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GENERAL PRINCIPLES

The incidence of dermatologic conditions is increasing in parallel to the aging population. Each year, there are >27 million visits to dermatologists and >5 million new skin cancers diagnosed, most in older adults. While there are many skin conditions that are common in both younger and older adults, there are certain important principles that make geriatric dermatology different from general dermatology. Taken together these principles can guide clinicians in making appropriate treatment decisions for skin diseases that are more likely to help older patients and improve their quality of life. With limited literature, these principles should be the backbone of decision making.

Aging skin is subject to both intrinsic aging processes and many years of environmental insults. With regard to intrinsic changes, as one ages, the skin’s barrier function declines, making it much more difficult to maintain moisture. Thus, dry skin in older adults is common. This has multiple consequences, the most common being pruritus. In addition to skin barrier changes, there are also intrinsic changes to the immune system that are believed to play an important role in aging skin.

While intrinsic changes contribute to aging skin pathology, external elements also play crucial role. Dry skin is also more susceptible to environmental insults, which can cause eczematous dermatitis because of an irritant or an allergen. After many years of being subject to oxidative damage from environmental pollution and radiation, skin cells have accumulated many mutations. Thus, skin cancers, are more prevalent in the older population.

The complex interplay between the intrinsic and extrinsic aging holds the key to clinical pathology of aging skin. Increases in certain infections such as herpes zoster and onychomycosis, inflammatory dermatoses, and neoplasms are examples of this complex interplay.

SEBORRHEIC KERATOSIS

ESSENTIALS OF DIAGNOSIS

  • Seborrheic keratosis is the most common benign epithelial tumor in adulthood.

  • The trunk is affected more than the extremities, head, and neck.

  • Primary lesions are 5- to 20-mm light brown to dark brown–black papules and plaques with a rough, warty surface (Figure 56–1).

  • Differential diagnosis includes solar lentigo, melanocytic nevus, verruca vulgaris, and lentigo maligna melanoma.

Figure 56–1.

Seborrheic keratoses. Waxy, stuck-on papules and plaques, with varying shades of brown and a verrucous surface. (Used with permission from Neill Peters, MD.)

Complications

Friction, pressure, and trauma to these lesions may cause irritation or inflammation.

Treatment

Irritated or inflamed lesions can be treated with cryotherapy (Box 56–1), curettage, or shave removal. Lesions in cosmetically sensitive areas are best treated with light electrodessication to minimize scarring and dyspigmentation.

Box 56–1. Cryotherapy

Indications to use liquid nitrogen

  • Actinic keratosis

  • Seborrheic keratosis (irritated)

  • Warts

  1. Dipstick technique

    1. Roll extra cotton over ...

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