group and only 6% above 80 years. This indicates that dermatological consultations are more frequent among the younger elderly population.

This trend may be attributed to better mobility, health-seeking behavior, and comparatively preserved functional status in the early geriatric age group, whereas reduced accessibility to healthcare and increased dependency may limit hospital visits in the very elderly. These findings are consistent with studies by Kshetrimayum S et al12, where 66% of patients were in the 60–69 age group, and Goyal A et al13, who reported 55.6% in the same age group.

Similarly, Kumar SS et al14 observed that 72% of their study population belonged to 60–69 years age group. However, Sadhwani VN et al9 reported relatively higher disease prevalence in the 80–89 age group for certain conditions like eczema, suggesting that while patient attendance may decline, disease severity or specific conditions may increase with advancing age.

The present study showed a male predominance (60.7%) compared to females (39.3%). This may reflect sociocultural factors, greater outdoor exposure among males, and increased healthcare utilization by men. Similar male preponderance was observed in studies by Kumar SS et al14 (70.67% males) and Goyal A et al13 (68.2% males). Aithal V et al15 also reported higher male representation.

 In contrast, Simin MK et al16 reported female predominance (female:male = 1.4:1), possibly due to regional and demographic variations. Despite gender differences in representation, the present study found no statistically significant association between gender and disease distribution (p = 0.516), which is in agreement with Sadhwani VN et al9.

In the present study, housewives constituted the largest group (32%), followed by retired individuals and those engaged in agriculture. This reflects the demographic pattern of the elderly population in semi-urban and rural India. Widowed individuals formed a substantial proportion (46.7%), highlighting psychosocial vulnerability in this age group. Psychocutaneous disorders observed in the study may be partly explained by social isolation and emotional stress. These findings correlated with the study conducted by Talukdar K et al17, who emphasized the psychosocial dimensions of geriatric dermatoses.

In the present study, generalized involvement was the most common presentation, followed by truncal areas like back and legs. This indicates that many dermatoses in elderly patients are widespread rather than localized. Pruritus was the most common symptom (72.33%), which is consistent with studies carried out by Chowdhury J et al18 (74%), Kumar SS et al14 (88%) and Simin MK et al16 that reported pruritus among 68% patients. Pruritus in elderly is multifactorial, often related to xerosis, systemic diseases, and neuropathic mechanisms.19 Pain and burning sensation were less common, indicating that itching remains the primary driver for healthcare consultation.

The predominance of plaques (46.66%) and scaly lesions reflects a high burden of chronic inflammatory dermatoses such as eczema and psoriasis. Pigmentary changes and excoriations further highlight chronicity and repeated scratching. This aligns with Kandwal M et al20, who reported erythemato-squamous disorders as the most common dermatoses (40%). The polymorphic presentation observed in this study emphasizes the need for careful clinical evaluation in elderly patients.

Fungal infections were the most common (22.67%), especially dermatophytosis. This is consistent with Aithal V et al15. Similarly, Simin MK et al16 reported fungal infections in 30.5%. The high prevalence may be due to immunosenescence, diabetes, and environmental factors such as humidity.21

Eczema (12.7%) was the second most common condition, with asteatotic eczema being predominant. This correlates with Thapa DP et al22 that reported 35.8% and Chowdhury J et al18 reported 39% eczema cases. However, Sadhwani VN et al9 reported eczema as the most common condition, contrasting with the present study where infections predominated.

The present study observed generalised pruritus observed in 11.3% cases, often associated with xerosis and systemic diseases like diabetes and CKD. Similar associations were reported by Simin MK et al16 that noted associated between xerosis and generalized pruritus.

In the present study, papulosquamous disorders accounted for 9% of cases with psoriasis and lichen planus being the predominant conditions observed. This finding is comparable to the study conducted by Kshetrimayum S et al12, who reported a prevalence of 10.4% for papulosquamous disorders among the geriatric population, indicating a similar burden of these chronic inflammatory dermatoses across different study settings.

Further, in the present study, scabies (5%) and herpes zoster (4.7%) highlight reduced immunity in elderly. Herpes zoster predominance is consistent with age-related decline in cell-mediated immunity. Low prevalence of immunobullous disorders, pigmentary disorders, and malignancies is consistent with most Indian studies, although Sharma S et al23 reported higher benign tumors.

Furthermore, no statistically significant association was found between age or gender and type of dermatoses. This suggests that dermatological conditions in elderly are multifactorial and not strongly influenced by demographic variables alone. This finding is supported by Sadhwani VN et al9.

A significant proportion of patients in the present study had associated comorbidities, with hypertension (23.33%) and type 2 diabetes mellitus (21.66%) being the most prevalent. These findings are comparable to those reported by Simin MK et al16, who observed hypertension in 36% and diabetes mellitus in 26% of elderly patients, as well as by Rajpoot et al24 who documented hypertension in 31.4% of cases, thereby reinforcing the strong association between dermatological disorders and metabolic comorbidities in the geriatric population.

The association of fungal infections with diabetes and eczema with hypertension observed in this study reflects underlying pathophysiological links such as impaired immunity, vascular changes, and skin barrier dysfunction. Sadhwani VN et al9 also emphasized the strong association between systemic diseases and dermatological conditions.

Wrinkling, xerosis, senile lentigines, and cherry angiomas were common findings, reflecting intrinsic aging and cumulative environmental exposure. Similar observations were reported by Agarwal R et al25, Kumar SS et al14, xerosis was strongly associated with pruritus, reinforcing its clinical importance.

The present study demonstrates an association between dermatological conditions and underlying systemic illnesses. Diabetes mellitus was commonly associated with fungal infections and generalized pruritus, while hypertension showed a correlation with eczematous disorders and vascular conditions. Chronic kidney disease was predominantly associated with pruritus. These observations are consistent with Talukdar K et al17, underscoring the importance of a holistic approach in the evaluation and management of geriatric patients.

Limitations: Being a single-center, hospital-based study conducted at a tertiary care institution, the results may not be fully generalizable to the wider community or rural population, as patients attending tertiary centers often represent more severe or complicated cases.

Furthermore, factors such as environmental exposure, nutritional status, and long-term medication use were not analyzed in detail, which could have provided deeper insights into disease patterns.

Recommendations: Based on the study findings, routine dermatological screening and early management of common geriatric skin disorders such as fungal infections, eczema, and pruritus should be encouraged. A multidisciplinary approach is essential for addressing associated systemic comorbidities, particularly hypertension and diabetes mellitus. Future multicentric, community-based studies with larger sample sizes, longitudinal follow-up, and diagnostic confirmation through laboratory and histopathological methods are recommended to enhance understanding of geriatric dermatoses and guide targeted preventive and therapeutic interventions.

This study demonstrates that dermatological disorders are common among the elderly, with the highest prevalence observed in individuals aged 60–69 years and a male predominance.

Fungal infections, eczematous disorders, and generalized pruritus constituted the most frequent dermatoses, while pruritus was the predominant presenting symptom. Physiological changes such as wrinkling, xerosis, and pigmentary alterations were also commonly observed.

Hypertension and type 2 diabetes mellitus were the most prevalent systemic comorbidities, with generalized pruritus showing notable associations with diabetes and chronic kidney disease. Although variations in disease patterns were observed across age groups and genders, these were not statistically significant.

These findings emphasize the need for comprehensive geriatric dermatological assessment, regular screening for systemic diseases, and integrated multidisciplinary management to facilitate early diagnosis, appropriate treatment, and improved quality of life in the elderly.

1. Yıldız H. Prevalence of Geriatric Dermatoses Among Elderly Patients Treated at the Dermatology Outpatient Clinic in Eskisehir, Turkey. Southern Clinics of Istanbul Eurasia. 2019 Mar 1;30(1).
2. Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. International journal of dermatology. 2015 Sep;54(9):e332-8.
3. Rajan SI, Sarma PS, Mishra US. Demography of Indian aging. J Aging Soc Policy. 2001;15(2-3):11-30.
4. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: Cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10:73-86.
5. Jafferany M, Huynh TV, Silverman MA, Zaidi Z. Geriatric dermatoses: A clinical review of skin diseases in an aging population. Int J Dermatol. 2012;51:509-22.
6. Krutmann J, Bouloc A, Sore G, Bernard BA, Passeron T. The skin aging exposome. J Dermatol Sci. 2017;85(3):152–161.
7. Mora Huertas AC, Schmelzer CE, Hoehenwarter W, Heyroth F, Heinz A. Molecular-level insights into aging processes of skin elastin. Biochimie 2016;128–129:163–173.
8. Linos E, Chren MM, Covinsky K. Geriatric Dermatology-A Framework for Caring for Older Patients With Skin Disease. JAMA Dermatol. 2018 Jul 1;154(7):757-758.
9. Sadhwani VN, Vithalani NJ, Dani AP, Hasani RJ. Clinical Pattern of Dermatological Diseases in Geriatric Patients: A Cross-Sectional Study From Central India. Cureus. 2025 Feb 3;17(2):e78468.
10. Yosipovitch G, Nedorost ST, Silverberg JI, Friedman AJ, Canosa JM, Cha A. Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management. Am J Clin Dermatol. 2023 Mar;24(2):275-286.
11. Brar G, Dhaliwal A, Brar AS, Sreedevi M, Ahmadi Y, Irfan M, et al. A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin. Cureus. 2025 Mar 24;17(3):e81109.
12. Kshetrimayum S, Thokchom NS, Vanlalhriatpuii HN. Pattern of geriatric dermatoses at a tertiary care center in North-East India. Int J Res Dermatol. 2017 Oct;3(4):527-34.
13. Goyal A, Balai M, Mittal A, Khare AK, Gupta LK. Pattern of geriatric dermatoses at a tertiary care teaching hospital of South Rajasthan, India. Our Dermatology Online. 2017 Jul 1;8(3):237.
14. Kumar SS, Jain O, Jain P. Study of geriatric dermatoses in a tertiary care hospital in North India – an observational study. J Evid Based Med Healthc 2021;8(17):1181-1186.
15. Aithal V, Chacko A, Prathibha JP. Dermatological Manifestations in the Elderly: A Descriptive Cross-Sectional Study. Clinical Dermatology Review. 2023 Jan 1;7(1):67-75.
16. Simin MK, Sasidharanpillai S, Rajan U, Riyaz N. Dermatoses among patients aged 60 years and above attending a tertiary referral center: A cross-sectional study from North Kerala. J Skin Sex Transm Dis 2021;3:166-72.
17. Talukdar K, Mitra D. A cross sectional observational study to evaluate various cutaneous manifestations in geriatric age group. Int J Med Res Rev 2016;4(2):186-92.
18. Chowdhury J, Das S, Roy AK. Skin diseases in elderly population from Eastern India-An observational study. Journal of Pakistan Association of Dermatologists. 2016;26(4):318-21.
19. Kurmuş GI, Menteşoğlu D, Çöteli S, Kartal SP. Chronic Pruritus Severity and Its Association with Clinical Frailty in Geriatric Dermatology Patients: A Cross-Sectional Study. J Clin Med. 2025 Dec 12;14(24):8809.
20. Kandwal M, Jindal R, Chauhan P, Roy S. Skin diseases in geriatrics and their effect on the quality of life: A hospital-based observational study. J Family Med Prim Care. 2020 Mar 26;9(3):1453-1458.
21. Soraci L, Beccacece A, Princiotto M, Villalta Savedra E, Gambuzza ME, Aguennouz M, et al. The emerging links between immunosenescence in innate immune system and neurocryptococcosis. Front Immunol. 2024 Aug 20;15:1410090.
22. Thapa DP, Jha AK, Kharel C, Shrestha S. Dermatological problems in geriatric patients: a hospital based study. Nepal Medical College Journal: NMCJ. 2012 Sep 1;14(3):193-5.
23. Sharma S, Chaudhary B, Panesar S, Singh A. Study of geriatric dermatoses from a tertiary care teaching hospital of northern India. IP Indian J Clin Exp Dermatol. 2019;5(3):191-194.
24. Rajpoot PS, Poojary S, Pathave H. A Cross-sectional Observational Study of Noninfectious Dermatoses in Geriatric Population. Clinical Dermatology Review 2024;8(3):204-209.
25. Agarwal R, Sharma L, Chopra A, Mitra D, Saraswat N. A Cross-Sectional Observational Study of Geriatric Dermatoses in a Tertiary Care Hospital of Northern India. Indian Dermatol Online J. 2019 Aug 28;10(5):524-529.