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the pretibial area and thigh. This does not require any active treatment but may be associated with diabetes. (e) Actinic elastosis: Lesions occur in areas exposed to the sun mostly in face and limbs. The skin is coarse, dry and accentuated skin markings. (f) Senile comedones: Multiple pigmented papular eruptions. (g) Nail dystrophy in the form of longitudinal striations. (h) Senile angioma or cherry angioma: Multiple erythematous papules in the trunk.

(iii) Diseases peculiar to senility

(a) Senile pruritus: This is associated with a dry skin resulting in itching which is generalised or localised to genital, perianal regions and nape of the neck. Repeated scratching leads to thickening, pigmentation and is called neurodermatitis. Diabetes mellitus and obstructive uropathy have to be ruled out.

(b) Eczema: This is an asteatotic eczema occurring in the legs due to lack of proper nutrition and oedema of legs.

(c) Leg ulcers occur due to .(i) lack of proper care (ii) malnutrition (iii) post-thrombo phlebotic changes (iv) progressive arteriosclerosis.
Bullae: Pemphigoid bullae in the form of multiple vesicle or bullae on the skin surfaces, usually asymptomatic, do not rupture and resolve in course of time. No steroid treatment is required. Pemphigoid has to be differentiated from pemphigus characterised by onset in the middle age, bullae which rupture with the fluid emanating cat's urine smell. In pemphigoid, the bullae are tense, do not occur in the mucous membranes, do not rupture and hence secondary infection is less.

(d) Dermatitis herpetiformis: Grouped vesicles occurring on the extensor surfaces with intense itching and associated with malabsorption syndrome. Malabsorption syndrome is also associated with extensive psoriasis and chronic eczema of the legs. Dapsone 100 mgs/day and antihistaminics would suffice. Steroids are not required.

(iv) Common skin diseases as in other age groups

(a) Scabies: Sarcoptes scabii or acarus scabii is the causative organism. The illness is characterised by nocturnal itching and papular eruptions occurring in inter-digital spaces, ulnar border of the hand, axillae and thigh. Secondary infection may lead to impetigo, furunculosis and acute nephritis. Sulphur ointment or 25% Benzyl Benzoate emulsion are the treatment of choice. Benzyl benzoate is applied from neck to feet and the patient is asked to take bath after 12 hours. Anti-bistamines and antibiotics are given orally.

(b) Pediculosis: Pediculosis is common in the scalp, trunk and pubic area. It is one of the common conditions for cervical node enlargement. Pediculosis corporis otherwise called 'Vagabond's disease' occur due to poor personal hygiene. Multiple scratch marks are seen on the trunk. In pediculosis pubis, blue lines are seen in the public, suprapubic and inguinal areas. Itching is severe. DDT powder and/ or Benzyl Benzoate emulsion are used.

(c) Impetigo, furunculosis and folliculitis: Caused by: staphylococcus. Recurrence is due to carrier stage. Diabetes mellitus has to beruledoutjn cases of recurrence. Impetigo occurs in any part of the body, becomes pustular and crust forms within 2 to 3 days. Furunculosis occurs most commonly with poor nutrition and

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