A Clinico-Epidemiological Study of Geriatric Dermatoses

(23, 6.57%), Favre - Racouchot syndrome (19, 5.42), solar lentigens (17, 4.85%) and cherry angioma (13, 3.71%). In some of these cases combination of above findings were seen. (Figure 1)

Infections and infestations were seen in 79 cases among which fungal infection was the commonest seen in 38 cases (48.10%) followed by bacterial infection seen in 16 cases (20.25%), viral infection in 10 cases (12.66%). Infestations were seen in 15 cases (18.99%).

Out of 350 patients enrolled for the study, most common dermatoses were infections and infestations (79, 22.57%), followed by cutaneous neoplasia (74, 21.14%), miscellaneous disorders (37, 10.57%), eczemas (32, 9.14%), pigmentary disorders (31, 8.86%), papulosquamous skin disorders (30, 8.57%), photodermatoses and psychodermatoses (16, 4.57%), vascular disorders (13, 3.71%), vesicobullous disorders and cutaneous drug reactions (11, 3.15%). (Table 1)

Cutaneous neoplasm were seen in 74 cases out of which benign neoplasm was seen in 70 cases (94.60%) which includes seborrheic keratosis, lentiges, cherry angioma, sebaceous hyperplasia, actinic keratosis, porokeratosis, syringoma etc and malignant neoplasm was seen in 4 cases (5.40%) that includes basal cell carcinoma seen in 3 cases and squamous cell carcinoma in 1 case.

Among miscellaneous dermatoses, keloid, palmoplantar keratoderma and post herpetic neuralgia was seen in 5 cases (13.51%), leg ulcer in 4 cases (10.81%), acquired perforating disorder in 3 cases (8.10%), granuloma annulare, miliaria, neurofibromatosis, xanthelasma, pyoderma gangrenosum and Alopecia areata in 2 cases (5.41%) each, acrokerataloelastoidosis marginalis, amyloidosis and hypertrichosis ectodermal dysplasia in 1 case each (2.70%). Eczematous conditions were seen in 32 cases. Different types of eczema were noted in the study. Among various types of Eczemas, Allergic contact dermatitis was the commonest noted in 6 cases (18.74%), followed by airborne contact dermatitis seen in 5 cases (15.64%), lichenified and endogenous dermatitis in 4 cases each (12.48%), Stasis eczema in 3 cases (9.37%), Irritant, Palmoplantar and Atopic eczema in 2 cases each (6.24%), Asteatotic, Seborrheic and Infectious eczema in 1 case each (3.12%).

Pigmentary disorders were observed in 31 cases out of which Melasma was seen in 18 cases (58.06%), Vitiligo in 6 cases (19.36%), Post inflammatory hypo or hyperpigmentation in 4 cases (12.90%), Lichen planus pigmentosus in 2 cases each (6.45%) and Cushing Syndrome related pigmentation in 1 case (3 .23%).

Total 30 cases of papulosquamous disorders were seen in the study, of which Psoriasis was the commonest seen in 16 cases (53.33%), connective tissue disorder in 5 cases (16.66%), lichen planus in 4 cases (13.32%), erythroderma in 2 cases (6.67%), ichtyosis, P. rosea and lichen scleroses et atrophicus in 1 case each (3.34%).

There were 16 cases of photodermatoses. Among which Chronic Actinic dermatitis was the commonest seen in 12 cases (75%), followed by polymorphic light eruption seen in 3 cases (18.75%) and Solar urticaria in 1 case (6.25%).

In Psychodermatoses; total 16 cases were seen, of which Lichen Simplex Chronicus was seen in 12 cases (75%), followed by delusion of parasitosis in 2 cases (12.50%), prurigo nodularis and neurodermatitis in 1 case each (6.25%).

13 cases of Vascular disorder were found in the study, of which Vasculitis and thrombophebitis was seen in 5 cases (38.46%), followed by Raynoulds phenomena in 2 cases (15.38%) and angiokeratoma of Fordyce in 1 case (7.70).

Vesiculobullous disorder were seen in 11 cases, of which 5(45.45%) cases had Pemphigus vulgaris, 3 (27.27%) cases of Bullous pemphigoid, 2(18.18%) cases of Pemphigus foliaceous and only one case of Paraneoplastic pemphigus (9.10%) was seen.

11 cases of adverse cutaneous drug reactions were seen in the study; of which most common was fixed drug eruption seen in 4 cases (36.36%), followed by erythema multiforme in 3 cases (27.27%), toxic epidermal necrolysis in 2 cases (18.19%), maculopapular drug reaction (MPDR) and Steven-Johnson Syndrome in 1 case (9.09%).

Out of 350 patients enrolled for the study, Hypertension was the commonest systemic disease seen in geriatric population shown in Figure 2.

Figure 2: Associated systemic disease

Discussion

In our study, a total of 350 patients with age ≥60 years and above were examined. The eldest patient was of 92 years. Of these, 251(71.71%) patients were males and 99 (28.29%) were females. In the present study, the number of males outnumbered the females which coincide with most of the other studies.7, 8, 9, 10, 11 Male:female ratio of the study population was 2.5:1.

In this study 51.42% were literate and remaining 48.57% were illiterate. 38.85% of study subjects were agricultural worker, 38.71% were retired, 22% were housewife and 0.57% were construction worker. Sociodemographic profile of our study subjects was different from other studies. This might be due to variation in socioeconomic, geographical and environmental differences in study population.

Various physiological changes noted in this study were wrinkling, graying of hairs, xerosis, idiopathic guttate hypomelanosis, senile purpura, senile comedones, seborrheic keratosis, acrochordon, fissured soles, Favre-Racouchot syndrome, Senile lentigens, Cherry angioma and Callosity. Wrinkling was the commonest physiological change seen in all cases. This was in accordance with study done by Pavithra S, Shukla P et al7 (2010), who reported 99.3% cases of skin wrinkling.

Greying of hairs was the second most common change observed and it was prevalent in 98.57% of the study population. This was almost similar with study by Pavithra S, Shukla P et al7 (2010) who recorded 96.8% incidence of graying of hairs.

Idiopathic guttate hypomelanosis was present in 12.28% cases. Our study had lower incidence as compared to study done by Grover, Narasimhalu et al12 (2009). The incidence of idiopathic guttate hypomelanosis reported in their studies is 76.5%, 51.8% and 45.35% respectively.

Senile Purpura was seen in 12% of the study population. This might be due to thin fragile skin in the elderly people. A study done by Priya Cinna Durai et al15 (2012) and Reetu Agarwal et al 13 (2019) reported 1% and 3% cases with senile purpura.

Senile comedones were observed in 33 cases (9.42%) was higher when compared to a studies done by Pavithra et al7 (2010) 8.5% and Grover, Narasimhalu et al12 (2009) 6.5%. This might be due to environmental and various such factors.

Seborrheic Keratosis occurred in 8.28% of the study population whereas Pavithra et al7 (2010) reported an incidence of 27.5% in their study. This might be due to various in genetic, epidermological and environmental factors.

Acrochordon was found in 6.57% of the study population which was lower as compared to a study done by Priya Cinna Durai et al15 (2012) and Grover, Narasimhalu et al12 (2009). They reported 49% and 24.5% cases with acrochordon.

Fissured soles were seen in 6.57% of the study population. Similiar results was also observed in a study by Pavithra et al7 (2010) reported 6.8%.

Favre – Racouchot Syndrome was found in 5.42% of the study population and all patients were males. Various other study by Leena Raveendra et al10 (2014) 2%, Patange VS, Fernandez RJ et al9 (1995) reported incidence as 2 % and 3% respectively in their studies.

Senile Lentigens was found in 4.85% of the study population and its presence was attributed by prolonged sun exposure. The incidence of senile lentigens in various studies done by Grover, Narasimhalu et al12 (2009), Patange VS, Fernandez RJ et al9 (1995) and Sheethal MP et al14 (2014) were 10% 12% and 30.3% respectively.

Cherry Angioma was the physiological dermatoses seen in 3.71% of our study population. This was much less as compared to the incidence quoted in the study by Priya Cinna Durai et al15 (2012) reported 7.2%.

A wide variety of pathological changes were seen in this study, they were classified into infections and infestations, neoplasia, eczema, pigmentory disorders, papulosquamous disorders, photodermatoses, psychodermatoses, vascular disorders, vesiculobullous disorders, cutaneous drug reactions and Miscellaneous skin changes.

In this present study, Infections and infestations were seen in (22.57%). Of which fungal infection in (48.10%), bacterial infections in (20.25%), viral infections in (12.66%) and (18.99%) of infestations were seen. The prevalence of infective conditions in our study is less compared to study done by Patange VS, Fernandez RJ et al9 (1995) and Grover, Narasimhalu et al12 (2009) reported 34.5% and 43.5% respectively.

Neoplasia was the second most common pathological dermatoses seen in our study population i.e 74 cases (21.14%). Benign cutaneous tumors were present in 70 (94.60%) cases and 4 (5.40%) cases were suffering from malignant cutaneous tumors. A study by Pavithra S, Shukla P et al7 (2010) noted benign neoplasms as the commonest pathological dermatoses and their incidence was 80.5% which is marginally less as compared to our study.

Among Malignant neoplasm, numbers of cases suffered from basal cell carcinoma were 75% while 25% had squamous cell carcinoma. A study by Sandhyarani Kshetrimayum et al6 (2017) reported 0.8% cases of squamous cell carcinoma and 0.4% of Basal cell carcinoma a lesser incidence as compared to our study.

In the present study eczema was noted in 9.14% of the study subject. The total percentage of eczema in study done by Leena Raveendra et al10 (2014) and DP Thapa, AK Jha et al16 (2012) were 31% and 35.8%. A higher incidence compared to our study.

Pigmentary disorders were seen in 8.86% of the study subjects and Melasma was the commonest pigmentary disorder as per our study (58.06%) followed by Vitiligo (19.36%). A Study by Priya Cinna Durai et al15 (2012) also reported melasma as the commonest pigmentary disorder seen in 8.3% cases with photoaging.

Papulosquamous Disorders were noted in 8.57% of the study population and Psoriasis was the commonest papulosquamous disorder noted in 53.33%. The incidence of papulosquamous disorders in our study was less in comparison with studies by Pavithra S, Shukla P et al7 (2010) 12.4% and Leena Raveendra et al10 (2014) 12%.

Photodermatoses was seen in 4.57% of the study subjects. Chronic actinic dermatitis (75%) was the most common followed by Polymorphic light eruption seen in (18.75%) cases and solar urticaria in 1 case. A study by Shashikant B. Dhumale et al17 (2016) also reported almost similiar incidence of photodermatoses 4%.

Psychodermatoses was seen in 4.57% of the study subjects. Lichen Simplex Chronicus was the commonest among psychodermatoses in 75% followed by Delusion of parasitosis in 12.50%. Prurigo nodularis and neurodermatitis was seen in (6.25%) each. The incidence of lichen simplex chronicus was 12% in the studies done by Leena Raveendra10 (2014) and Patange VS, Fernandez R J et al9 (1995) much less as compared to our study.

Vascular Disorders were seen in 3.71% of the study subjects.

Vasculitis and thrombophebitis were the commonest seen in 38.46% cases followed by Raynoulds Phenomena in