Skin Disease in the Elderly
8/15/2014 Skin Disease in the Elderly in the Summertime.
In my practice at Skilled Wound Care, I have noticed the number of calls for abnormal skin conditions in the elderly at nursing homes increases in the summer months. Many times I am called to come in and see whether or not the patient has scabies. Having examined skin conditions exclusively in elderly patients in the nursing facility population, I have come to understand that they are very prone to specific conditions that can often be confused as others.
NOT ALL RASHES ARE SCABIES. Scabies is “the itching disease”, and whenever a physician even dermatologist, see a patient from a nursing home who is itching, they immediately jump to call it Scabies. Although I have treated a large number of scabies cases and nursing home infestations, one must be careful to make this diagnosis. Scabies is a linear rash usually found in the skin folds of the groin and the palms of the patients, and it spreads from there. Non-linear rashes that are diffuse with no specific tracts are most likely not Scabies.
In the summer months in Southern California the air is more dry, and therefore patients develop dry skin. This dry skin must be treated with effective moisturizers. Repeat and heavy baths can also worsen the dry skin (xerosis). This dry skin then is open to a whole host of diseases, including bacterial infections, heat rashes, eczema, dermatitis, and yes even Scabies. So if you find a diffuse rash in the summer time what is it? Most likely if it is on the patient’s back it is most likely Miliaria, AKA as a heat rash. No matter what, you should be very careful with the soaps you use in the summer months, limit the bath/shower time, use a mild cleanser, do not make abrasive scrubbing strokes when washing, and moisturize the patients right after the bath.
In our practice we do prescribe topical steroids, and at times antifungals to treat these heat rashes. Although you should have a physician treat these patients there is a lot a family member and nurse can do:
· Avoid excess baths (should only bathe for 3-5 minutes 2-3 times per week)
· Keep water temperature lukewarm
· Add bath oil
· Do not use most soap products as they contain detergent (Dove is the exception)
· Do not use washcloths
· Pat dry
· Apply moisturizer immediately after bathing and reapply 4 times each day
· Stay well hydrated
· Avoid caffeine, spices and alcohol
For more information please visit http://www.skilledwoundcare.com/dermatology/