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
(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