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Geriatric Dermatology

Geriatric Health Care, Atlanta | Dr. Kathleen J. SmithThe average American is getting older, according to the U.S. Government Census and our daily observations. A higher percentage of people are age sixty-five and older. This trend is likely to continue as Baby Boomers (born from 1946 to 1964) continue to age. In addition, the numbers of people aged eighty or more continues to increase, so geriatric medicine and geriatric dermatology are important to more and more patients. Older people have a higher probability of suffering skin-related diseases and disorders. Dermatology Specialists of Atlanta, a nationally triple-board certified dermatology and dermopathology practice, specializes in diagnostic studies and surgical and medical therapies.

According to Harvard University School of Medicine, geriatric dermatology divides the aging of human skin in two basic ways: intrinsic age processes, those changes that occur as the body ages in all people; and extrinsic aging, brought on by external or extrinsic factors, including environment, harmful UV rays, or smoking. Chronic diseases, including congestive heart failure, HIV, atherosclerosis, or diabetes also increase the patient’s likelihood of suffering skin disease. All these conditions slow down vascular efficiency while decreasing the body’s immune function. The net result is that patients have a lessened ability to heal the skin.

Extrinsic vs. Intrinsic Skin Aging

A variety of changes occur during the extrinsic aging process. Skin cells’ shape, size, or staining results are specific to photoaging and sun damage. Though numbers of melanocytes decrease in general aging, these cells responsible for skin pigmentation double in sun-damaged skin; unattractive lentigines increase; and the numbers of intradermal macrophages (Langerhans cells) are less plentiful. The patient’s dermis is generally less dense, loses elasticity as collagen fibers decrease about one percent a year in normal skin aging. In comparison, sun-damaged skin loses almost double the amount of fibers at a faster rate. Skin then develops furrows, lines, and wrinkles. Sweat glands, nerves, and the microcirculatory system decline, so that patient feels hot or cold or becomes more sensitive to bruises and burns. Nails thin, split, and present longitudinal ridges as the under-skin fat atrophies and thins. The patient is likely to lose facial volume and may lose confidence or self-esteem as aging progresses.

The patient’s skin loosens, wrinkles, exhibits uneven pigmentation or hyperpigmentation, and may tear easily. Xerosis, or severely dry skin, affects many aging patients. Those with the worst sun damage are also most prone to the development of actinic keratoses, elastotic skin, redness, roughness, coarse wrinkles, blotchiness, telangiectasia, and blocked pores.


Xerosis is uncomfortable, dry, scaly skin that occurs most frequently on the legs, hands, or trunk. According to the Mayo Clinic, the appearance of the condition looks like crazed porcelain. Cracks and even fissures occur as the skin loses moisture. Some patients’ skin is so dry that it bleeds. Pruritus may result in secondary infections. Thin, damaged skin becomes more easily penetrated by bacteria, viruses, or fungi. The patient may become more sensitive to allergens as the skin barrier’s integrity is diminished. Many patients experience very dry skin and resulting problems during the cold winter months. It’s essential for the patient to use gentle cleansers, creams, lotions, and moisturizers after bathing and hand washing.

Patients with other diseases, including poor nutrition, thyroid disease, renal disease, and those undergoing radiation or chemotherapy treatments may be more susceptible to extremely dry skin. Dermatology Specialists of Atlanta prescribes topical treatments and skin care products to reduce the effects of clinically and severely dry skin. Dr. Kathleen J. Smith will instruct patients to bathe only in lukewarm water, use very gentle cleansers or non-irritating soaps, apply hydrating and emollient creams directly to damp skin after bathing, avoid washcloths, abrasive treatments, or irritating fabrics; and install humidifiers in the patient’s living area. Xerosis is a serious and often chronic medical condition that requires treatment and long-term management.


Pruritus causes the patient to scratch skin itch. Inflamed, red skin results. This condition is frequently associated with other illnesses, such as kidney disease, anemia, cancer, infection, diabetes, malaria, dermatitis, HIV, parathyroid illness, excessive Vitamin A consumption, liver disease, or some medicines. Researchers at Johns Hopkins University believe the condition is the result of the peripheral nervous system. As with patients suffering from xerosis, Dr. Kathleen J. Smith will recommend avoidance of hot water, environmental irritants, moisturizers, cold compresses, topical prescription medications, and moisturizers in those patients diagnosed with this skin condition.


Purpura often presents as skin or mucous membrane hemorrhages. The condition may occur in patients with lower platelet counts (e.g. thrombocytopenia) and other blood diseases, as the result of trauma, or due to vascular problems. Some patients experience purpura as the result of drug reactions.

Chronic Venous Insufficiency

The condition may result from venous hypertension that is usually the result of valvular problems. The patient may present with swelling, brown discolorations on the skin, venous ulcers (often on the lower legs), or varicosities. Patients diagnosed with this condition usually receive corticosteroid medicines, antibiotics (for secondary infection), and recommendations about lifestyle. Surgery may be required.


Patients are living longer and long life predisposes some patients to diseases of the skin. Skin is the body’s largest organ and the diseases of geriatric dermatology require diagnosis, treatment, and management. Patients in greater Atlanta, North Atlanta, Decatur, Panthersville, Doraville, Redan, and Druid Hills/North Druid Hills, GA should contact Dr. Kathleen J. Smith at Dermatology Specialists of Atlanta for an appointment at 678-904-4932 now.

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