DERMATOLOGIC PROBLEM

IN GERIATRIC

Khairuddin Djawad
Bag SMF. Kulit Dan Kelamin FK UNHAS
 Aging continous process +

variable spectrum manifestation

Decreased maximal function & reserve

capacity of organ (skin)

Intrinsic aging and extrinsic aging
 Oxidative damage
Cell senescence
Amino acid racemization
Nonenzymatic glycosilation of protein

Flattening dermoepidermal
Intrinsic aging junction
throughout the
cellularity
skin
dermal thickness
Loss of vascular & lymphatic
bad
Primary function losses
Function of human skin that
decline with age
Barrier function
Cell replacement
epidermal turn over rate 30-50 %
epid >thin 10-50% (30-80 th)
derm >
DNA repair
Chemical clearance
Epidermal hydration
Immune responsiveness
 Mechanical protection
Sebum production
Size & number gland not change

Sensory protection
Sweat production eccrine gland &
produce

Thermoregulation
Vitamin D production 7-
dehydrocolesterol
Wound healing
Clinical sign intrinsic aging
Xerosis dry , roughness
Wrinkling
Laxity
Benign neoplasma
Inelastic skin and more
slowly recovery after injury
 External factor
Intrinsic Aging + Ultraviolet
Humidity
Temperature/ heat
PHOTO AGING:
Polution
(extrinsic aging, premature
aging) smoking

Dermatologic problem:
Skin cancer Ulcers
Xerosis Varicella zoster
Pruritus Bullous pemphigoid
Drug eruption
 Triggered :
receptor signaling,
mitochondrial damage, Variable epidermal
protein oxidation thickeness
Dermal elastosis
PHOTO AGING: /fragmented
collagen
superposition of chronic UV
intrinsic aging matrix degrading
metalloproteinase
Inflamatory infiltrat
Dermatologic problem:
Vessel ectasia
Skin cancer Ulcers
Xerosis Varicella zoster
Pruritus Bullous pemphigoid
Drug eruption
 Prematur aging

Chronologic age
Normal skin

Premature
aging
 Clinical sign of skin aging :
Xerosis cutis / roughness
Wrinkling
Inelastic skin with thickened
leathery appearance
Dyspigmentation
Skin disease in elderly

Related to ultraviolet radiation

Photoaging / dermatoheliosis
Lentigo solaris /Lentigo senilis /
liver spot
Cutis rhomboidalis nuchae
Solar purpura
venouslake
Favre-racoucot disease / Nodular
elastosis
Photoaged skin is characterized by fine and coarse wrinkling,
irregular mottled pigmentation, lentigines, roughness, and
sallowness
Coarse wrinkling, gravitational changes (nasolabial fold),
sallowness, irregular hyperpigmentation
A woman in early middle age with prominent
telangiectasia, and fine wrinkling
Hyperpigmented macules consisting of sun-induced
lentigines and freckles.
Coarse wrinkling, mottled hyperpigmentation, lentigines,
and a cherry angioma of the lower eyelid.
 Benign Proliferation
Acrochordon (skin tag)
Cherry angioma (senil
hemangioma )
seborhoic Keratosis
Xerosis cutis
 Others skin disease on geriatric:
Senile pruritus
most common > 80 /associated dry
rough scally skin
worse : night, change temp / after
hot bath ,
aggravated: winter + humidity +
temp despite the lack physical sign
Exclud contcat dermatitis mimic
xerosis & systemic pruritus
Ekzematous dermatitis
Static dermatitis / gravitational eksema
associated chronic venous
hypertention
trigger factor: obesity, trauma,
multiple pregnancies, venous
thrombosis
GE + acute udem deep venous
trombosis
eflor: erythem, scaling, pigmentation,

fibrosis
Asteatotic eczema
transient dermatitis associated:
humidity , frequent bathing, not use
emolient.
Always precedes with xerosis
Cracked river bed app with poorly
defined border on ekstensor limb and
trunk
respon to emolient therapy (w/o
emulsion)
Numular dermatitis
Coin like patches : 1-3 cm
most on extremities: leg, arm
& hand
sometimes delayed
manifestation atopic derm
Xerosis is the background for
develop
Lichen simplex chronicus
circumscribed, intense pruritic
plaque from habitual
scratching and rubbing,
lichenification is a hall mark
Predisposing factor: atopy,
xerotic
Infection
Herpes zoster
decrease cell immunity & impaired wound
heal: slower resolution of the acut eruption
neuralgia post herpetik
Dermathophyte infection
Candidiasis
Cellulitis
Infestation
Scabies lesion atypical, less inflamation &
pruritus