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Geriatric Dermatology

»How common are skin disorders in the elderly population?
»What is intrinsic aging of the skin?
»What is extrinsic aging of the skin?
»How does intrinsically aging human skin vary from young skin under the microscope?
»Why does skin wrinkle as we age?
»Does smoking cigarettes accelerate skin aging?
»What is solar elastosis?
»What is nodular elastosis with cysts and comedones?
»How do liver spots, solar lentigo, and lentigo senilis differ?
»Why do elderly patients frequently develop bleeding into the skin on the dorsum of their hands and arms?
»Advertisements in newspapers and magazines frequently tout products that “rejuvenate” the skin or make the skin younger. Is there truth to these claims?
»What is the difference between superficial, medium, and deep chemical peels?
»Are some sunscreens better than others in preventing wrinkles due to photodamage?
»Which are the most common inflammatory skin diseases in the elderly?
»Why are elderly patients prone to develop xerosis?
»What is the best way to treat xerosis?
»How common is chronic venous insufficiency in the geriatric population?
»Explain the pathogenesis of chronic venous insufficiency.
»How should you manage chronic venous insufficiency?
»What is rosacea? How does it present?
»Is rhinophyma related to alcohol abuse?
»Name the most common types of skin tumors seen in the elderly.
»What are seborrheic keratoses?
»What are stucco keratoses?
»What is sebaceous hyperplasia?
»A 70-year-old man presents to your clinic with the sudden onset of hundreds of seborrheic keratoses. Is there any reason for concern?
»Describe the methods for treating seborrheic keratoses.
»An elderly man presents with a soft blue papule on the helix of his cheek and is concerned about malignant melanoma. What is the most likely diagnosis?
»Is there a future in geriatric dermatology?

 
 
 

Why do elderly patients frequently develop bleeding into the skin on the dorsum of their hands and arms?


Severe senile purpura on the dorsum of the hands and forearms of an elderly patient.
Fig. 59.4 Severe senile purpura on the dorsum of the hands and forearms of an elderly patient.
These lesions, referred to as senile purpura (solar purpura, Bateman’s purpura, purpura senilis), are common. One study of patients over age 64 years found them in 9% of those examined. The lesions are characterized by sharply demarcated areas of purpura that typically measure 1 to 5 cm (Fig. 59-4). The associated skin is atrophic and inelastic. Patients typically report that these lesions are brought on by minor trauma. It is believed that they are secondary to UV damage to the fibroblasts surrounding the blood vessels, which results in the loss of normal supporting collagen. The role of solar damage is supported by case reports of lateralization of solar purpura to one arm that receives more sunlight (e.g., left arm of a taxicab driver).

Joshi RS, Phadke VA, Khopar US, Wadhwa SL: Unilateral solar purpura as a manifestation of asymmetrical photodamage in taxi drivers, Arch Dermatol 132:715–716, 1996.