Figure 1 – Stasis dermatitis is seen here on the leg of an elderly woman. This bilateral circumferential dermatitis is characterized by lichenified and hyperpigmented plaques.
ABSTRACT: Eczematous and xerotic inflammatory dermatoses are more common in older adults because of the impairment in epidermal integrity that occurs with aging. Stasis dermatitis usually affects the lower extremities, often in areas of long-standing venous insufficiency, and occurs more frequently in women than in men. Support stockings, elastic wraps, and Unna boots are examples of compression devices that can be used to mitigate the effects of venous insufficiency. In elderly persons, irritant contact dermatitis is often caused by topical medications. The dermatitis responds well to bland, topical corticosteroids; however, the only truly effective treatment is avoidance. Treatment of allergic contact dermatitis involves identification of the allergen with patch testing and avoidance of it. Immediate symptoms can be treated with topical corticosteroids.
Figure 2 – Xerosis and stasis dermatitis coexist on the leg of this elderly woman.
Because the immune response declines with age, many inflammatory skin diseases are less common in older adults than in younger persons.1 However, eczematous and xerotic inflammatory dermatoses are more prevalent among persons older than 60 years as a result of the impairment in epidermal integrity that occurs with aging.
In this 2-part series, I focus on the diagnosis and treatment of these dermatoses in older adults. Here I discuss stasis dermatitis, irritant contact dermatitis, and allergic contact dermatitis. In a previous issue ("Skin Disorders in Older Adults: Eczematous and Xerotic Inflammatory Conditions, Part 1"), I addressed seborrheic dermatitis, xerosis, asteatotic eczema, and nummular dermatitis
Figure 3 – Secondary infection of stasis dermatitis has occurred in this elderly woman.
1. Nedorost ST, Stevens SR. Diagnosis and treatment of allergic skin disorders in the elderly. Drugs Aging. 2001;18:827-835.
2. Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. 2010;81:989-996.
3. Jacob SE, James WD. From road rash to top allergen in a flash: bacitracin. Dermatol Surg. 2004; 30(4, pt 1):521-524.
4. Dickel H, Kuss O, Schmidt A, et al. Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol. 2002;3:283-289.
5. Tosti A, Pazzaglia M, Silvani S, Delorenzi F. The spectrum of allergic contact dermatitis in the elderly. Contact Dermatitis. 2004;50:379-381.
6. Hogan DJ. Widespread dermatitis after topical treatment of chronic leg ulcers and stasis dermatitis. CMAJ. 1988;138:336-338.