William Lear, MD, FRCPC, FAAD, Dermatologist, Silver Falls Dermatology PC, Salem, OR, USA.
Jennifer Akeroyd, RN, PhD student, Oregon Health & Science University, Portland, OR, USA.

In this article, we discuss skin findings affecting older adults, with a focus on pruritus, flushing, dermatitis, and ulcers, and consider related internal diseases. Our goal is to make this information readily transferable to the clinical setting for the non-dermatologist.
Key words: dermatology, skin manifestations, older adults, pruritus, flushing, dermatitis, ulcers.

Siobhan Ryan, MD, FRCPC, Dermatology Daycare & Wound Healing Centre, Women’s College Campus, Sunnybrook & Women’s College Health Sciences Centre, Toronto, ON.

Itch in the older patient is a common complaint, and one that must be approached in a systematic manner to determine the etiology. Deciding if the itchy older patient fits into one of two categories–itchy with a rash, versus itchy without a rash–will often help to establish the cause of the pruritus. Endogenous causes as well as exogenous causes of pruritus must be considered. Management depends on the etiology; however, regardless of the cause, control of xerosis and general skin care practices will help alleviate some of the distress of pruritus, especially in the aging population.
Key words: pruritus, itch, aging, skin assessment, scratching.

The itchy older adult represents a complex and somewhat convoluted path to diagnosis, and management may not always be that satisfying to the patient. However, there are a number of steps that can be followed in order to determine the etiology of pruritus in the older patient. A systematic approach to managing pruritus may lead to good symptomatic control, depending on the cause.

Pruritus, like pain, is a subjective and multifaceted symptom that can be affected by emotional, physiologic, environmental, cognitive and social factors, as well as comorbid illness and medications.¹ These features must be kept in mind throughout the assessment of the pruritic patient.