Symptoms from skin disease
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Symptoms from skin disease Itch Pain burning - PowerPoint PPT Presentation

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Symptoms from skin disease Itch Pain (burning / soreness) Dryness Scale Spots Redness Pigmentary changes Hair changes Sweat changes. Stimulation of different nerves  different sensations: -Fine myelinated nerves  localised sensation of pricking

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Symptoms from skin disease


Pain (burning / soreness)





Pigmentary changes

Hair changes

Sweat changes

Stimulation of different nerves  different sensations:

-Fine myelinated nerves  localised sensation of pricking

-Non-myelinated C fibres  sensation of burning

Causes in the elderly
Causes in the Elderly

  • 20% about have a dermatosis

  • 30% have an underlying metabolic cause

  • Approximately 50% idiopathic i.e. half!

Causes of itchy elderly skin
Causes of itchy elderly skin

  • Primary rashes, i.e. as above

  • Pruritus:

    • Metabolic disorder

    • Result of mental state

    • Medicament related

    • Unknown cause

Primary rashes
Primary Rashes

  • Eczemas


  • Others in approximate order of frequency:

  • Psoriasis -not usually itchy, despite name

  • Urticarias

  • Fungal -not usually itchy

  • Scabies

  • Lichen Planus

  • Bullous disorders

  • Lichen sclerosis

  • Lymphoma


  • Past history of skin disease

  • Medication including OTC drugs?

  • Any complementary / alternative therapies?

  • What are you using on the skin?

  • How do you wash & how often?

  • Does anyone else in the house also itch?

Specific history of the itch
Specific History of the Itch

  • When did the itch start?

  • Where does it itch?

  • When does it itch?

    -all day / at night / only when warm?

  • Does anything make it worse?

    -heat / bathing?


No one else in the home is complaining of itch

She only moved in 2 months ago

Grand-daughter visits & has bad ‘hand eczema’

Metabolic causes
Metabolic Causes

In the elderly 30% can have a metabolic cause

  • Iron Deficiency

  • Thyroid problems

  • Cholestasis

  • Renal failure

  • Polycythaemia

  • Lymphoma

  • Paraneoplastic


  • General examination

    • Dry skin

    • Rash or just excoriations

    • ‘Butterfly’ sign

    • Weight loss

    • Signs of burrows – scabies

    • Mouth

    • Nails

    • Genitalia


  • LFT

  • U+E

  • Glucose

  • FBC

  • Serum electrophoresis

  • ESR

  • Calcium

  • Ferritin

  • TSH

  • CXR

  • Urinary dipstix

Secondary features of itch
Secondary features of itch


Papular / nodular lichenification

Shiny Nails

Secondary infection


Healing scars

‘Butterfly’ sign

  • Management of pruritus

    -moisturisers & topical antipruriticsetc

    -sedating antihistamine at night

    -iron supplements

Drugs causing pruritus



ACE Inhibitors



Tricyclic Antidepressants


Diuretics may cause skin dryness


Correct low humidity

Avoid synthetic fabrics (cotton better than wool)

Pare nails down

Avoid excessive bathing and hot baths

Soap substitute

Moisturisers (consider those with NMF –urea)

‘Gate out’ itch with 1% menthol in a moisturiser

Aqueous cream
Aqueous Cream

  • Never meant as a leave on cream

  • Is a wash product only but best avoided altogether

  • Not even a good moisturiser

  • Can exacerbate eczema

  • Sting many people -contains sodium lauryl sulphate

    -also Epaderm cream / Cetraben / Hydromol)

Moisturiser ftu
Moisturiser FTU

Face 15-30g 100mls

Both Hands 25-50g 200mls

Scalp 50-100g 200mls

Both Arms or legs 100-200g 200mls

Trunk 400g 500mls

Groins and genitalia 15-25g 100mls

Whole body 605 - 805g 1300mls

This is BD use for an adult for 1 week

Management 2
Management 2

Topical steroids if skin inflamed -be bold!

Balneum plus cream / E45 itch relief

Occlusive bandages

Antihistamines if dermographism / urticarial

Systemic sedative antihistamines at night -care

Review history & signs / Ix

Review medication (including OTC)

Consider cognitive effect -esp disturbed sleep

Avoid polypharmacy


In generalised pruritus with itch / scratch damage, complete sparing of the areas not accessible to the patients hands suggest that the rash is due to scratching rather than a primary dermatosis

Most widespread pruritus is due to a dermatosis rather than to systemic disease