Itchy, Dry and Fragile Skin in Older Adults

Why older skin is vulnerable

• Thinner outer layers and less fat cushioning make skin fragile and prone to tears and bruises.
• Less oil and sweat cause dryness and itching.
• Slower healing and weaker immunity make infections more likely.
• Reduced sensation in neuropathy means injuries go unnoticed; see peripheral neuropathy and balance.
• Poor circulation and swelling in the legs cause skin breakdown; see swollen legs in older adults.
• Sun damage over a lifetime causes wrinkling, spots and skin cancer risk.
• Medicines that thin the blood, affect the skin or cause rashes; see medicine side effects families should watch for.
• Illness and nutrition: diabetes, kidney disease, liver disease, thyroid disease, iron deficiency, dehydration and malnutrition; see hydration for older adults: how much and how to remember and malnutrition in older adults: signs and prevention.

A simple daily routine

1. Moisturise every day, ideally right after bathing while the skin is slightly damp, with a thick, fragrance-free cream or ointment rather than a thin lotion. Apply generously to arms, legs, back and feet, gently in the direction of hair growth. Repeat in the evening for very dry skin. Do not put moisturiser between the toes or in moist skin folds. 2. Wash gently: use lukewarm (not hot) water, a mild, soap-free or fragrance-free cleanser, and a soft cloth or hand; avoid scrubbing, loofahs and strong soaps. Short baths of five to ten minutes are enough. Use a shower chair and handheld shower if standing is difficult; see bathing safely with a shower chair, handheld shower guide and hot water and scald safety for older skin. 3. Pat dry, do not rub, paying attention to skin folds, under the breasts, groin and between the toes. 4. Check the skin daily, or ask a helper to, looking at the back, heels, hips, buttocks, between the toes and under skin folds for redness, breaks, blisters, rashes, new moles or changes. 5. Dress in soft, loose cotton; avoid wool, rough seams and tight bands next to the skin; wash clothes in mild detergent and rinse well. 6. Drink enough fluids and eat a balanced diet with protein, fruit and vegetables; see how much protein do older adults need. 7. Protect from sun with a hat, long sleeves and, for exposed skin, a sunscreen suited to your parent's skin. 8. Keep nails short to avoid scratch injuries; see nail, hair and foot care for the dependent elderly. 9. Keep the home air comfortable: avoid very dry air from heaters in winter; see temperature and ventilation at home and cold-weather health risks for older adults.

Bed linen matters too; see bed linen for sensitive older skin.

Itching (pruritus)

Itch in older adults is very common. Dry skin is the usual cause, but not the only one.

Possible causes: dry skin; eczema; fungal infection; scabies (a contagious mite, with intense night itching, burrows between fingers, and affecting others at home); allergic reactions to soaps, creams, fabrics or medicines; kidney, liver or thyroid disease; iron deficiency; diabetes; blood disorders; and, rarely, cancers. Itch without a visible rash that is persistent, severe or widespread should be investigated.

What helps at home - Gentle skin care as above, especially thick moisturiser and lukewarm bathing. - Keep the room cool; avoid overheating in bed. - Wear loose cotton; avoid sweating and occlusive clothing. - Cool compresses on itchy areas. - Trim nails, and use soft cotton gloves at night if scratching in sleep. - Avoid known irritants such as strong soaps, perfumed products, wool and hot showers. - Avoid alcohol and very spicy foods if they worsen itching. - Do not use leftover creams, steroid-type creams or antihistamine tablets without a doctor's advice; they can thin skin, mask infection or cause drowsiness and falls.

See a doctor if itching lasts more than two weeks, disturbs sleep, is widespread, comes with a rash, weight loss, yellow eyes or tiredness, or if others in the household itch too.

Common skin conditions

### Eczema (dermatitis)

Red, dry, scaly, itchy patches, sometimes weeping. May occur on legs ("stasis" eczema with swelling and brown discoloration), hands and elsewhere. Management is gentle skin care and treatment from a doctor; avoid irritants.

### Fungal infections

Red, itchy, scaly patches in skin folds, groin, under the breasts, between the toes or on nails; common in the monsoon, with diabetes, obesity, and in bedridden or incontinent people. Keep skin clean and dry, change damp clothes and pads promptly; see monsoon illnesses and older adults: prevention, incontinence-associated dermatitis and barrier cream and skin care. A doctor can confirm and prescribe treatment; do not use leftover creams. Thrush in the mouth: see mouth, teeth and general health in older adults.

### Scabies

Intense itch, worse at night, tiny burrows and bumps between fingers, wrists, waist and groin. Spreads by close contact; whole households and care settings need treatment together, as a doctor directs, with washing of clothes and bedding in hot water.

### Shingles

Painful band of blisters on one side of the body; see a doctor within a day or two; see shingles and nerve pain in older adults.

### Bruises and skin tears

Thin skin bruises and tears easily, especially on forearms, hands and shins; blood thinners increase bruising. Prevent injury by padding sharp furniture, using soft sleeves, moisturising and handling gently during transfers. A tear is a flap of skin torn from the wound bed; gently replace the flap if possible, cover with a non-stick dressing and seek advice the same day; do not use adhesive tape directly on fragile skin; see wound care at home for older adults and how to lift and transfer safely.

### Leg ulcers and swelling

Open sores on the lower legs, often with swelling, brown skin and poor circulation, or with diabetes. Need medical assessment, correct dressings and sometimes compression; do not apply compression stockings without checking circulation; see compression stockings guide, swollen legs in older adults and diabetic foot ulcers: prevention.

### Pressure injuries

Red areas that do not fade, blisters or open sores over bony areas in people who sit or lie for long periods; see preventing bedsores at home, pressure ulcers: stages and care and air mattress for pressure sores.

### Moisture damage

Skin red, sore and breaking down from urine, stool or sweat; see incontinence-associated dermatitis and wipes and perineal hygiene.

### Rashes from medicines

New rashes after starting a medicine need prompt medical advice; do not stop the medicine yourself unless told to, but call the doctor the same day. A rash with fever, mouth sores, blistering or breathing difficulty is an emergency.

### Sun damage and skin cancer

Persistent sores that do not heal, scaly or crusted patches, pearly lumps, or changing moles need a doctor's examination. Skin cancers are common in later life, particularly on the face, ears, scalp and hands, and are usually treatable when found early.

### Seborrhoeic keratoses, skin tags and "age spots"

Common harmless growths and spots; a doctor can confirm if there is doubt.

Red flags

Call 112 or go to hospital for: - Widespread blistering or peeling of skin, with fever or mouth sores. - Rapidly spreading redness, severe pain, fever, confusion or shock with a skin infection. - A rash with swelling of the lips, face or throat, difficulty breathing or collapse. - A deep wound with heavy bleeding. - A hot, red, swollen, very painful leg with fever.

See a doctor within days for: - Skin that is red, hot, swollen, weeping, with pus or a bad smell. - Wounds that do not heal in two weeks. - A new, changing, bleeding or non-healing mole or sore. - Persistent itching with no obvious cause. - Blisters in a band on one side of the body. - Skin breakdown on pressure areas. - A very pale, yellow or dark change in skin colour.

Care for dependent or bedridden people

• Turn and reposition regularly and keep skin clean and dry; see turning a bedridden patient and personal hygiene for bedridden patients.
• Use suitable mattresses and cushions; see choosing an anti-bedsore mattress and cushions for wheelchair users.
• Lift, do not drag, when moving; see changing bed linen with someone in bed.
• Check skin at every change and care session.
• Keep the person comfortable in heat; see summer heat and bedridden care.

When to ask a professional

Ask the doctor or a dermatologist about persistent itch, rashes, wounds, changing spots and suspected infections. Ask a nurse about wound care and a pharmacist before any cream or tablet. Ask a dietician about nutrition. Seek urgent help for the emergency signs above.