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A new report serves as a guide to the most common inflammatory skin diseases that affect the geriatric population.

The reference guide, published in , focuses mainly on six common inflammatory skin diseases: psoriasis, atopic dermatitis (AD), contact dermatitis, seborrheic dermatitis, rosacea, and Grover disease. Details on clinical presentation, pathogenesis, differentials, diagnosis, and treatment are provided for each condition.

What prompted this guide?

Inflammatory skin conditions and their comorbidities place a large burden on the health care system in the U.S. The geriatric population is often afflicted by these frequently chronic and relapsing conditions. The authors catalogued the common inflammatory skin diseases that affect this population and provide diagnostic and treatment summaries.

What were the key findings?

The primary complaint of inflammatory dermatoses can be pruritus, including in elderly adults. Relevant clinical questions can include:

• When was the onset of the eruption?

• What underlying diseases are present and could be contributing to the eruption?

• Is there an association between the eruption and a certain trigger?

• What type of management is required for this condition based on associated risks of the condition versus risks of the treatment options taking into account the patient's comorbidities and current medications?

• How long is treatment required for the condition?

Management considerations for older patients include the possibility of difficulty associated with mobility and dexterity, of concurrent medical conditions, and of polypharmacy.

Here, review co-author Gillian Heinecke, MD, assistant professor of dermatology, Saint Louis University School of Medicine focuses on highlights on atopic dermatitis.

What did the review report about atopic dermatitis?

Heinecke: If an older patient has had eczema since they were five years old, I think you can accept that they have atopic dermatitis. But a new diagnosis of atopic dermatitis in an older individual can occur. You want to make sure you're not missing an alternate diagnosis like a drug eruption or a cancer in this patient population.

It's important to feel confident in your diagnosis of atopic dermatitis because it's one of the most common dermatoses that dermatologists see and it affects people of all ages. In the elderly, atopic dermatitis mimics some conditions that would require very different treatment. I've had patients who I thought had atopic dermatitis, but biopsy revealed an alternate diagnosis.

Like psoriasis and other chronic disorders, atopic dermatitis often requires years of therapy. In older persons, consideration of possible toxicities is crucial. Skin atrophy, for example, is common in this population. The new JAK inhibitors look to be fairly safe, but much of the data are based on younger patients. Given the potential risk of thromboembolic disease linked with some of the rheumatologic uses, these medications need to be used with caution in older patients.