Some gerontologic considerations in the practice of dermatology

Abstract

Gerontology and geriatrics are areas of increasing importance in medicine today. Although changes in the appearance and behavior of human skin have long been noted to accompany aging, physicians have only recently begun to consider the impact of such an age-associated change on the manifestations of dermatologic disease and on the dermatologic management of elderly patients. Gerontologic studies in such fields as immunology, epidermal cell kinetics, DNA damage and repair, and therapeutics are potentially of great relevance to the practicing dermatologist and deserve increased emphasis within our specialty.

Geriatric Infectious Diseases

“…Regardless of the pathogenetic relationship to aging, these changes affect the host's capacity to respond to a variety of stresses, including infectious diseases. For example, such age‐related changes of the skin as thinning of the epidermis, slowing of cell replacement in the stratum corneum, decreased output of eccrine and apocrine glands, and diminished blood flow may contribute to an increased incidence of skin and soft tissue infections in the elderly 61–63 . Degenerative joint disease, a common problem of the elderly population, is one important predisposing factor for septic arthritis 64 …”

Age‐associated Changes in the Skin

“…Linear growth rates for hair and nails also decrease by approximately 30–50 per cent between early and late adulthood 17 . The repair rate in the skin likewise declines with age, whether measured in terms of wound closure, regeneration of blister roofs (epidermal cell migration and mitosis), or excision of thymine dimers in ultraviolet‐irradiated DNA of dermal fibroblasts 18 …”

Kinetics of Lymphokine Production by Lymphocytes from Elderly Humans

“…In addition, whereas assays of cell-mediated immunity may be abnormal in elderly humans, the function of the complement system and phagocytic cells appear to be intact [Phair et al, 1978]. Even so, elderly humans do appear to be at increased risk for certain infections where the defense is thought to involve cell-mediated immunity such as herpes zoster [Hope-Simpson, 1965], tuberculosis [Dhar et al, 1976], and dermatophytosis [Gilchrest, 1979]. Aging has been found to be associated with decreases in delayed skin test reactivity [Foad ct al., 1975;Palmer and Reed, 1974], lymphocyte transformation responses to mi togens [Pisciotta et al, 1967;Weksler and Hutteroth, 1974], and antigens [Czlonkowska andKodak, 1979: Peel andEdsall, 1978], lymphokine production to antigens [Girard et al, 1977;Sohnle et al, 1980], and cellular cytotoxicity [Shigemoto et al, 1975], Al though there may be modest decreases in the numbers of thymic-derived lymphocytes in the elderly, this finding does not appear to be sufficient to explain the deficiencies of cellmediated immunity in this group [Makinodan, 1978], Decreased levels of the thymic hormone thymosin appear to parallel the thymic involution which occurs with advanc ing age [Lewis et al, 1978], and it is possible that the loss of this substance may be respon sible for decreased cell-mediated immunity in the elderly.…”