Skin Disease More Severe, Bothersome in Adults and Elderly

Internal Medicine World ReportMarch 2007
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From the American Academy of Dermatology New Questionnaire Assesses Patient Discomfort Level

The National Eczema Association has developed a new questionnaire called LIFE (Life Improvements For Eczema) that is designed to help physicians diagnose the stage of a skin disease and determine the impact on the quality of life of the patient, especially in adults.

"Adult and elderly patients with even a small percentage of body surface involvement are very bothered by their skin disease," said William Abramovits, MD, of Baylor University Medical School, Dallas, Tex.

The questionnaire can take a patient 1 minute to complete and helps the physician assess the frequency and severity of eczema outbreaks; a high score suggests problems that may involve sleep disturbance, work disability, and intractable pruritus (Table).

"Eczema refers to the lesions, not the skin disease," Dr Abramovits said. The atopic dermatitis of childhood presents differently in adults. "People with eczema beyond the age of 12 have more severe skin disease than that seen in children."

Skin conditions common in adults and the elderly include:

? Discoid eczema, manifested as circular patches with thicker, plaquelike surfaces that are widely scattered over the entire body

? Nummular eczema, characterized by extremely pruritic coin-shaped lesions on the arms, legs, abdomen, and/or back; it is more common in the elderly, and the discomfort of the back lesions is especially troublesome, because often the patient cannot reach them.

"Pruritus is the most taxing of all the symptoms to patient quality of life, and patients often complain of waking throughout the night, and their level of exhaustion is high," Dr Abramovits said.

Elderly patients are also more likely to have dry skin, especially during the winter months, which can compound their discomfort.

You can suggest to patients some of these therapies once you narrow down the specific complaints:

? Take oatmeal baths before going to bed

? Take a sedating antihistamine at nighttime

? Keep topical anesthetic cream near the bed for immediate pruritus relief

? Sleep medication may also be useful.

However, "for elderly patients, caution must be exercised when considering the use of sedating antihistamines due to the increased risk of falls and possible fractures," Dr Abramovits emphasized. Thus, nonsedating medications should be tried first.

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