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If you are a nurse and would like to learn more about wound care and become wound certified, please contact us at

(866) 968-6380 to register for a live course or register for our online course at

Skilled Wound Care offers dermatology and skin integrity services to manage the most common chronic skin conditions in the elderly population. Dermatologic diseases can be a challenge to properly diagnose and treat on a chronic basis as the skin turgor and collagen elasticity deteriorates with age.


A common misdiagnosis in the nursing facility is "scabies." Geriatric Dermatology necessitates an understanding of the patient environment as a whole including: soaps, detergents, clothing type, ventilation, humidity, seasonal changes, and continence management. A misdiagnosis can be very costly to a nursing facility, especially without supporting documentation. SWC's unique dermatologic services address all of the facets of the patient's skin disease in addition to properly diagnose and treat the disease itself.

Patients in the Long Term Care Setting are at increased risk for skin breakdown and the development of dermatologic diseases such as:


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 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


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.


Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very superficial skin infection, cellulitis is an infection that also involves the skin's deeper layers: the dermis and subcutaneous tissue.


Scabies is a well-known infection that results in a particularly relentless and devastating itch that starts out slowly and increases in severity over time. The mites that cause the condition, scientifically known as Sarcoptes scabiei, burrow into the skin of infected humans. While they are so tiny that it's not possible to see them with the naked eye, they can be appreciated by examination with a magnifying glass or microscope.


Eczema is a term for a group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever.


Fungi usually make their homes in moist areas of the body where skin surfaces meet: between the toes, in the genital area, and under the breasts. Common fungal skin infections are caused by yeasts (such as Candida—see Candidiasis) or dermatophytes, such as Epidermophyton, Microsporum, and Trichophyton (see Overview of Dermatophytoses (Ringworm, Tinea)). Many such fungi live only in the topmost layer of the epidermis (stratum corneum) and do not penetrate deeper.


Dermatitis can have many causes and occurs in many forms. It usually involves an itchy rash on swollen, reddened skin.
Skin affected by dermatitis may blister, ooze, develop a crust or flake off. Examples of dermatitis include atopic dermatitis (eczema), dandruff and rashes caused by contact with any of a number of substances, such as poison ivy, soaps and jewelry with nickel in it.


Melanoma/Skin Cancer Overview
Skin cancers include melanoma, basal cell, and squamous cell. Basal and squamous cell are common and treatment is very effective. Malignant melanoma can be difficult to treat. Early diagnosis and treatment can increase the survival rate from melanoma.


1. Robert A Norman, Geriatric Dermatology. 2001

2. 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.

3. Mikel Gray. Incontinence Related Skin Damage: Essential Knowledge. Ostomy Wound Management 2007;53(12)28-32.

4. Farage MA, et al. Clinical Implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86.

5. Online Education Sites.

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