ATOPIC DERMATITIS AND AGING
Atopic dermatitis is a chronic condition, with no cure. It will therefore continue to affect people’s lives as they age. Recent studies have shown increasing numbers of elderly individuals with atopic dermatitis, either as a continuing, reoccurring, or new condition.1-4 What changes does the skin undergo as we age, and how does this affect the symptoms of atopic dermatitis? Does aging change the way the condition is treated? Let’s see what the experts are saying.
Age-related skin changes could trigger or worsen atopic dermatitis.
The skin, like many other organs, undergoes unique changes as we age. Many of these changes – like dryness, itching, decreased barrier function, decreased regulation of the immune system and increased risk of certain skin infections – overlap with certain features of atopic dermatitis.5
Aging skin is less able to protect.
Aging results in changes in both the skin’s structure and function.7 This leads to thin, dry, sagging skin with limited ability to maintain barrier function and protect the body.2,6,7 There are also age-related changes to the skin’s immune responses, which result in a state of chronic low-grade inflammation.2,6 All of these factors can interact with and amplify each other, leading to the symptoms associated with atopic dermatitis.2,3,5,6
Aging skin tends to be dry and itchy.
For example, loss of moisture contributes to itchiness, and both dryness and itching are prominent symptoms in atopic dermatitis.2-5 Older, thin skin is less able to maintain its barrier function, allowing more external pollutants, allergens, and toxins in.2-4,6 These irritants can trigger immune mechanisms that result in flares.2
Other age-related factors, both inside the body and in the environment, can also complicate the situation.
Aside from the changes in skin-related immune response, overall immunity is also affected by age. There is a decreased ability to fight infections, which can lead to more of the skin infections associated with atopic dermatitis.2,6 Hormonal changes in the body also affect the condition, with the decrease in certain hormones making elderly men more susceptible compared to women.3
Diagnosis may take 6 months or more.
Aging skin is associated with many different diseases, both skin diseases and conditions like diabetes or kidney disease that can also affect the skin.3,6 Moreover, there are no specific laboratory tests that can confirm atopic dermatitis.3,6 In order to make a diagnosis, doctors need at least 6 months of evaluating a patient’s symptoms.3,6
Mental status in the elderly also needs to be taken into account.3,4,6,7 Older individuals may have difficulty identifying or explaining their problems.3,4,6,7 Chronic conditions can cause depression and anxiety, and this can impact not just their journey to diagnosis, but their ability to manage their condition as well. 3,4,6,7 In these situations, it’s important for caregivers to be aware of atopic dermatitis and to be able to identify and report symptoms.3,4,6,7
Skin care and trigger avoidance are still the most important aspects of management.
Once diagnosed, management of atopic dermatitis in older patients needs a strong foundation of good skin care.1,4 Given their dry, fragile skin, it’s important to have a regular schedule for both cleansing and moisturization.1,4 If they are unable to take care of themselves, well informed caregivers are crucial.1,4
Trigger avoidance is the next step.1,4 The two allergens that commonly affect this age group are dust mites and pollen, so keep this in mind when making adjustments to the environment.3,4,6 Some people might not have the ability to change their situation or avoid triggers, especially if they have reduced mobility or mental issues, so this needs to be considered.1,4
Medication will need to be modified with age, and some drugs may no longer be useful.
In terms of drugs, topical medications like low-dose steroids and oral anti-allergic drugs are the usual first-line of treatment.1,4 However, if these medications are not, for example in cases of moderate to severe disease, systemic medications such as biologics or oral corticosteroids may be required.1,4 Unfortunately, in most cases, other systemic medications like higher-dose steroids need to be avoided, particularly if the patient has other medical conditions.1,4 Ultimately, your doctor will have the best information on the most appropriate treatment for your situation, so make sure to consult and follow their advice.
Adding atopic dermatitis to the list of things to worry about as you get older might seem daunting, but it does not need to be difficult. With the right information and proper preparation, people can age gracefully with this condition.
- Howell, A.N., Ghamrawi, R.I., Strowd, L.C. & Feldman, S.R. (2020). Pharmacological management of atopic dermatitis in the elderly. Expert Opin Pharmacother, 7(21), 761-771. https://www.tandfonline.com/doi/abs/10.1080/14656566.2020.1729738?journalCode=ieop20
- St. Bocheva, G., Slominski, R.M. & Slominski, A.T. (2021). Immunological aspects of skin aging in atopic dermatitis. Int J Mol Sci, 22(11), 5729. https://www.mdpi.com/1422-0067/22/11/5729/htm
- Tanei, R. & Hasegawa, Y. (2016). Atopic dermatitis in older adults: A viewpoint from geriatric dermatology. Geriatr Gerontol Int, 16(Suppl S1), 75-86. https://onlinelibrary.wiley.com/doi/full/10.1111/ggi.12771
- Tanei, R. (2020) Atopic dermatitis in older adults: a review of treatment options. Drugs Aging, 37(3), 149-160. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044141/
- National Eczema Association. (2019, Updated 2021). “Atopic dermatitis in older adults is common, hard to treat”. https://nationaleczema.org/ad-in-elderly-adults/ (Accessed October 21, 2021).
- Williamson, S., Merritt, J. & De Benedetto, A. (2020). Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol, 182(1), 47-54. https://www.eskeen.com.ph/oorgedro/2020/10/Atopic-dermatitis-in-the-elderly-a-review-of-clinical-and-pathophysiological-hallmarks.pdf
- Nigam, Y. & Knight, J. (2017) Anatomy and physiology of ageing 11: the skin. Nursing Times [online], 113, 51-55. https://www.nursingtimes.net/roles/older-people-nurses-roles/anatomy-and-physiology-of-ageing-11-the-skin-27-11-2017/
Health information contained herein is provided for general educational purposes only. Your healthcare professional is the single best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment.