Itchy skin is an unpleasant sensation associated with the need to scratch. It can occur on diseased skin or non-diseased skin.
Itchy skin can be due to skin problems, a systemic disease, a neurological condition or other diseases. It is the most common grievance among elderly patients during a dermatological consultation.
Itchy skin in elderly people can be defined as chronic pruritus in a person over 65 years old.
Skin, like many other organs, undergoes deterioration with the passage of time as nearly every aspect of skin biology is affected by the ageing phase.
The epidermis’s self-renewing capability, which provides a vital barrier function is diminished with age. The collagenous extracellular matrix at the dermal level, which is the bulk of skin that confers strength and resiliency, undergoes gradual fragmentation, which negatively impacts the skin’s mechanical properties and dermal cell functions.
Age-related alterations of skin consequently lead to age-related skin fragility and diseases.
Old age and itchy skin
Ageing affects three important components that induce itchy skin. This includes the barrier function of the epidermis, the immune system and the nervous system.
With age, there are significant changes that cause a decline in surface lipid production that maintains the epidermal barrier.
- Starting at approximately age 55, the surface pH of the epidermis becomes less acidic. The enzymes required to process the lipids that compose the epidermal water barrier require an acid pH.
- By the age of 70, the rate of production of the precursors of the lipid barrier is reduced, resulting in insufficient lipids to maintain the barrier.
The epidermal barrier insufficiency may be related to the increased risk of the development of contact dermatitis. This explains why an elderly patient complains of irritation and itchiness from washing products that were well tolerated at a younger age.
- Loss of sweat and oil glands on the skin will also lead to itchiness due to dry skin, the most common skin disorder among the elderly.
- Changes in the immune system are termed “immunosenescence”.
- The aged immune system is pro-inflammatory with dysfunction of immune cells. In some patients, this can result in an allergic reaction and the body’s inability to react effectively to infectious agents.
- Neurological conditions such as degenerative diseases of the spine may affect the elderly. In some cases, the sensory nerves may be affected and cause itchiness. Diabetes polyneuropathy can also manifest with the itchiness of the trunk.
- In the elderly, chronic itching can also be triggered by light pressure, such as the brush of fibres from a sweater.
According to a study by anaesthesiology researcher at the Washington University School of Medicine, older people may have less pressure-sensing cells that can lead to touch-related itchiness.
The study involved mice by applying a precise amount of pressure to a patch of shaved skin on the necks of young and old rodents.
It was discovered that older mice scratched more on the spot than the young mice in response to the light touch. Through skin analysis, the team found that older mice had far fewer pressure-sensing cells than young mice did.
Managing itchy skin in the elderly
Itchy skin, though it may seem trivial to most of us, can actually affect the quality of life of individuals especially the elderly.
- Itchiness is often observed as a sign of being unclean and can influence other’s perception of the elderly.
- Itchy skin may also be perceived as a source of infection or infestation. This perception can lead to an avoidance of the patient and isolation that could influence their quality of their lives.
Interventions to prevent this includes proper hydration, protection from irritants and daily sun protection.
This article first appeared in hellodoktor.com and was reviewed by The Hello Doktor Medical Panel. The Hello Health Group does not provide medical advice, diagnosis or treatment.