10.5826/dpc.1304a262
Introduction: Aging is a ubiquitous human trait that predisposes older persons to chronic diseases. Compared with systemic non-communicable diseases, a significant gap exists in literature on the burden of non-communicable dermatoses (NCDs) amongst older adults, particularly in low and middle-income countries.
Objectives: The aim of this study was to document the epidemiology and clinical pattern of non-communicable skin diseases among older adults in Nigeria.
Methods: We conducted a retrospective review of medical records of ambulant adults aged ≥60 years referred for dermatological care at a teaching hospital in Southwestern Nigeria between February 2017 and February 2022. The frequency and pattern of NCDS were recorded for descriptive statistical analysis using SPSS 20 statistics software.  The level of statistical significance was set at 0.05.
Result : A total of 553 medical records were reviewed with a female: male ratio of 1.3:1 The mean age of the study population was 68.85 ±7.87. Six out of every 10 patients (60.6%) had at least one chronic NCD. The incidence of chronic NCDs declined with increasing age. Chronic eczemas (22.4%), pigmentary dermatoses (9.4%), and skin tumors (8.7%) were the most frequent chronic non-communicable dermatoses recorded. Older males had a significantly higher incidence of chronic eczemas while chronic urticarias and skin tumors demonstrated significant female preponderance.
Conclusion: There is a high burden of Chronic NCDs with significant gender disparities among older adults with skin problems in Nigeria. Pre-emptive planning and resource allocation towards specialist geriatric-dermatology services are needed to address the skin-health needs of the growing geriatric population.
text/xml
2160-9381
3241
en
Olayinka  Olasode
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
chronic disease
A Retrospective Review of Chronic Non-Communicable Dermatoses Among Older Adults at a Tertiary Healthcare Facility in Southwestern Nigeria
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-10-31
2023-02-13
2023-10-31
2024-01-16
e2023262
Dermatol Pract Concept
Introduction: Aging is a ubiquitous human trait that predisposes older persons to chronic diseases. Compared with systemic non-communicable diseases, a significant gap exists in literature on the burden of non-communicable dermatoses (NCDs) amongst older adults, particularly in low and middle-income countries.
Objectives: The aim of this study was to document the epidemiology and clinical pattern of non-communicable skin diseases among older adults in Nigeria.
Methods: We conducted a retrospective review of medical records of ambulant adults aged ≥60 years referred for dermatological care at a teaching hospital in Southwestern Nigeria between February 2017 and February 2022. The frequency and pattern of NCDS were recorded for descriptive statistical analysis using SPSS 20 statistics software.  The level of statistical significance was set at 0.05.
Result : A total of 553 medical records were reviewed with a female: male ratio of 1.3:1 The mean age of the study population was 68.85 ±7.87. Six out of every 10 patients (60.6%) had at least one chronic NCD. The incidence of chronic NCDs declined with increasing age. Chronic eczemas (22.4%), pigmentary dermatoses (9.4%), and skin tumors (8.7%) were the most frequent chronic non-communicable dermatoses recorded. Older males had a significantly higher incidence of chronic eczemas while chronic urticarias and skin tumors demonstrated significant female preponderance.
Conclusion: There is a high burden of Chronic NCDs with significant gender disparities among older adults with skin problems in Nigeria. Pre-emptive planning and resource allocation towards specialist geriatric-dermatology services are needed to address the skin-health needs of the growing geriatric population.
Olayinka  Olasode
2023/10/31
10.5826/dpc.1304a262
e2023262
Department of Dermatology and Venereology, Obafemi Awolowo University, Ile-Ife, Nigeria
2160-9381
chronic disease
en
e2023262
Ohga Y, Bayaraa B, Imafuku S. Chronic idiopathic erythroderma of elderly men is an independent entity that has a distinct TARC/IgE profile from adult atopic dermatitis. Int J Dermatol. 2018 Jun 1;57(6):670–4.
A Retrospective Review of Chronic Non-Communicable Dermatoses Among Older Adults at a Tertiary Healthcare Facility in Southwestern Nigeria
https://dpcj.org/index.php/dpc/article/download/3241/2377
             A Retrospective Review of Chronic
        Non-Communicable Dermatoses Among Older
           Adults at a Tertiary Healthcare Facility
                  in Southwestern Nigeria
Atinuke Arinola Ajani1, Fatai Olatunde Olanrewaju1, Ademola Enitan1, Olufikemi Fabusuyi2,
         Mufutau Oripelaye1, Olumayowa Abimbola Oninla1, Olayinka Olasode1


1 Department of Dermatology and Venereology, Obafemi Awolowo University, Ile-Ife, Nigeria
2 Department of Medicine, University of Medical Science Teaching Hospital Complex, Akure, Nigeria



Key words: geriatric, aged, skin diseases, non-infectious, chronic disease
Citation: Ajani AA, Olanrewaju FO, Enitan A, et al. A Retrospective Review Of Chronic Non-Communicable Dermatoses Among Older
Adults At A Tertiary Healthcare Facility In Southwestern Nigeria. Dermatol Pract Concept. 2023;13(4):e2023262. DOI: https://
doi.org/10.5826/dpc.1304a262
Accepted: June 23, 2023; Published: October 2023
Copyright: ©2023 Ajani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Ajani Atinuke Arinola, Consultant Dermatologist & Genitourinary Physician, Department of Dermatology and
Venereology, Obafemi Awolowo University, Ile-Ife, Phone: +2348025559295 Email: daraolu@yahoo.com




  ABSTRACT              Introduction: Aging is a ubiquitous human trait that predisposes older persons to chronic ­diseases.
                        Compared with systemic non-communicable diseases, a significant gap exists in literature on the
                        burden of non-communicable dermatoses (NCDs) amongst older adults particularly in low and
                        ­middle-income countries.
                        Objectives: The aim of this study was to document the epidemiology and clinical pattern of non-­
                        communicable skin diseases among older adults at a tertiary healthcare facility in Southwestern Nigeria.
                        Methods: We conducted a retrospective review of medical records of ambulant adults aged ≥60
                        years referred for dermatological care at a teaching hospital in ile-ife, South-Western Nigeria between
                        ­February 2017 and February 2022. The frequency and pattern of NCDs were recorded for descriptive
                         statistical analysis using SPSS 20 statistics software. The level of statistical significance was set at 0.05.
                        Results: A total 553 medical records were reviewed with a female: male ratio of 1.3:1 The mean
                        age of the study population was 68.85 ±7.87. Six out of every 10 patients (60.6%) had at least
                        one chronic NCD. The incidence of chronic NCDs declined with increasing age. Chronic eczemas
                        (22.4%), pigmentary dermatoses (9.4%) and skin tumors (8.7%) were the most frequent chronic




Original Article | Dermatol Pract Concept. 2023;13(4):e2023262                                                                            1
                      ­ on-communicable dermatoses recorded. Older males had a significantly higher incidence of chronic
                      n
                      eczemas while chronic urticarias and skin tumors demonstrated significant female preponderance.
                      Conclusions: There is a high burden of chronic NCDs with significant gender disparities among older
                      adults with skin problems in Nigeria. Pre-emptive planning and resource allocation towards specialist
                      geriatric-dermatology services are needed to address skin-health needs of the growing geriatric pop-
                      ulation.




Introduction                                                       non-communicable dermatoses amongst older adults. Studies
                                                                   evaluating chronic health problems of older persons rarely
The human population is experiencing a major demographic           report on the burden of skin diseases in them[4–6,15,16].
shift with an unprecedented growth in the number of older          Nevertheless, there is a high burden of non-communicable
adults (60 years and older) [1,2]. This change in the world        dermatoses (NCDs) in lder adults with significant impact on
population characteristic is most profound in lower- and           morbidity, mortality and quality of life [11,17–21].
middle-income countries where majority of the world’s older
adults reside [3]. Currently, over 1 billion adults are 60 years
or older. It is expected that this figure will double by 2050
                                                                   Objectives
and by then, 80% of older adults will be resident in less de-      We conducted a 5-year review of the medical records of all
veloped countries [2,3].                                           new patients aged 60 years and above attending the derma-
    Although longevity is desirable, it comes with social,         tology outpatient clinic to determine the frequency and dis-
economic and health consequences. As such, the gains of            tribution of chronic, non-communicable dermatoses across
increased life expectancy are overshadowed by additional           various age sub-groups of older adults with skin complaints.
years of poor health and dependency [2]. This can be at-
tributed to inevitable, age-related non-linear decline in the
human body. As one ages, the structural and functional in-         Methods
tegrity of various organ-systems are gradually compromised.
                                                                   This sub-study is the retrospective arm of a larger study in-
Physiological and immunological processes progressively
                                                                   vestigating dermatoses of senescence among adults at a ter-
become less efficient, and there is a corresponding increase
                                                                   tiary health care facility in Southwestern Nigeria. A review
in susceptibility to a wide variety of diseases, particularly
                                                                   of the health records of older adult who received care at the
non-communicable diseases.
                                                                   outpatient dermatology clinic of Obafemi Awolowo Univer-
    Studies have demonstrated an increasing burden of
                                                                   sity Teaching Hospitals Complex, Ile-Ife, Nigeria between
chronic diseases with increasing age and an evolution of the
                                                                   February 2017 and February 2022 was conducted with ap-
pattern of these diseases over time [4–6]. Chronic morbidities
                                                                   proval from the institutional ethics and research committee.
in older adults tend to be multiple with over 30% of older
                                                                   The medical records of all new patients aged 60 years and
persons having co-morbid chronic health ­
                                        problems[4–6].
                                                                   older seen during the study period were retrieved and infor-
Additionally, adults with chronic health problems have sig-
                                                                   mation regarding their age, sex and clinical diagnosis were
nificantly worse health-related quality of life, higher costs
                                                                   recorded in a data proforma for subsequent transfer to a
and increased risk of death when compared with adults
                                                                   digital data spread sheet for coding and analysis. Only case
without chronic health conditions [7,8].
                                                                   records with conclusive clinical diagnosis were documented
    Chronic dermatological conditions contribute to the
                                                                   while those with inconclusive diagnosis were excluded from
burden of non-communicable diseases in the older adults
                                                                   the study. All documented dermatologic diagnosis were made
[9–12]. A significant association has been demonstrated
                                                                   by a consultant dermatologist after appropriate clinical and
between chronic inflammatory skin diseases such as psoria-
                                                                   laboratory evaluation.
sis, atopic dermatitis and immunobullous skin diseases and
long standing systemic and psychiatric disorders including
cardiovascular diseases, renal diseases, metabolic problems        Grouping and Categorization of Skin Diseases
as well as extra-cutaneous malignancies [11–14]. Unfor-            Cases with a clinical diagnosis of non-communicable
tunately, compared with systemic non-communicable dis-             (non-infectious) dermatoses were selected for further cate-
eases, a significant gap exists in literature on the burden of     gorization and analysis. The NCDs were sub-categorized as




2                                                                      Original Article | Dermatol Pract Concept. 2023;13(4):e2023262
acute or chronic NCDs, based on the duration of presenting            Results
complaints and/or clinical propensity for relapse. Chronic
NCDs were defined as non-relapsing dermatoses of non-                 Five hundred and fifty-three patients comprising of 316 fe-
infectious etiology with a duration of symptoms greater than          males (57.1%) and 237 males (42.9%) within the age range
or equal to six months or non-infectious dermatosis with a            of 60-98 years were treated for skin problems during the
chronic remitting and relapsing course lasting greater > 3            period of review. More than half (58.2%) of the study pop-
months. As such, subjects with acute NCDs such as irritant            ulation were in their 7th decade, with a mean age of 68.85
contact dermatitis, acute adverse drug reactions and acute ur-        ±7.87 years. The male patients were significantly older than
ticaria were eventually excluded from the final data analysis.        the females in this study (P = 0.00) and had a significantly
      Patients presenting with multiple chronic NCDs condi-           lower incidence of non-communicable dermatoses compared
tions were noted with each diagnosis coded separately under           with females (P = 0.011).
each case for further analysis as multiple response set. Those           Three hundred and sixty-four (60.6%) patients had at
who developed new co-morbid chronic non-communicable                  least one non-communicable dermatosis (NCD), majority
diagnosis at a separate time during the period under review           (92.0%) of whom had chronic NCDs. Most patients with
were included separately as new cases.                                chronic NCDs were in their 7th decade while those with
      Statistical analysis was performed using IBM SPSS Sta-          acute NCDs were significantly older and predominantly in
tistics (IBM Corp. Released 2017. IBM SPSS Statistics for             their 8th decade of life (Table 1). A progressive decline in
Windows, Version 25.0). Continuous variables are presented            proportion of chronic NCDs was observed with advancing
as means ± standard deviation (SD). Comparison of means               age. Conversely, an up-ward trend occurred in the incidence
was done using Student T test. Categorical variables are pre-         of acute NCDs with age (Figure 1). Female sex was signifi-
sented as tables and charts and comparison between groups             cantly associated with a diagnosis of chronic NCDs. Though
done with chi square test. The level of statistical significance      no gender differences occurred in the incidence of acute
was set at 0.05.                                                      NCDs, females with acute NCDs were significantly older
                                                                      than those with chronic NCD (P < 0.05) (Table 1).
Ethical Consideration
The study protocol complied with the Declaration of Hel-              Frequency of Chronic NCDs Amongst
sinki. The study was approved by the Ethics and Research              Study Subjects
Committee of the Obafemi Awolowo University Teaching                  A diverse spectrum of chronic NCDs (Tables 2-5) was re-
Hospitals Complex with a national registration number:                corded in the study population. Eczemas (22.4%) consti-
NHREC/17/03/2021 and an international registration num-               tuted the highest overall burden of chronic NCDs followed
ber: IRB/IEC/0004553. The need for informed consent for               rather remotely by pigmentary disorders (9.4%) and skin
the retrospective arm of the study was waived by institu-             tumors (8.7%). The three most common diagnosis in fe-
tional ethics and research committee as this arm of the study         males were eczemas, pigmentary dermatoses and skin tu-
did not require direct contact with patients and the clinical         mors while in males, eczemas, cutaneous pain syndromes
data used was anonymized.                                             and papulo-squamous disorders were most frequent. The


                       Table 1. Age and sex comparison of NCDs in the study population.
                                  Acute NCDs                     Chronic NCDs                      NCDsa
                                      N (%)                          N (%)                    N= 553 (%)              P value
    Gender
    Female                           18(3.25)                      204 (36.9)                  222 (40.1)              0.534
    Male                             11(2.0)                        131(23.7)                  142 (25.7)
    Total                            29 (5.2)                       335(60.6)                     364(65.8)
    Mean age
    Female                        72.94 ±11.86                     68.04 ±7.85                68.44 ±8.32              0.02
    Male                           73.00 ±5.53                     70.20 ±7.56                70.42 ±7.44              0.14
    Total                          72.97 ±9.82                     68.89 ±7.80                69.21 ±8.04              0.037

NCD =† = Non communicable dermatoses
a
NCDs‡ = includes both acute and chronic NCDs




Original Article | Dermatol Pract Concept. 2023;13(4):e2023262                                                                  3
proportion of males with eczemas was significantly more              Conclusions
than females (P < 0.05) (Table 2). Unlike eczemas, Chronic
urticaria/reactive inflammatory skin diseases and skin tumors        The skin is not immune to the impact of aging on health
demonstrated significant female preponderance (P < 0.05).            and in fact, may be the first or most severely affected organ
Chronic urticaria occurred 4.9 times more frequently in fe-          by the consequences of aging. The spectrum of cutaneous
males than males. The disparity in incidence of skin tumors          manifestations in the aging skin is wide, with diverse patho-
widened between both sexes with increasing age (Figure 2).           physiological mechanisms. In this study, we documented a
The incidence of co-morbid communicable skin diseases was            high incidence (65.8%) of non-communicable skin diseases
8.1% and was mainly due to fungal infections in females and          (NCDs) in older adults with dermatological complaints in
parasitic and viral diseases in male (Figure 3).                     the hospital setting. This is similar to an incidence of 61.38%
                                                                     reported by Jha in Nepal[22]. Although communicable der-
                                                                     matoses have been previously reported as the most frequent
                                                                     dermatologic problem in developing and tropical countries
                                                                     [23–27], a closer look at many of these studies reveals that
                                                                     the incidence of NCDs is higher when comparison is done as
                                                                     a collective group. In addition, many recent studies corrobo-
                                                                     rate a predominance of NCDs in older adults as well as the
                                                                     general population adult population both in developing and
                                                                     developed economies [28–32].
                                                                         Chronic NCDs (60.6%) occurred 11.5 times more fre-
                                                                     quently than acute NCDs and were significantly more fre-
                                                                     quent in older females in this study. The true incidence of
                                                                     chronic NCDs as a collective group of dermatoses in older
                                                                     adults is unknown. Nevertheless, a similarly high prevalence
                                                                     can be inferred from previous works on individual dermato-
                                                                     ses that constitute this spectrum in older adults [18,33–36].
                                                                     In a study by Gaber et al. [32], four out of the five most fre-
Figure 1. Incidence of acute and chronic non communicable derma-     quent groups of skin diseases in elderly patients were chronic
toses. The incidence of acute non communicable dermatoses (blue
                                                                     non communicable skin diseases, diagnosed in 56.5% of the
line) increased with age while chronic non communicable (red line)
                                                                     study population [32, 40].
diseases showed progressive decline with advancing age. Linear by
linear association = 6.44, P = 0.011.




      Table 2. Gender differences in the incidence of various groups of chronic NCDs in older adults.
                                                         % of total
                                                        populationa      Total NCDsb          Female            Males            P
                                                          N = 553        N = 335 (%)       N = 204 (%)      N = 131 (%)        value
    Eczemas                                              124(22.4)        124(37.0)          66 (32.4)         58 (44.3)        0.03
    Pigmentary                                             52(9.4)         52(15.5)          37(18.1)          15(11.5)         0.10
    Skin tumours                                           48(8.7)         48(14.3)          37(18.1)           11(8.4)         0.02
    Papulosquamous dermatoses                              34(6.1)         34(10.1)           19(9.3)          15(11.5)         0.53
    Chronic cutaneous pain syndromes                       31(5.6)          31(9.3)           15(7.4)          16(12.2)         0.14
    Miscellaneous                                          18(3.1)          18(5.4)           11(5.4)           7(5.3)          0.96
    Chronic Urticaria/ reactive dermatoses                 17(3.1)          17(5.1)           15 (7.4)          2(1.5)          0.02
    Erythroderma                                           14(2.5)          14(4.2)            7(3.4)           7(5.3)          0.40
    Cutaneous manifestation of systemic disorders          11(2.0)          11(3.3)            4(2.0)           7(5.3)          0.09
    Autoimmune & Immunobullous dermatoses                  8(1.4)            8(2.4)            5(2.5)           3(2.3)          0.61
    Multiple skin diseases                                 45(8.1)         45(13.4)          26 (12.7)         19 (14.5)        0.65

NDCs = non communicable dermatoses.
a
total population of older adults seen during the period of reviewbtotal number of adults with chronic non communicable dermatoses



4                                                                         Original Article | Dermatol Pract Concept. 2023;13(4):e2023262
           Table 3. Comparison of non communicable dermatoses across different age groups.
                                                                    60-69 years         70-79 years            ≥80 years
                     Diagnostic Group                              N = 194 (%)           N = 91 (%)            N = 50 (%)       P value
 Eczemas                                                             64 (33.0)            38 (41.8)             22(44.0)          0.20
 Pigmentary dermatoses                                                30(15.5)             16(17.6)             6(12.0)           0.68
 Skin tumours                                                        29 (14.9)            12 (13.2)             7(14.0)           0.92
 Papulosquamous disorders                                             18(9.3)              11(12.1)             5(10.0)           0.76
 Chronic cutaneous pain syndromes                                     19(9.8)               6(6.6)              6(12.0)           0.94
 Miscellaneous                                                        13(6.7)               3(3.3)                  2(4.0)        0.29
 Chronic urticaria and reactive dermatoses                            13 (6.7)              4 (4.4)                 0(0.0)        0.06
 Erythroderma                                                          6(3.1)               4(4.4)                  4(8.0)        0.14
 Cutaneous manifestation of systemic disorders                         7(3.6)               3(3.3)                  1(2.0)        0.60
 Autoimmune & Immunobullous dermatoses                                 5(2.6)               2(2.2)                  1(2.2)        0.79
 Multiple skin diseases                                               22(11.3)             16(17.6)             7(14.0)          0.351

Linear by linear association used to test association between variables when Chi2 assumptions were violated.




   Table 4. Spectrum of chronic inflammatory non communicable dermatoses in study population.
                                                  Percentage                                                                 Percentage
                                   No of              (%)                                                  No of                 (%)
         Diagnosis                patients          (N= 335)                     Diagnosis                patients            (N= 335)
 Inflammatory NCDs                   197              ‘58.8             Bullous pemphigoid                      3               0.90
 Eczemas                             124               37.1             Cutaneous lupus                         2               0.60
 Asteatotic eczema                    35               10.4             Bechets disease                         1               0.30
 Seborrheic dermatitis                27               8.1              Scleroderma                             1               0.30
 Lichen simplex                       20               6.0              Vasculitis                              1               0.30
 Atopic dermatitis                    10               3.0
 Chronic hand and foot                 9               2.7              Papulo-squamous                        34               10.1
 eczema                                                                 disorders
 Photodermatitis                       5               1.5              Psoriasis                              21               6.3
 Stasis eczema                         4               1.2              Lichen planus                          12               3.6
 Nummular eczema                       4               1.2              Lichen sclerosus et                     1               0.3
 Prurigo nodularis                     4               1.2              atrophicus
 Allergic contact                      3               0.9
 dermatitis                                                             Chronic urticaria and                  17               5.1
 Periorbital dermatitis                2               0.6              reactive dermatosis
 Pompholyx                             1               0.3              Chronic urticaria                      12               3.6
                                                                        Pyoderma gangrenosum                    2               0.6
 Autoimmune &                          8               2.4              Papular urticaria                       2               0.6
 Immunobullous                                                          Erythema nodosum                        1               0.3
 dermatoses                                                             Erythroderma                           14               4.2

NCDs = non communicable dermatoses.




    The high incidence of chronic NCDs in older adults can             thickness, increased permeability to chemical substances
be attributed in part to age-related deterioration in the skin         and diminished vascular support [37]. These changes lead
functional and structural integrity caused by intrinsic and            to increased skin susceptibility to injury, irritation, inflam-
extrinsic aging as well as age-related co-morbid systemic              mation, along with reduced propensity for repair and re-
conditions. Intrinsic aging is characterized by decreased skin         generation therefore, establishing a foundation for the



Original Article | Dermatol Pract Concept. 2023;13(4):e2023262                                                                            5
Table 5. Spectrum of chronic non-inflammatory
    non communicable dermatoses in study
                 population.
                                          Percentage
                                No of         (%)
            Diagnosis          patients   (N = 335)
 Non inflammatory NCDs            160        47.8
 Pigmentary skin diseases         52         15.5
 Vitiligo                         33         9.9
 Idiopathic guttate                   8      2.4
 hypomelanosis
 Exogenous ochronosis                 6      1.8
 Other pigmentary disorders           5      1.5


 Cutaneous manifestations of      11         3.3
 systemic disorders                                    Figure 2. Incidence of skin tumors in female and male patients. The
                                                       incidence of skin tumors increased with age in females in contrast
 Pruritus due to systemic             7      2.1
                                                       to the decline observed in males. The difference in incidence of skin
 disorders
                                                       tumors widened with increasing age between the two sexes.
 Paraneoplastic dermatoses            2      0.6
 Other cutaneous                      2      0.6
 manifestations of systemic                            pathogenesis of most chronic NCDs. Extrinsic aging, mainly
 disorders
                                                       due to ultraviolet exposure also plays a significant role in the
                                                       pathogenesis of NCDs in advanced age. Chronic ultraviolet
 Cutaneous dysesthesias           31         9.3       exposure causes cellular DNA damage, accelerates intrinsic
 Post-herpetic neuralgia          26         7.8       skin aging [37,38] increases skin fragility [37], and depletes
 Cutaneous sensory disorders          5      1.5       the skin cutaneous immune cell population predisposing to
 Skin tumors                      48         14.3      skin tumorigenesis [37,38]. In addition, hormonal factors,
 Benign skin tumors               41         12.2      diet, psychosocial problems, systemic co-morbid conditions
    Dermatofibroma                    2      0.6       and treatments for these conditions also contribute to the
    Cherry angioma                    1      0.3       pathogenesis of chronic non-communicable skin diseases in
    Acrochordon                       3      0.9       old age.

    Keloids                       14         4.2           Inflammatory NCDs affect about 20 – 25% of the world
                                                       population[39]. The incidence amongst older adults in this
    Syringoma                         4      1.2
                                                       study was higher (35.6%). Chronic inflammatory dermato-
    Seborrheic keratosis          16         4.8
                                                       ses especially eczemas are often reported as one of the most
 Pre-malignant and                    7      2.1
                                                       frequent skin findings in older adults [18,32,40]. Eczemas
 malignant skin tumors
                                                       (37.0%) were the most frequently diagnosed chronic NCDs
    Actinic keratosis                 2      0.6
                                                       amongst older adults in this study. A similar finding of high
    Squamous cell carcinoma           1      0.3
                                                       prevalence of eczemas amongst older persons was reported
    Melanoma                          1      0.3
                                                       by Wang et al [41] in China as well as several other research-
  Other malignant skin               3      0.9
                                                       ers in different geographical regions [18,22,35,42–44]. The
   tumors
                                                       etiology of inflammatory NCDs including eczemas in older
 Miscellaneous                    18         5.4
                                                       persons is multifactorial. Age-related physiological dete-
 Hair disorders                       2      0.6
                                                       rioration in epidermal barrier function with correspond-
 Chronic adverse cutaneous            6      1.8
                                                       ing decline in skin barrier homeostasis, stratum corneum
 drug reactions
                                                       hydration and increased skin pH appear to play a central
 Keratoderma                          5      1.5
                                                       role [41,45]. Impaired epidermal barrier function is asso-
 Chronic ulcer                        3      0.9
                                                       ciated with increased cutaneous cytokine expression and
 Nutritional dermatosis               1      0.3
                                                       chronic low grade cutaneous and systemic inflammation
 Sarcoidosis                          1      0.3       [45–48]. Other endogenous factors including, reduced epi-
NCDs = non communicable dermatoses.                    dermal synthesis of natural moisturizing factors, lipids and




6                                                           Original Article | Dermatol Pract Concept. 2023;13(4):e2023262
                Figure 3. Co-morbid infectious dermatoses in the study population. The incidence of concomitant infectious
                dermatoses was highest in the seventh decade. Fungal skin infections followed by parasitic skin diseases
                were the most frequent in female and male patients respectively.




sebum as well as exogenous factors such as drugs contribute            differences in the incidence of late-onset vitiligo as well as
to the pathogenesis of eczemas and cutaneous inflammation              age-related differences in the etiopathogenesis, morpholog-
in the elderly [49,50].                                                ical variant and clinical course of the disease. In Nigeria,
    Given that the deterioration in epidermal barrier func-            older adults account for 5.8% of dermatology consulta-
tion progresses relative to age [51,52], the substantial male          tions for vitiligo [54], while in Singapore and Kuwait, up to
preponderance of eczemas in this study may be due to the               14% of subjects with vitiligo have late onset vitiligo [55,56].
significant age difference between male and female patients            Lower incidences were reported in India [20,57], Egypt [32]
in the study. Age-related decline in epidermal barrier func-           and Tanzania [18]. Vitiligo with onset in late adult hood is
tion may also be responsible for the observed increase in in-          often more rapidly progressive and tends to be frequently
cidence of acute NCDs (comprising predominantly of acute               associated with other autoimmune disorders [58,59].
eczemas such as contact dermatitis) with advancing age in                  Other pigmentary disorders occurred infrequently in
this study.                                                            our study population. We documented a much lower inci-
    Cutaneous aging is associated a variety of divergent pig-          dence of idiopathic guttate hypomelanosis (2.4%) compared
mentary changes ranging from mottled hyperpigmentation in              with values as high as 9 - 70% reported in previous studies
sun-exposed areas to hypopigmented macules of guttate hy-              [26,53,60]. It is known that genetics and environmental fac-
pomelanosis in relatively less exposed skin. Pigmentary der-           tors play major roles in the pathogenesis of idiopathic gut-
matoses consisting predominantly of vitiligo and idiopathic            tate hypomelanosis with the disease being more frequent in
guttate hypomelanosis occurred in 9.4% of older adults and             individuals with lighter ethnic skin tones. The low incidence
were the second largest group of chronic non communicable              of idiopathic guttate hypomelanosis among older adults in
dermatoses in this study. Vitiligo (9.9%) was the most fre-            this study may therefore be related to the predominantly
quent pigmentary disorder. A similar finding was reported              darker skin tone of our study population.
by Raveendra in India [53]. Overall, vitiligo in older adults is           Skin tumors were the third most frequent group of
not uncommon. However, there are racial and geographical               chronic NCDs diagnosed in the study. The overall incidence




Original Article | Dermatol Pract Concept. 2023;13(4):e2023262                                                                      7
of skin tumors (14.3%) is similar to findings by Otike-Odibi        grouped under their respective causes. The true incidence of
et al in the south-southern part of the country[61] but lower       chronic idiopathic erythroderma in older adults is unknown,
than reports from other countries [62,63]. There was a sig-         however, a significant preponderance in elderly men has been
nificant gender disparity in the frequency of skin tumors with      previously documented [72]. We found a higher incidence of
a higher incidence in females compared to males. The gender         CIEs in males that was not statistically significant (P > 0.05).
gap in skin tumors widened with increasing age (Figure 2)               The incidence of co-morbid communicable dermatoses
due to a steep increase in the proportion of females with           was surprisingly low (8.1%) in the study population. The
skin tumors with age. Although a higher prevalence of skin          spectrum of infectious dermatoses was dominated by fun-
tumors in older adult females compared with males has been          gal infections in females and parasitic and viral infections
previously documented [63,64], this opposing trend in inci-         in males.
dence as well as a statistically significant gender difference in       This was a healthcare facility-based study, and as such
incidence of skin tumors has not been previously reported.          findings of this research reflect predominantly chronic skin
    Seborrheic keratosis was the most common skin tumor             conditions in older adults warranting specialist care. Older
diagnosed in 4.8% of the patients and comprised of 33.3%            adults with minor or less severe skin conditions that may
of all skin tumors in this study. This incidence is lower than      otherwise present to the general practitioner or remain un-
reports from other parts of the world [62,63,65] most likely        treated are therefore not captured by this study.
due to differences in skin phototype of the population stud-            This study establishes a high burden of chronic non
ied. Studies from other parts of Africa report Kaposi sar-          communicable dermatoses with significant gender dispari-
coma[18] and keloids[66] as the most frequent skin tumors           ties among older adults receiving dermatological care at a
encountered in older adults. In our study, keloids (4.2%)           tertiary healthcare facility in Southwestern Nigeria. With
ranked second highest in the tumor category constituting            increasing longevity, a corresponding rise in the prevalence
less than a third of the total number of skin tumors. The           these chronic skin conditions is foreseeable, and the demand
differences in incidence and pattern of skin tumors in vari-        for specialist geriatric skin care is bound to grow. Healthcare
ous studies may be related to genetic factors, other prevail-       providers therefore need to be proactive in planning and al-
ing co-morbid conditions such as HIV infection, as well as          locating resources, to ensure that specialized geriatric skin
the influence of environmental and cultural factors on per-         care services are available to meet the skin health needs of
ception of skin diseases. Although seborrheic keratoses are         the growing elderly population.
benign in nature and often considered a cutaneous mani-
festation of extrinsic skin aging, they are worth mentioning
particularly in older adults as their occurrence may herald         References
more sinister diagnosis of internal malignancies particularly
                                                                     1. Luebberding S, Krueger N, Kerscher M. Skin physiology in men
when eruptive [37,67].                                                  and women: In vivo evaluation of 300 people including TEWL,
    Other frequently diagnosed chronic NCDs amongst                     SC hydration, sebum content and skin surface pH. Int J Cosmet
older adults in this study were: papulo-squamous dermato-               Sci 2013;35:477–83.
ses, cutaneous dysesthesias and urticaria/reactive dermatoses        2. World Health Organization (WHO). Aging and health 2022.
                                                                        https://www.who.int/news-room/fact-sheets/detail/ageing-and-
in decreasing order of frequency. Erythroderma was the least
                                                                        health (accessed September 27, 2022).
frequently diagnosed group of chronic NCDs in the study
                                                                     3. World Health Organization (WHO). UN Decade of Healthy
population. It has been found to occur most frequently in               Ageing 2022. https://www.who.int/initiatives/decade-of-healthy
adults after the age of 50 and often demonstrates male pre-             -ageing (accessed September 1, 2022).
ponderance [68–70]. We documented a higher incidence of              4. Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic
erythroderma in males and over a 2-fold higher frequency in             Conditions Among US Adults, 2018. Prev Chronic Dis 2020;17.
                                                                     5. da Silva DSM, de Assumpcao D, Fransisco PM, Yassuda MS,
subjects ≥ 80 years compared with those in their 7th decade.
                                                                        Neri AL, Borim FS. Chronic non-communicable diseases consid-
Most reported cases of erythroderma in literature are sec-
                                                                        ering sociodemographic determinants in a cohort of older adults.
ondary to exacerbation of pre-existing skin diseases [68–71].           Rev Bras Geriatr Gerontol 2022;25:e210204.
As such, erythroderma is often considered a severe manifes-          6. Nwani PO, Isah AO. Chronic diseases and multimorbidity among
tation of pre-existing inflammatory dermatological disorders            elderly patients admitted in the medical wards of a Nigerian ter-
rather than a diagnostic entity. However, in 3.9%-25% of                tiary hospital. Journal of Clinical Gerontology and Geriatrics
                                                                        2016;7:83–6. https://doi.org/10.1016/J.JCGG.2015.10.001.
cases, no underlying cause is found [68–71]. In this study,
                                                                     7. Maresova P, Javanmardi E, Barakovic S, Barakovic Husic J,
patients categorized as having erythrodermas were those in
                                                                        Tomsone S, Krejcar O, et al. Consequences of chronic diseases
whom no primary cause could be identified after extensive               and other limitations associated with old age – a scoping re-
clinical evaluation and investigations (Chronic idiopathic              view. BMC Public Health 2019;19. https://doi.org/10.1186
erythroderma; CIE). Those with identifiable diagnosis were              /s12889-019-7762-5.



8                                                                       Original Article | Dermatol Pract Concept. 2023;13(4):e2023262
 8. Rizzuto D, F Melis RJ, Angleman S, Qiu C, Marengoni A. Effect            23. Ayanlowo O, Okesola O. Pattern of Skin disorders across age
    of Chronic Diseases and Multimorbidity on Survival and Func-                 groups. Res J Health Sci 2017;5:148. https://doi.org/10.4314
    tioning in Elderly Adults. J Am Geriatr Soc 2017;65:1056–60.                 /rejhs.v5i3.4.
    https://doi.org/10.1111/jgs.14868.                                       24. Gibbs S. Skin diseases and socioeconomic conditions in rural
 9. Yamanaka K. Special Issue: “Skin Disease and Comorbidities.” J               Africa: Tanzania. Int J Dermatol 1996;35:633–9. https://doi
    Clin Med 2021;10:5754. https://doi.org/10.3390/jcm10245754.                  .org/10.1111/J.1365-4362.1996.TB03687.X.
10. Kwa MC, Silverberg JI. Association Between Inflammatory Skin             25. Badame AJ. Incidence of Skin Disease in Rural Jamaica. Int J Derma-
    Disease and Cardiovascular and Cerebrovascular Co-Morbidities                tol 1988;27:109–11. https://doi.org/10.1111/J.1365-4362.1988
    in US Adults: Analysis of Nationwide Inpatient Sample Data.                  .TB01283.X.
    Am J Clin Dermatol 2017;18:813–23. https://doi.org/10.1007               26. Kumar D, Das A, Bandyopadhyay D, Chowdhury S, Das N,
    /S40257-017-0293-X.                                                          Sharma P, et al. Dermatoses in the elderly: Clinico-demographic
11. Försti A-K, Jokelainen J, Timonen M, Tasanen K. Risk of                      profile of patients attending a tertiary care centre. Indian J Der-
    Death in Bullous Pemphigoid: A retrospective Database Study                  matol 2021;66. https://doi.org/10.4103/ijd.IJD_245_20.
    in Finland. Acta Derm Venereol 2016;96:758–61. https://doi               27. Hay RJ. Skin disease in the tropics and the lessons that can be
    .org/10.2340/00015555-2347.                                                  learned from leprosy and other neglected diseases. Acta Derm Vene-
12. Wang L, Bierbrier R, Drucker AM, Chan A-W. Noncutaneous                      reol 2020;100:235–41. https://doi.org/10.2340/00015555-3469.
    and Cutaneous Cancer Risk in Patients With Atopic Dermati-               28. Aman S, Nadeem M, Mahmood K, Ghafoor MB. Pattern of skin
    tis. A Systematic Review and Meta-analysis. JAMA Derma-                      diseases among patients attending a tertiary care hospital in La-
    tol 2020;156:158–71. https://doi.org/10.1001/jamadermatol                    hore, Pakistan. J Taibah Univ Med Sci 2017;12:392–6. https://
    .2019.3786.                                                                  doi.org/10.1016/J.JTUMED.2017.04.007.
13. Farzanfar D, Dowlati Y, French LE, Lowes MA, Alavi A. Inflam-            29. Ukonu AB, Eze EU. Pattern of Skin Diseases at University of
    mation: A Contributor to Depressive Comorbidity in Inflam-                   Benin Teaching Hospital, Benin City, Edo State, South-South
    matory Skin Disease. Skin Pharmacol Physiol 2018;31:246–51.                  Nigeria: A 12 Month Prospective Study. Glob J Health Sci
    https://doi.org/10.1159/000490002.                                           2012;4:148–57. https://doi.org/10.5539/gjhs.v4n3p148.
14. Vaengebjerg S, Skov L, Egeberg A, Dyrberg N. Prevalence, In-             30. Akinboro AO, Mejiuni AD, Akinlade MO, Audu BM, Ayo-
      cidence, and Risk of Cancer in Patients With Psoriasis and                   dele OE. Spectrum of skin diseases presented at LAUTECH
      Psoriatic Arthritis. A Systematic Review and Meta-analysis.                  Teaching Hospital, Osogbo, southwest Nigeria. Int J Dermatol
      JAMA Dermatol 2020;156:421–9. https://doi.org/10.1001                        2015;54:443–50. https://doi.org/10.1111/IJD.12693.
      /jamadermatol.2020.0024.                                               31.   Sharma H, Kumar Chawla R, Pruthi S, Resident S. The pattern
15.   Ekpenyong CE, Udokang NE, Akpan EE, Samson TK. Double                        of dermatological disorders among patients attending OPD of
      Burden , Non-Communicable Diseases And Risk Factors Evalua-                  dermatology department At a Tertiary Care Hospital, Mathura.
      tion In Sub-Saharan Africa : The Nigerian Experience . European              Indian Journal of Clinical and Experimental Dermatology
      Journal of Sustainable Development 2012;1:249–70.                            2019;5:154–7. https://doi.org/10.18231/j.ijced.2019.033.
16.   Chang AY, Gomez-Olive F, Payne C, Rohr JK, Manne-Goehler J,            32.   Gaber M, Hasanin AZ. Skin diseases in elderly. Menoufia Medi-
      Wade AN, et al. Chronic multimorbidity among older adults in                 cal Journal 2020;3:272–6.
      rural South Africa. BMJ Glob Health 2019;4:e001386. https://           33.   Bilgili SG, Karadag AS, Ozkol HU, Calka O, Akdeniz N. Original
      doi.org/10.1136/bmjgh-2018-001386.                                           Article The prevalence of skin diseases among the geriatric pa-
17.   Kandwal M, Jindal R, Chauhan P, Roy S. Skin diseases in geri-                tients in Eastern Turkey. J Pak Med Assoc 2012;62:5–9.
      atrics and their effect on the quality of life: A hospital-based ob-   34.   Robinson MK. Racial differences in acute and cumulative skin
      servational study. J Family Med Prim Care 2020;9. https://doi                irritation responses between Caucasian and Asian populations.
      .org/10.4103/jfmpc.jfmpc_1188_19.                                            Contact Dermatitis 2000;42:134–43.
18.   Mponda K, Masenga J. Skin diseases among elderly patients at-          35.   Yavuzcan G. Prevalence of skin disorders among geriatric
      tending skin clinic at the Regional Dermatology Training Cen-                patients in the black sea region of Turkey. J Exp Clin Med
      tre, Northern Tanzania: a cross-sectional study. BMC Res Notes               2022;39:327–33. https://doi.org/10.52142/omujecm.39.2.4.
      2016;9:119. https://doi.org/10.1186/s13104-016-1933-6.                 36.   Landis ET, Davis SA, Taheri A, Feldman SR. Top dermatologic
19.   Papadopoulos I. Comparative Study of Dermatological Diseases                 diagnoses by age. Dermatol Online J 2014;20. https://doi.org
      of the Elderly in Relation to the Rest Population. Clin Cosmet               /10.5070/d3204022368.
      Investig Dermatol 2020;13. https://doi.org/10.2147/CCID.               37.   Jafferany M, Huynh T V, Silverman MA, Zaidi Z. Geriat-
      S242294.                                                                     ric dermatoses : A clinical review of skin diseases in an ag-
20.   Alam MN, Husain MA, Siddiqua A, Babar ZUM, Hasan MR.                         ing population. Int J Dermatol 2012;51:509–22. https://doi
      The prevalence of skin and venereal diseases among the geriatric             .org/10.1111/j.1365-4632.2011.05311.x.
      patients attending in a tertiary care hospital in Dhaka, Bangla-       38.   Mesa-Arango AC, Flórez-Muñoz SV, Sanclemente G. Mech-
      desh. Bangladesh Journal of Medical Science 2019;18. https://                anisms of skin aging. IATREIA 2017;30:160–70. https://doi
      doi.org/10.3329/bjms.v18i1.39563.                                            .org/10.17533/UDEA.IATREIA.V30N2A05.
21.   Ansorge C, Miocic JM, Schauer F. Skin diseases in hospitalized         39.   Ujiie H, Rosmarin D, Schon M, Stander S, Boch K, Metz M, et al.
      geriatrics: a 9-year analysis from a University Dermatology Cen-             Unmet medical needs in Chronic, Non-communicable Inflamma-
      ter in Germany. Arch Dermatol Res n.d.;314:427–37. https://doi               tory skin diseases. Front Med (Lausanne) 2022;9.
      .org/10.1007/s00403-021-02244-9.                                       40.   Uprety S, Paudel S, Thapa P. Pattern of Skin Diseases in Geriatric
22.   Jha HK. Study of clinical spectrum of geriatric dermatoses in pa-            Population: Our Year Long Experience from Nepal. Indian Der-
      tients attending a multi-specialty hospital. Journal of Chitwan Med-         matol Online J 2021;12:888–91. https://doi.org/10.4103/idoj
      ical College 2020;10:77–80. https://doi.org/10.54530/jcmc.191.               .IDOJ_65_21.



Original Article | Dermatol Pract Concept. 2023;13(4):e2023262                                                                                     9
41. Wang X, Li LF. Clinical features of eczema and dermatitis in          57. Simin MK, Sasidharanpillai S, Rajan U, Riyaz N, Simin MK,
     the elderly: A cross-sectional study in mainland China. Eur J In-        Sasidharanpillai S, et al. Dermatoses among patients aged 60 years
    flamm 2022;20. https://doi.org/10.1177/20587392211069758.                 and above attending a tertiary referral center: A cross-sectional
42. Yew YW, Kuan AHY, George PP, Zhao X, Tan SH. Prevalence                   study from North Kerala. Journal of Skin and Sexually Trans-
    and burden of skin diseases among the elderly in Singapore: a             mitted Diseases 2021;3:166–72. https://doi.org/10.25259
    15-year clinical cohort study. Journal of the European Academy            /JSSTD_52_2020.
    of Dermatology and Venereology 2022;36:1648–59. https://doi           58. Thng S, Chuah SY, Gan EY. Age and Vitiligo: Childhood, Preg-
    .org/10.1111/JDV.18205.                                                   nancy and Late-Onset Vitiligo. In: Picardo M, Taïeb A, ed-
43. Bains P. Skin disorders among elderly population without comor-           itors. Vitiligo, Springer, Cham; 2019, p. 141–51. https://doi
    bidities: a hospital based study. International Journal of Research       .org/10.1007/978-3-319-62960-5_14.
    in Dermatology 2019;5. https://doi.org/10.18203/issn.2455             59. Dogra S, Parsad D, Handa S, Kanwar AJ. Late onset vitiligo: A
    -4529.intjresdermatol20190441.                                            study of 182 patients. Int J Dermatol 2005;44:193–6. https://doi
44. Polat M, İlhan MN. Dermatological complaints of the elderly at-           .org/10.1111/J.1365-4632.2004.01948.X.
    tending a dermatology outpatient clinic in Turkey: A prospective      60. Brown F, Crane JS. Idiopathic Guttate Hypomelanosis. Derma-
    study over a one-year period. Acta Dermatovenerologica Croat-             tological Cryosurgery and Cryotherapy 2022:407–11. https://doi
    ica 2015;23.                                                              .org/10.1007/978-1-4471-6765-5_84.
45. Wang Z, Man MQ, Li T, Elias PM, Mauro TM. Aging-associated            61. Otike-Odibi B. Scope of Skin Diseases in the Geriatric Popula-
    alterations in epidermal function and their clinical significance.        tion of an Urban Dermatology Clinic in Port Harcourt , Nigeria.
    Aging 2020;12. https://doi.org/10.18632/aging.102946.                     Central African Journal of Public Health 2022;8:69–73. https://
46. Troy T-C, Arabzadeh A, Lariviè Re NMK, Enikanolaiye A,                    doi.org/10.11648/j.cajph.20220802.17.
    ­Turksen K. Dermatitis and Aging-Related Barrier Dysfunction in       62. Darjani A, Alizadeh N, Rafiei E, Moulaei M, Naseri Alavi SH,
     Transgenic Mice Overexpressing an Epidermal-Targeted Clau-               Eftekhari H, et al. Skin Diseases among the Old Age Residents
     din 6 Tail Deletion Mutant. PLoS One 2009;4:e7814. https://doi           in a Nursing Home: A Neglected Problem. Dermatol Res Pract
    .org/10.1371/journal.pone.0007814.                                        2020;2020. https://doi.org/10.1155/2020/8849355.
47. Hu L, Mauro TM, Dang E, Man G, Zhang J, Lee D, et al. Epi-            63. Bıyık Özkaya D, Erfan G, Okuturlar Y, Tosuner Z, Demircioğlu
    dermal Dysfunction Leads to an Age-Associated Increase in                 D, Timurkaynak Ö. Skin Biopsy Results of Geriatric Patients
    Levels of Serum Inflammatory Cytokines. Journal of Investiga-             Over a 5-year Period and the Frequency of Skin Diseases Before
    tive Dermatology 2017;137:1277–85. https://doi.org/10.1016/J              and After COVID-19 Pandemic. Med J Bakirkoy 2022;18:189–
    .JID.2017.01.007.                                                         94. https://doi.org/10.4274/BMJ.galenos.2022.2022.3-13.
48. Velarde MC. Epidermal Barrier Protects against Age-Associated         64. Makrantonaki E, Steinhagen-Thiessen E, Nieczaj R, Zoubou-
    Systemic Inflammation. Journal of Investigative Dermatology                 lis CC, Eckardt R. Prevalence of skin diseases in hospitalized
    2017;137:1206–8. https://doi.org/10.1016/J.JID.2017.02.964.                 geriatric patients. Z Gerontol Geriatr 2017;50. https://doi
49. Joly P, Corven-Benoit C, Baricault S, Lambert A, Hellot M, Josset           .org/10.1007/s00391-016-1084-3.
    V, et al. Chronic eczematous eruptions of the elderly are associ-     65.   Cvitanović H, Knežević E, Kuljanac I, Jančić E. Skin disease in a
    ated with chronic exposure to calcium channel blockers: Results             geriatric patients group in outpatient dermatologic clinic Karlo-
    from a Case-Control study. Journal of Investigative Dermatology             vac, Croatia. Coll Antropol 2010;34.
    2007;127:2766–71.                                                     66.   Saka B, Mouhari-toure A. Cutaneous pathology in the el-
50. Shevchenko A, Valdes-Rodriguez R, Yosipovitch G. Causes,                    derly in dermatology at Lomé subject, Togo: Study of 325
    pathophysiology, and treatment of pruritus in the mature                    cases. Pan Afr Med J 2014;18. https://doi.org/10.11604/pamj
    patient. Clin Dermatol 2018;36. https://doi.org/10.1016/j                   .2014.18.151.3066.
    .clindermatol.2017.10.005.                                            67.   Wollina U. Recent advances in managing and understanding
51. Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations               seborrheic keratosis. F1000Res 2019;8. https://doi.org/10.12688
    between skin barrier characteristics, skin conditions and health of         /F1000RESEARCH.18983.1.
    aged nursing home residents: A multi-center prevalence and cor-       68.   César A, Cruz M, Mota A, Azevedo F. Erythroderma. A clini-
    relational study. BMC Geriatr 2017;17. https://doi.org/10.1186              cal and etiological study of 103 patients. J Dermatol Case Rep
    /s12877-017-0655-5.                                                         2016;10:1. https://doi.org/10.3315/JDCR.2016.1222.
52. Wilhelm KP, Cua AB, Maibach HI. Skin aging. Effect on transepi-       69.   Hoxha S, Fida M, Ritjona M, Vasili E. Erythroderma: A Man-
    dermal water loss, stratum corneum hydration, skin surface pH,              ifestation of Cutaneous and Systemic Diseases. EMJ Allergy
    and casual sebum content. Arch Dermatol 1991;127:1806–9.                    Immunol 2020. https://doi.org/10.33590/emjallergyimmunol
53. Raveendra L. A clinical study of geriatric dermatoses. Our Derma-           /19-00182.
    tology Online 2014;5. https://doi.org/10.7241/ourd.20143.59.          70.   Li J, Zheng HY. Erythroderma: a clinical and prognostic
54. Onunu AN, Kubeyinje EP. Vitiligo in the Nigerian African: A study           study. Dermatology 2012;225:154–62. https://doi.org/10.1159
    of 351 patients in Benin City, Nigeria. Int J Dermatol 2003;42:800–         /000342365.
    2. https://doi.org/10.1046/j.1365-4362.2003.01908.x.                  71.   Khaled A, Sellami A, Fazaa B, Kharfi M, Zeglaoui F, Kamoun.
55. Kong Y, Ching V, Chuah S, Thng T. Retrospective study on the                Acquired erythroderma in adults: a clinical and prognostic
    characteristics and treatment of late-onset vitiligo. Indian J Der-         study. J Eur Acad Dermatol Venereol 2010;24:781–8. https://doi
    matol Venereol Leprol 2017;83:625. https://doi.org/10.4103                  .org/10.1111/J.1468-3083.2009.03526.X.
    /IJDVL.IJDVL_650_16.                                                  72.   Ohga Y, Bayaraa B, Imafuku S. Chronic idiopathic erythrod-
56. Al-Mutairi N, Al-Sebeih KH. Late onset vitiligo and audiological            erma of elderly men is an independent entity that has a distinct
    abnormalities: Is there any association? Indian J Dermatol Venereol         TARC/IgE profile from adult atopic dermatitis. Int J Dermatol
    Leprol 2011;77:571–6. https://doi.org/10.4103/0378-6323.84059.              2018;57:670–4. https://doi.org/10.1111/IJD.13976.



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