Xerosis is characterized by itchy, dry, cracked, and fissured skin with scaling. Xerosis is most commonly found on the lower extremities of elderly patients, likely a result of vascular insufficiency. For patients, xerosis is very uncomfortable, causing itching, which eventually leads to cracks and breaks in the skin. These cracks and breaks can bleed and fissure, resultantly, they can become eczematous or they can become infected with bacteria (cellulitis) and fungus.
Miliaria Rubra is pictured above
Miliaria Crystalline is pictured above
Miliaria is the medical term for heat rash, it is characterized by three types: miliaria rubra, miliaria crystalline, and miliaria pustulosa. Miliaria occurs when your sweat glands cannot properly release sweat. These sweat glands are usually occluded by either substances, clothing, or the mattress. Most commonly in the elderly this rash is seen on the patient's back. This rash is commonly confused with Scabies. In the summer time this rash is most common with changes in temperature and humidity. Patients should have these affected areas fanned and open to air.
Diaper Rash also known as Incontinence Associated Dermatitis (IAD) is a form of Moisture Associated Skin Damage. IAD affects patients with urinary and/or fecal incontinence. The enzymes in the stool and ammonia in the urine are caustic to the skin after repetitive insult. This leads to inflammation and erythema in the skin with eventually denuding. The denuded skin allows for the development of fungal rashes in the skin, worsening the condition. Therefore treatment is multifold: 1. application of moisture barrier creams, 2. keep the area as dry and clean as possible, 3. use of antifungal ointments, creams, and powders.
- Robert A Norman, Geriatric Dermatology. 2001
- Paul C et al. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology. 2011;223(3):260-5. Epub 2011 Nov 22.
- Mikel Gray. Incontinence Related Skin Damage: Essential Knowledge. Ostomy Wound Management 2007;53(12)28-32.
- Farage MA, et al. Clinical Implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86.