Aging represents a biological process characterized by a gradual decline in functionality, driven by a series of molecular alterations over time. Similar to other organs, human skin experiences chronological aging, making it susceptible to disorders due to structural and physiological changes. With advancing age, the skin's ability to perform essential functions such as DNA repair, wound healing, and immune response diminishes significantly. Changes such as the flattening of the dermoepidermal junction, reduced interdigitations, and a 20% decrease in melanocyte numbers contribute to a pale appearance of the skin and hair. Additionally, the dermis undergoes thinning, and the accumulation of lipofuscin, a brown pigment indicative of cellular damage, becomes evident [1-3].

As life expectancy continues to rise, the prevalence of diseases among the elderly population has also increased. The aging process of the skin often results in relatively minor dermatological issues, such as pruritus, xerosis, and eczema. However, certain conditions, including skin malignancies, can be life-threatening, leading to significant morbidity and adversely impacting the quality of life [4,5]. In India, the growing elderly population has emerged as a global concern, emphasizing the need for effective healthcare services tailored to this group. Despite limited research on geriatric skin conditions in India, numerous studies have been conducted in Western countries on this subject [6-8].

One of the primary challenges in assessing geriatric skin lies in distinguishing between normal and abnormal changes as well as physiological versus pathological alterations. Many skin changes and lesions observed in older individuals are deemed normal, though their extent and frequency vary [9,10]. This study aims to investigate the spectrum of both physiological and pathological skin changes among elderly patients in a tertiary care hospital in northern India.

This cross-sectional observational study was conducted on 578 participants aged 60 years and above, recruited from both inpatient wards and the outpatient department of Dermatology at a tertiary care hospital. Participants aged 60 and above were included if they had comorbidities lasting less than five years.Those with comorbidities lasting more than five yearsas well as those diagnosed with genodermatoses, photosensitivity, albinism, premature aging, or inherited DNA stability disorders, were excluded due to the potential interference of these conditions with age-related skin changes. 

A comprehensive dermatological and systemic examination was performed for all participants after obtaining their informed consent. Relevant routine laboratory investigations, including hematological and biochemical tests, were conducted alongside specialized diagnostic procedures such as skin biopsy, cytology, immunofluorescence, immunohistochemistry, and dermoscopy, whenever clinically indicated.

Table 1 presents the prevalence of various physiological changes in the elderly population. Wrinkling was the most commonly observed change, affecting 97.75% of the participants. Cherry angioma followed closely at 91.87%, and canitis was found in 89.45% of the elderly individuals. Idiopathic guttatehypomelanosis, which occurred in over half of the sample (51.73%), was also notable. Other common changes included seborrheic keratosis (39.97%), xerosis (34.08%), and fissured soles (29.93%).

Table 1: Prevalence of Physiological changes in elderly

Table 2 shows the prevalence of various dermatoses in elderly individuals, categorized by sex. Significant differences between males and females were observed for several conditions. Acanthosis nigricans was notably more prevalent in females (20.83%) compared to males (9.76%), with a statistically significant p-value of <0.01. Similarly, allergic contact dermatitis was more common in females (39.58%) than in males (18.05%) with a p-value of <0.01, suggesting a significant difference between the sexes. Bacterial infections were also significantly more prevalent in females (35.00%) compared to males (18.64%) with a p-value of 0.00. Dermatophytosis was more frequently observed in females (33.75%) than males (20.71%), with a p-value of 0.00, indicating statistical significance. Pruritus was another condition with a marked difference, affecting 77.92% of females versus 30.47% of males (p < 0.01). Other notable conditions included asteatotic dermatitis, which was more common in females (12.92%) than males (6.80%), with a p-value of 0.02, and irritant contact dermatitis, which showed a significant gender difference (p = 0.00).

Table 2: Prevalence of dermatoses in elderly

The physiological signs of aging, an inevitable biological process, were extensively evaluated in this study. Findings indicated that many of the observed skin changes were attributable to cumulative sun exposure over an individual’s lifetime, compounded by intrinsic aging processes. Although the majority of these alterations were benign, some, such as chronic actinic dermatitis and cutaneous malignancies, had a detrimental impact. A lower age threshold of 60 years was selected for inclusion, consistent with studies by Chopra et al. [9] and Nair et al. [11]. The age distribution of patients exhibiting significant dermatological manifestations in this study aligns with the observations of LeenaRaveendra et al. [10]. 

An investigation by Ankur Ghosh et al. involving 500 patients aged 60 years and older in Jharkhand revealed that dermatological issues are prevalent in the elderly population. Their study noted geriatric patients accounted for 4.2% of outpatient visits, with a male-to-female ratio of 2.2:1, contrasting with the 1.41:1 ratio in the current study [12]. The incidence of cherry angiomas in this study was significantly higher than the 37% reported by LeenaRaveendra [10]. Xerosis was identified in 48% of elderly individuals in the study by B. Rathore et al. [13], particularly affecting the legs, hands, and trunk. In this study, xerosis was observed in 37.08% of cases, closely matching the 50.8% reported by Chopra et al. [9].

The study had certain limitations. Referral bias may have influenced the findings, as the study population was drawn from a tertiary care center catering primarily to armed forces personnel. Furthermore, the study did not explore differences based on regional or ethnic diversity, as patients from across the country were referred to this premier dermatology facility.  An additional critical issue that was not addressed in this study is the growing problem of drug resistance in the elderly, driven by the widespread and indiscriminate use of antibiotics and polypharmacy. Factors contributing to this resistance are particularly prevalent among institutionalized patients. Dermatologists must remain cognizant of the resistance patterns within their geographic region. Tackling this issue requires a multi-level approach, including efforts to curb the over-the-counter availability of various medications.

Nail thinning was noted ingeriatric patients. Durai et al. [3] identified the most prevalent nail change as loss of luster, observed in 50.8% of participants. Pruritus emerged as the most frequent symptom in this study, affecting 50.17% of patients, which was lower than the 78.5% noted by Patange and Fernandez [14], where 3.8% of cases were attributed to senile pruritus, while the remainder were linked to dermatoses.

Exogenous eczema was the predominant type identified in this study. Statistically significant p-values were recorded for irritant contact dermatitis and hyperkeratotic hand eczema. Vesicobullous conditions occurred at a higher frequency in this study compared to the findings by B. Rathore et al. [13], while Durai et al. [3] reported a lower incidence of dermatitis herpetiformis and a higher incidence of bullous pemphigoid.

Connective tissue disorders were also seen in few patients. In contrast, Grover S. et al. [15] reported 3.5% cases in a similar population. Psoriasis was observed in 15.23% of participants in this study, lower than findings by Patange and Fernandez [9] and Sahoo Singh et al. [16]. Notably, malignant skin conditions were absent inLeenaRaveendra's study [10].

Pruritus was the most frequent symptom observed in diabetic patients in this study, with fungal infections in about 30% of cases. The heightened prevalence of fungal infections may result from poor hygiene, hot and humid climatic conditions, and factors such as peripheral neuropathy and diminished immune responses. Candidal infections were less prevalent. Thyroid disease was associated with pruritus in this study, as reported previously [16], likely due to autoimmune mechanisms or xerosis in hypothyroidism.In elderly patients, pruritus is commonly linked to xerosis, leading to skin fragility and pigmentation changes. Systemic diseases further reduce the itch threshold, often intensifying pruritus in institutionalized or inactive individuals [17]. This emphasizes the need for targeted management strategies to improve quality of life for elderly patients with dermatological conditions.

The expanding field of geriatric dermatology necessitates continuous updates to improve patient care. Comprehensive knowledge of the prevalence and gender-based distribution of dermatological conditions in elderly individuals within a tertiary care setting can inform healthcare providers about the health status and dermatological needs of this demographic.Such insights will support effective resource allocation, optimized material and workforce distribution, and informed clinical decision-making, ultimately enhancing patient satisfaction.

1. Yaar M, Gilchrest BA. Aging of skin. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ,editors. Fitzpatrick’s Dermatology in General Medicine, 8th ed. New York: McGraw‑Hill; 2012.p. 1213‑26.
2. Durai PC, Thappa DM, Kumari R, Malathi M. Aging in elderly: Chronological versus photoaging. Indian J Dermatol 2012;57:343‑52.
3. Cvitanović H, Knežević E, Kuljanac I, Jančić E. Skin disease in a geriatric patients group in outpatient dermatology clinic Karlovac, Croatia. CollAntropol 2010;34:247‑51.
4. Waller JM, Maibach HI. Age and skin structure and function, a quantitative approach (I): Blood flow, pH, thickness, and ultrasound echogenicity. Skin Res Technol 2005;11:221‑35.
5. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin. Am J ClinDermatol 2009;10:73‑86.
6. Indira B, Darsan S, Satyanarayana VV, Purushothaman S. Novel trends in cutaneous manifestations of geriatric dermatoses in a tertiary care hospital, South India: Latest trends in geriatric dermatosis. Journal of Pakistan Association of Dermatologists. 2022 Dec 8;32(4):701-6.
7. 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. Journal of family medicine and primary care. 2020 Mar 1;9(3):1453-8.
8. Niaz F, Shams N, Asim S, Maryum H, Ali A, Seetlani NK. Geriatric dermatosis; the concerns of aging skin. The Professional Medical Journal. 2020 Nov 10;27(11):2445-52.
9. Chopra A, Kullar J, Chopra D, Dhaliwal RS. Cutaneous physiological and pathological changes in elderly. Indian J DermatolVenereolLeprol 2000;66:274.
10. Raveendra L. A Clinical study of geriatric dermatoses. Our Dermatol Online 2014;5:235‑39..
11. Nair P, Bodiwala N, Arora T, Patel S, Vora R. A study of geriatric dermatosis at a rural hospital in Gujarat. J Indian AcadGeriatr 2013;9:15‑9.
12. Ghosh A, Jahan G, Choubey P, Chaudhary SS. Spectrum of geriatric dermatosesinJharkhand.IOSR JDMS 2017;16:59‑62.
13. Rathore BS, Arvind K, Sanyogita S, Tushyata A. Geriatric dermatoses˗ A clinical study. Int J Scientific Res 2017;6:176‑9.
14. Patange SV, Fernandez RJ. A study of geriatric dermatoses. Indian J DermatolVenereolLeprol 1995;61:206‑8.
15. Grover S, Narasimhalu CR. A clinical study of skin changes in geriatric population. Indian J DermatolVenereolLeprol 2009;75:305‑6.
16. Karnath BM, Bernard M. Pruritus: A sign of underlying disease. Hosp Physician 2005;41:25‑9.
17. Waller JM, Maibach HI. Age and skin structure and function, a quantitative approach (II): Protein, glycosaminoglycan, water, and lipid content and structure. Skin Res Technol 2006;12:145‑54.