The High Prevalence of Skin Diseases in Adults Aged 70 and Older

Suvi-Päivikki Sinikumpu, MD, PhD; Jari Jokelainen, MSc; Anna K. Haarala, MD; Maija-Helena Keränen, MD; Sirkka Keinänen-Kiukaanniemi, MD, PhD; Laura Huilaja, MD, PhD

Disclosures

J Am Geriatr Soc. 2020;68(11):2565-2571. 

In This Article

Results

Prevalence of Skin Diseases

Table 1 presents the subjects' demographics and skin disease status. The overall finding of the clinical evaluation was that 75.7% of the study population had at least one skin disease that required treatment or follow-up. More than one-third of the study cases (39.1%) had three or more skin diseases, with fungal skin infections the most common. Tinea pedis (Figure 1A,B) was seen in 48.6% and onychomycosis in 29.9% of participants. To test the consistency of clinically described onychomycosis with microbiological diagnosis of the same condition, randomly selected clinically diagnosed individuals (n = 20) were sampled for microbiological dermatophyte samples (dermatophyte polymerase chain reaction). Overall, 19 of these 20 samples were positive. The prevalence of MASD[16] was 9.1%. Folliculitis was diagnosed in 3.6% (Table 2).

Figure 1.

Clinical presentations of the most common skin diseases. (A) Tinea pedis (T. rubrum); (B) T. interdigita; (C) asteatotic eczema; (D) seborrheic dermatitis; (E) papulopustular rosacea.

The most frequent eczema subtype was asteatotic eczema (Figure 1C), found in 20.8% of the population. Seborrheic dermatitis (Figure 1D) affected 10.1% of the participants; nummular eczema affected 9.2%. Hand eczema was seen in 8.5%. The prevalence of rosacea was 25.0%, and 65% of rosacea cases were erythematotelangiectatic, 13.9% papulopustular (Figure 1E), and 8.0% phymatous. Cutaneous autoimmune diseases were generally infrequent, but lichen planus was the most common (2.5%), and there were no cases with bullous pemphigoid.

Previously undiagnosed actinic keratosis was found in 22.3% of the population. The prevalence of basal cell carcinoma was 5% (n = 28). Bowen's disease was diagnosed in nine, squamous cell carcinoma in two, and malignant melanoma in three individuals.

Overall, benign skin tumors were the most common skin findings in this study. Of those, seborrheic keratoses were found most often, with 78.8% of the population having at least one and 15.8% having at least 50. Nearly as common were lentigo senilis (69.5%) and cherry angiomas (63.2%), followed by melanocytic nevi (50.1%). Multiple (≥50) melanocytic nevi were found in 7.4% of study cases (Table 2).

Prevalence of Skin Diseases in the Population Stratified by Sex

Table 3 shows the sex distribution of all the studied skin disorders. Seborrheic dermatitis, nummular eczema, tinea pedis, onychomycosis, folliculitis, and actinic keratosis were more frequent in men, and asteatotic eczema, cherry angiomas, and lentigo senilis were more common in women. Men also had more simultaneous cutaneous findings than women. Female pattern hair loss was seen in 22.5% of the women and male pattern hair loss in 83.0% of the men. In an adjusted model, SES and living status did not have any effect on these results (data not shown).

Distribution of Skin Diseases According to SES and Living Status

Cherry angiomas were more frequent in high SES individuals than in those with low SES (P < .05), and urticaria and psoriasis were more common in those with low education status (P < .05). Male pattern hair loss (P < .05) and folliculitis (P < .05) were more usual in those living with a spouse when compared with those living alone. In comparison, female pattern hair loss was found more often in those living alone when compared with those living with a spouse (P < .05) (data not shown).

The Need for Treatment

Nearly one-half (43.1%) of the study subjects had at least one skin disease that was considered severe enough to require further treatment by a physician. In addition, one in three (32.6%) had a dermatological finding classified as curable by self-treatment. Overall, male subjects were more likely than women to need treatment (OR = 1.63; P < .01).

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