Diagnosing itch in the elderly requires looking beyond dry skin as the culprit.
Winston-Salem, N.C. - A diagnosis of dry skin only scratches the surface of causes of geriatric itching. And the oversimplified diagnosis can lead to inadequate treatment.
"Aging skin includes several factors - dry, aging skin and also probable damage to nerve fibers that causes itch without noticeably dry skin," Dr. Yosipovitch says.
"Another important localized type of itch in old age is chronic venous insufficiency, varicose eczema or chronic venostasis or of the lower extremity veins," Dr. Yosipovitch says.
"Dermatologists also commonly see geriatric patients with localized itching of the face and scalp from seborrheic dermatitis," he says.
Seborrheic dermatitis itching in the elderly is also associated with diseases that appear in older age, such as Parkinson's, as well as neuropyschiatric conditions, such as dementia.
"Rarely, itch could be related to post cerebral vascular accident. It is not common, but should be part of the differential," Dr. Yosipovitch says.
Some systemic diseases can induce itch in the older population, such as chronic kidney disease and non-Hodgkin's lymphoma. The itching in these cases can present as generalized itch without any rash.
Patients who have diabetes can have localized itch, probably related to neuropathy, according to Dr. Yosipovitch.
Medications such as opioids and cough syrups that contain opioids can induce itch without rash.
Differences in presentation
While Dr. Yosipovitch says that there is not enough data to provide information about different characteristics of itch in the elderly, it is his experience that the elderly tend more than younger patients to suffer from generalized itch without rash, or asteatotic itch.
"In younger patients, we might have itch without rash related to underlying systemic diseases. In older age, it could be that there is not any systemic disease, but the skin, by itself, is probably more prone to develop the itch.
"So, for example, we could see more itching scalps in older patients, but not always with seborrheic dermatitis," he says.
The common notion that in older age people have dry skin and that is why they itch is a simplistic view that led to an unfortunate term, according to Dr. Yosipovitch.
"Often, we see old age skin that does not look significantly dryer than in a younger age; yet, the patient itches. We call that advanced aging itch; it was formerly coined incorrectly as senile pruritus.
"I, and patients, find that to be an improper term. We, as physicians, are not in a position to define an older patient as senile based on an itch," Dr. Yosipovitch says.