Itchy skin is an unpleasant sensation associated with the need to scratch. It can occur on diseased skin or non-diseased skin. Itchy skin can be due to skin problems, a systemic disease, neurological and other diseases. It is the most common grievance among elderly patients during a dermatological consultation. Itchy skin in elderly people can be defined as chronic pruritus in a person over 65 years old.
Skin, like many other organs, undergoes deterioration with the passage of time. Nearly every aspect of skin biology is affected by ageing phase. The epidermis’s self-renewing capability, which provides vital barrier function is diminished with age. The collagenous extracellular matrix at dermal level, the bulk of skin that confers strength and resiliency, undergoes gradual fragmentation, which deleteriously impacts skin mechanical properties and dermal cell functions. Age-related alterations of skin consequently lead to age-related skin fragility and diseases.
Old age and itchy skin
Ageing affects three important components that induce itchy skin. This includes the barrier function of the epidermis, the immune system and the nervous system.
With age, there is a significant change that causes a decline in surface lipid production that maintain the epidermal barrier. Starting at approximately age 55, the surface pH of the epidermis becomes less acidic. The enzymes required to process the lipids that compose the epidermal water barrier require an acid pH. By the age of 70, the rate of production of the precursors of the lipid barrier is reduced, resulting in insufficient lipids to maintain the barrier.
The epidermal barrier insufficiency may be related to increased risk for the development of contact dermatitis. This explains why an elderly patient complains of irritation and itchiness from washing products that were well tolerated at a younger age. Loss of sweat and oil glands on the skin will also lead to itchiness due to dry skin, the most common skin disorder among the elderly.
The changes that occur in the immune system with age are termed “immunosenescence”. The aged immune system is pro-inflammatory with dysfunction of immune cells. In some patients, this can result in an allergic reaction and the body inability to react effectively to infectious agents.
Neurological conditions such as degenerative diseases of the spine may affect the elderly patient. In some cases, the sensory nerves may be affected and causing itchiness. Diabetes polyneuropathy can also manifest with the itchiness of the trunk.
In the elderly, chronic itching can also be triggered by light pressure, such as the brush of fibres from a sweater. According to a study by anesthesiology researcher at the Washington University School of Medicine, older people may have less pressure sensing cells that can lead to touch-related itchiness. The study involves mice by applying a precise amount of pressure to a patch of shaved skin on young and old rodents’ necks. Older mice are discovered to scratch more on the spot than the young mice in response to the light touch. Through skin analysis, the team found that older mice had far fewer pressure-sensing cells than young mice did.
Managing itchy skin in elderly
Itchy skin, though may seems trivial to most of us, can actually affect the quality of life of individuals especially in the elderly. The itchiness was often observed as a sign of being unclean and could influence other’s perception on the elderly. They may be perceived to be a source of infection or infestation. This perception could lead to an avoidance of the patient and an isolation that influences their quality of life. Interventions to prevent this include proper hydration, protection from irritant and daily sun protection.
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