Skin Care Today

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16 SKIN CARE TODAY 2017,Vol 3, No 1
FOCUS ON OLDER SKIN ›
› Skin colour: people with fair
skin are more susceptible to
photoageing than those with
pigmented skin who have more
epidermal melanin and a thicker
dermis (Vashi et al, 2016)
› Religion and culture: religion
may require some people to wear
clothing that covers the skin
resulting in reduced sun exposure
› History of long-term or intense
sun exposure
› Occupation: those who work
outside will be more exposed
to the sun
› Geographical location, i.e. living
in certain climates increases the
risk of sun exposure.
Repeated exposure to UVL breaks
down existing collagen and impairs
the synthesis of new collagen.
The sun also attacks elastin (elastic
protein found in connective
tissue), leaving the skin loose,
wrinkled and‘leathery’. Other
features of photoaged skin include
(Gawkrodger, 2002):
› Coarseness
› Pale yellow colour
› Telangiectatic (broken capillaries)
› Irregularly pigmented
› Prone to purpura
› Subject to benign and
malignant neoplasms.
SKIN CONDITIONS AFFECTING
ELDERLY PEOPLE
There are a variety of skin conditions
and underlying medical conditions
that affect older people, including
(see Table 1):
› Eczematous conditions
› Infections such as impetigo and
herpes zoster
› Infestations such as scabies
› Lesions such as those arising from
skin cancer.
Dryness and pruritus (itch) are
often the major presenting symptoms,
while itching in the absence of any
obvious skin disease is very common.
Persistent severe itching, like pain, can
take over a person’s day-to-day life,
leading to sleepless nights, exhaustion
and affecting daily activities and
relationships (Fitzpatrick et al, 2001).
Pruritus should trigger a search for
underlying causes, including metabolic
irregularities such as iron deficiency
anaemia, and systemic malignancies
such as lymphoma and leukaemia,
which may only become obvious after
the onset of itching (Kirkup, 2014).
Other causes of pruritus include
endocrine conditions, haematological
disease, liver disease, drugs and
psychological causes such as
depression, obsessive-compulsive
disorder and anxiety.
Assessment of itch
A comprehensive history should
be undertaken, including skin
assessment to look for any
rashes/lesions, a general physical
examination and questions relating
to weight loss, fatigue, fever,
malaise, recent emotional stress and
medication history. If the itching is
persistent and no cause is found,
blood tests and chest x-rays may be
required (Fitzpatrick et al, 2001).
ASSESSMENT
A comprehensive history (Table 2) and
skin assessment (Table 3) should be
undertaken to identify possible causes
for itching, dryness, rash or lesions
where older people present with a skin
condition. Other age-related factors to
consider include (Burns et al, 2010):
› Social circumstances such as poor
housing, bathroom facilities and
Table 2: Dermatological history (Lawton, 2015)
Assessment should include basic demographics including age, race, sex, occupation, hobbies and a
detailed history of the following:
› Constitutional symptoms associated with acute and chronic illnesses such as headaches, fever,
weakness, fatigue, malaise, loss of appetite, weight loss
› Past medical history: operations, illnesses, allergies, medications (past and present), atopic history
(eczema, asthma, hay fever)
› Family history of skin disease, atopic conditions, autoimmune conditions
› Social history: smoking, alcohol and drug abuse, sexual behaviour and travel
› The lesion or rash: when it appeared (onset) and where. Has it spread or changed in appearance? Does
it fluctuate, or has it been persistent? Is the rash itchy, sore, or painful?
› Triggers: heat, cold, sun, exercise, travel history, medications, pregnancy, time of year
› Treatments: current and previous treatments used, both prescribed and those purchased over the
counter, internet and borrowed from friends and relatives. Have they helped?
› Other interventions tried: sunbeds, homeopathy, dietary interventions, herbal remedies
Table 3: Skin assessment (Lawton, 2015)
Any skin examination should be performed in a warm well-lit room with natural light. The nurse
should provide clear explanations to the patient as to why all areas of the skin are being exposed.
It is considered best practice to examine the whole skin and a comprehensive history will signpost
and provide clues for the examination.
› Examine the skin systematically, working from the top down, including the hair, nails,
skin creases and folds
› Note any unusual odours or smells, which could indicate infection, continence issues or poor care
› Skin lesions should be palpated; this will provide clinical information about skin texture
and temperature
› Lesions should be measured accurately and documented on a body plan. This description should include
the distribution, type, size, shape and colour of the lesions. The surface characteristics and texture
(superficial or deep) should also be recorded
› Lesions are classified as primary lesions, which present at the initial onset of the disease, and secondary
lesions, which are the result of changes over time caused by disease progression, manipulation
(scratching, rubbing, picking) or from treatments applied to the skin (further information:
)
› Other factors to consider when performing a skin assessment are the range of skin colours and hair
types — lesions which in white skin appear red or brown, can appear black or purple in pigmented skin,
with mild redness (erythema)
› Skin inflammation commonly leads to post inflammatory pigmentary changes: lighter (post-
inflammatory hypopigmentation) and darker (post-inflammatory hyperpigmentation) can persist for a
long time after the initial inflammation and is often of great concern to patients who think their skin is
permanently scarred