Skin Itching in Elderly People - Causes and Management

Introduction:

Itching is a common symptom in older individuals over 65 years old, often a chronic, long-lasting condition that can last for more than six weeks. Significant effect on the general health status and quality of life by impaired daily activities and lack of sleep, and can lead to cases like depression and anxiety. The cause of chronic itching in older individuals is often multifactorial due to impaired skin barrier function, physiological changes with age, and a decline in immunological and neurological changes. The most common reason for itching is dermatological conditions systemic, neurodegenerative, and xerosis.

What Causes Itching in the Elderly?

Chronic itching is a common condition in elderly individuals and can be caused by various dermatological and non-dermatological conditions. This significantly affects the quality of life. Changes in immunosenescence, neuronal changes, neuropathies, and age-related barrier function can act as a predisposing factor for chronic itching in the elderly. Primary dermatological conditions are common in the elderly and can cause chronic itch. Comorbid conditions like hepatobiliary (conditions that include liver, bile ducts, and gallbladder), hematologic systems, psychological conditions, renal, and medications can contribute to chronic itch in the elderly. Other causes are:

• Dermatologic: This results in inflammation and swelling within the body.

• Neuropathic: Conditions and nerve damage that leads to itching.

• Systemic: Itching results as an underlying condition and can affect the skin and internal organs. Natural changes to the body and age and hormonal changes.

• Psychogenic: Psychiatric conditions affect the brain and cause itching.

• Environmental: Irritants in the environment can cause itching. The clothing material, reacting to drugs taken, temperature, insect bite, and touching something uncomfortable can cause itching.

What Is the Underlying Condition That Can Cause Itching of the Skin in the Elderly?

The underlying conditions that are potent enough to cause itching are conditions:

• Pregnancy.

• Liver and kidney disease.

• Diabetes.

• Thyroid disease.

• Dermatitis.

• Allergies.

• Cholestasis (reduced bile flow).

• Psoriasis (condition that leads to severe skin itching).

• Eczema (a condition with dry, itchy, and inflamed skin).

• Obsessive-compulsive disorder (pattern of unwanted fears and thoughts that lead to repetitive behaviors).

How Is Skin Itch Managed in the Elderly?

The itch that is caused by an underlying systemic condition is suspected. A detailed history is taken from the individual. Tests like liver and kidney function tests are done to check for the presence of causative disease, and these conditions should be treated properly.

1. Gentle Cleanser and Emollient: Emollients are the first line of therapy for individuals with xerosis (dry skin at any age) and chronic kidney conditions. Dry skin can be caused by the composition of epidermal lipids and increased transepidermal water loss. Cutaneous barrier functions are due to erythema, itching episodes, and hyperkeratosis. Moisturizers are used to hydrate the stratum corneum, restore the barrier function and relieve itching. Fragrances and preservatives in moisturizers can act as allergic contact dermatitis and lead to itchy dermatitis. Xerotic eczema can get worse with more visits and staying in hot places and saunas for longer.

2. Topical Corticosteroids: Topical corticosteroids are effective in treating conditions like a cutaneous inflammatory disease that reduces inflammation that improves with associated pruritus. Effectiveness may be limited to prioritize without inflammatory skin disease. Additional skin barrier functions can get degraded, and telangiectasia (dilated blood vessels on the skin), and senile purpura (a common disorder of dermal connective tissue due to chronic sun exposure), by highly potent topical corticosteroids. Topical calcineurin inhibitors can be used in inflammatory skin disorders like atopic dermatitis and seborrheic dermatitis.

3. Immunomodulators: Azathioprine and Cyclosporine are the most effective drugs for inflammatory skin conditions like chronic urticaria, autoimmune disease, and neurodermatitis that are hardly affected by antihistamines. Nephrotoxicity is often an asymptomatic condition and requires careful monitoring. Azathioprine can cause vomiting, anemia, nausea, and hypersensitivity reactions that include diarrhea, fatigue, dizziness, and skin rashes. Methotrexate has anti-inflammatory effects on neutrophils and lymphocytes and is thought to be effective in treating itching. Effective treatment of eczema and chronic urticaria is shown by methotrexate. Dapsone is also reported to be effective in angioedema and chronic urticaria. Side effects include rash, dose-related anemia, hepatotoxicity, gastrointestinal side effects, peripheral neuropathy, and methemoglobinemia.

4. H1 Antihistamines: Oral H1 antihistamine blocks the h1 receptor on afferent C nerve fibers. By high doses, they can inhibit the release of mediators from mast cells. H1 antihistamines are used in the primary treatment of individuals with pruritis. Classic first-generation antihistamines and new second-generation antihistamines. This generation includes chlorpheniramine, diphenhydramine, and hydroxyzine which can easily cross the blood barrier and leads to anticholinergic side effects and sedation.

5. Ultraviolet Phototherapy: Treatment with the UV alone with the combination of UV- A reduces itching that is caused by chronic kidney conditions and skin conditions like atopic dermatitis, eczema, and psoriasis. Systemic drugs are difficult where the UV has few side effects like temporary sunburn reaction. The elderly often take medications for systemic diseases.

6. Opiate Agonists and Antagonists: These are effective against atopic dermatitis, chronic kidney disease, and cholestasis. Side effects like nausea, stomach cramps, diarrhea, and loss of appetite. Kappa opioid analogs reduce itching that is associated with non-Hodgkin’s lymphoma, refractory pruritus, and cholestasis.

7. Antidepressants: Selective serotonin inhibitors are reported to reduce types of general pruritus and psychogenic itching. Side effects include sexual dysfunction and anticholinergic effects. Older individuals are particularly susceptible to anticholinergic side effects are constipation, dizziness, urinary retention, cardiac conduction abnormalities, dry mouth, and blurred vision.

8. Treatment of Itch Due to Psychogenic And Systemic Causes: Itching that is caused by systemic disease is done by managing the underlying cause. For example, iron medications are indicated in cases of iron deficiency anemia. In cases of cholestatic pruritus, the biliary tract is treated first by using Cholestyramine. Non-sedative histamine san moisturizers are prescribed for all individuals with itching.

Conclusion:

Skin itching is a common condition that occurs in elderly individuals not only due to skin disease but also due to various underlying causes like psychotic, secondary, and systemic diseased conditions. Older people with itching suffer from extreme distress and reduced quality of life if appropriate treatment is not provided. The treatment gets affected by the extent of symptoms and the factors stimulating the itch. Various modes of treatment are used to relieve the itch, and studies are carried out on the effectiveness of these treatments. Wise choices of moisturizers, essential oils, and emollients are best for managing itch in elderly individuals.