Skip to main content
SpringerLink
Log in

Contact Dermatitis in the Elderly: Predisposing Factors, Diagnosis, and Management

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Increased aging of the general population is a well-known fact with serious effects on health systems worldwide. Skin aging involves various immunological and structural changes that increase the risk of numerous skin diseases such as contact dermatitis. Contact dermatitis is characterized by an inflammation of the skin caused by an interaction between the skin and external agents and is divided into irritant and allergic contact dermatitis. Irritant contact dermatitis occurs on skin areas directly exposed to irritant substances, which results in a stream of pro-inflammatory cytokines mediating the skin injury. Asteatotic and perineal irritant contact dermatitis are the most important subtypes of irritant contact dermatitis in the elderly. Allergic contact dermatitis is a T cell-mediated inflammatory reaction and requires a prior sensitization. The most common allergens responsible for allergic contact dermatitis in the elderly are fragrance mix, nickel, and balsam of Peru. Elderly patients with stasis dermatitis, chronic wounds, and chronic venous insufficiency have an increased prevalence of sensitization due to the frequent exposure to topical treatments. In this review, the most common types of contact dermatitis in the elderly are enumerated in order to assist dermatologists and other physicians to identify contact dermatitis in this distinct group of the population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. United Nations DoEaSA, Population Division (2017) world population prospects: the 2017 revision, key findings and advance tables. https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf2017. Accessed 1 Apr 2018

  2. Caruso C, Buffa S, Candore G, Colonna-Romano G, Dunn-Walters D, Kipling D, et al. Mechanisms of immunosenescence. Immun Ageing. 2009;6:10. https://doi.org/10.1186/1742-4933-6-10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Wiegand C, Raschke C, Elsner P. Skin aging: a brief summary of characteristic changes. Textbook of aging skin. Berlin/Heidelberg: Springer-Verlag; 2015.

    Google Scholar 

  4. Lukacs J, Elsner P. Irritant contact dermatitis. Textbook of aging skin. Berlin/Heidelberg: Springer-Verlag; 2015.

    Google Scholar 

  5. Fulop T, Dupuis G, Baehl S, Le Page A, Bourgade K, Frost E, et al. From inflamm-aging to immune-paralysis: a slippery slope during aging for immune-adaptation. Biogerontology. 2016;17(1):147–57. https://doi.org/10.1007/s10522-015-9615-7.

    Article  CAS  PubMed  Google Scholar 

  6. Solana R, Tarazona R, Gayoso I, Lesur O, Dupuis G, Fulop T. Innate immunosenescence: effect of aging on cells and receptors of the innate immune system in humans. Semin Immunol. 2012;24(5):331–41. https://doi.org/10.1016/j.smim.2012.04.008.

    Article  CAS  PubMed  Google Scholar 

  7. Wenisch C, Patruta S, Daxbock F, Krause R, Horl W. Effect of age on human neutrophil function. J Leukoc Biol. 2000;67(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  8. Denkinger MD, Leins H, Schirmbeck R, Florian MC, Geiger H. HSC Aging and senescent immune remodeling. Trends Immunol. 2015;36(12):815–24. https://doi.org/10.1016/j.it.2015.10.008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Listi F, Candore G, Modica MA, Russo M, Di Lorenzo G, Esposito-Pellitteri M, et al. A study of serum immunoglobulin levels in elderly persons that provides new insights into B cell immunosenescence. Ann N Y Acad Sci. 2006;1089:487–95. https://doi.org/10.1196/annals.1386.013.

    Article  CAS  PubMed  Google Scholar 

  10. Minciullo PL, Catalano A, Mandraffino G, Casciaro M, Crucitti A, Maltese G, et al. Inflammaging and anti-inflammaging: the role of cytokines in extreme longevity. Arch Immunol Ther Exp (Warsz). 2016;64(2):111–26. https://doi.org/10.1007/s00005-015-0377-3.

    Article  CAS  Google Scholar 

  11. Di Lorenzo G, Di Bona D, Belluzzo F, Macchia L. Immunological and non-immunological mechanisms of allergic diseases in the elderly: biological and clinical characteristics. Immun Ageing. 2017;14:23. https://doi.org/10.1186/s12979-017-0105-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Farage MA, Miller KW, Elsner P, Maibach HI. Structural characteristics of the aging skin: a review. Cutan Ocul Toxicol. 2007;26(4):343–57. https://doi.org/10.1080/15569520701622951.

    Article  PubMed  Google Scholar 

  13. Kosmadaki MG, Gilchrest BA. The role of telomeres in skin aging/photoaging. Micron. 2004;35(3):155–9. https://doi.org/10.1016/j.micron.2003.11.002.

    Article  CAS  PubMed  Google Scholar 

  14. Ning MS, Andl T. Control by a hair’s breadth: the role of microRNAs in the skin. Cell Mol Life Sci. 2013;70(7):1149–69. https://doi.org/10.1007/s00018-012-1117-z.

    Article  CAS  PubMed  Google Scholar 

  15. Kottner J, Lichterfeld A, Blume-Peytavi U. Maintaining skin integrity in the aged: a systematic review. Br J Dermatol. 2013;169(3):528–42. https://doi.org/10.1111/bjd.12469.

    Article  CAS  PubMed  Google Scholar 

  16. Thune P, Nilsen T, Hanstad IK, Gustavsen T, Lovig Dahl H. The water barrier function of the skin in relation to the water content of stratum corneum, pH and skin lipids. The effect of alkaline soap and syndet on dry skin in elderly, non-atopic patients. Acta Derm Venereol. 1988;68(4):277–83.

  17. Elsner P, Wilhelm D, Maibach HI. Sodium lauryl sulfate-induced irritant contact dermatitis in vulvar and forearm skin of premenopausal and postmenopausal women. J Am Acad Dermatol. 1990;23(4 Pt 1):648–52.

    Article  CAS  PubMed  Google Scholar 

  18. Harvell JD, Maibach HI. Percutaneous absorption and inflammation in aged skin: a review. J Am Acad Dermatol. 1994;31(6):1015–21.

    Article  CAS  PubMed  Google Scholar 

  19. Choi EH, Man MQ, Xu P, Xin S, Liu Z, Crumrine DA, et al. Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol. 2007;127(12):2847–56. https://doi.org/10.1038/sj.jid.5700913.

    Article  CAS  PubMed  Google Scholar 

  20. Fenske NA, Lober CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986;15(4 Pt 1):571–85.

    Article  CAS  PubMed  Google Scholar 

  21. Yaar M, Gilchrest BA. Skin aging: postulated mechanisms and consequent changes in structure and function. Clin Geriatr Med. 2001;17(4):617–30 (v).

  22. Sudel KM, Venzke K, Mielke H, Breitenbach U, Mundt C, Jaspers S, et al. Novel aspects of intrinsic and extrinsic aging of human skin: beneficial effects of soy extract. Photochem Photobiol. 2005;81(3):581–7. https://doi.org/10.1562/2004-06-16-RA-202.

    Article  PubMed  Google Scholar 

  23. Farage MA, Miller KW, Elsner P, Maibach HI. Characteristics of the aging skin. Adv Wound Care (New Rochelle). 2013;2(1):5–10. https://doi.org/10.1089/wound.2011.0356.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10(4):262–8. https://doi.org/10.1634/theoncologist.10-4-262.

    Article  PubMed  Google Scholar 

  25. Menon G, Ghadially R. Morphology of lipid alterations in the epidermis: a review. Microsc Res Tech. 1997;37(3):180–92. https://doi.org/10.1002/(SICI)1097-0029(19970501)37:3%3c180:AID-JEMT3%3e3.0.CO;2-S.

    Article  CAS  PubMed  Google Scholar 

  26. Saint-Mezard P, Krasteva M, Chavagnac C, Bosset S, Akiba H, Kehren J, et al. Afferent and efferent phases of allergic contact dermatitis (ACD) can be induced after a single skin contact with haptens: evidence using a mouse model of primary ACD. J Invest Dermatol. 2003;120(4):641–7. https://doi.org/10.1046/j.1523-1747.2003.12093.x.

    Article  CAS  PubMed  Google Scholar 

  27. Leonard A, Guttman-Yassky E. The unique molecular signatures of contact dermatitis and implications for treatment. Clin Rev Allergy Immunol. 2018. https://doi.org/10.1007/s12016-018-8685-0.

  28. Gittler JK, Krueger JG, Guttman-Yassky E. Atopic dermatitis results in intrinsic barrier and immune abnormalities: implications for contact dermatitis. J Allergy Clin Immunol. 2013;131(2):300–13. https://doi.org/10.1016/j.jaci.2012.06.048.

    Article  CAS  PubMed  Google Scholar 

  29. Simon M, Bernard D, Minondo AM, Camus C, Fiat F, Corcuff P, et al. Persistence of both peripheral and non-peripheral corneodesmosomes in the upper stratum corneum of winter xerosis skin versus only peripheral in normal skin. J Invest Dermatol. 2001;116(1):23–30. https://doi.org/10.1046/j.1523-1747.2001.00208.x.

    Article  CAS  PubMed  Google Scholar 

  30. Loffler H, Effendy I, Happle R. Irritant contact dermatitis. Hautarzt. 2000;51(3):203–15.

    Article  CAS  PubMed  Google Scholar 

  31. Beele H, Smet S, Van Damme N, Beeckman D. Incontinence-associated dermatitis: pathogenesis, contributing factors, prevention and management options. Drugs Aging. 2018;35(1):1–10. https://doi.org/10.1007/s40266-017-0507-1.

    Article  CAS  PubMed  Google Scholar 

  32. Fluhr JW, Dickel H, Kuss O, Weyher I, Diepgen TL, Berardesca E. Impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption. Br J Dermatol. 2002;146(5):770–6.

    Article  CAS  PubMed  Google Scholar 

  33. Adam R. Skin care of the diaper area. Pediatr Dermatol. 2008;25(4):427–33. https://doi.org/10.1111/j.1525-1470.2008.00725.x.

    Article  PubMed  Google Scholar 

  34. Mugita Y, Minematsu T, Huang L, Nakagami G, Kishi C, Ichikawa Y, et al. Histopathology of incontinence-associated skin lesions: inner tissue damage due to invasion of proteolytic enzymes and bacteria in macerated rat skin. PLoS One. 2015;10(9):e0138117. https://doi.org/10.1371/journal.pone.0138117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Campbell JL, Coyer FM, Mudge AM, Robertson IM, Osborne SR. Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study. Int Wound J. 2017;14(3):488–95. https://doi.org/10.1111/iwj.12630.

    Article  PubMed  Google Scholar 

  36. Wilhelm KP, Maibach HI. Factors predisposing to cutaneous irritation. Dermatol Clin. 1990;8(1):17–22.

    Article  CAS  PubMed  Google Scholar 

  37. Slodownik D, Lee A, Nixon R. Irritant contact dermatitis: a review. Australas J Dermatol. 2008;49(1):1–9 (quiz 10-1). https://doi.org/10.1111/j.1440-0960.2007.00409.x.

  38. Krasteva M, Kehren J, Ducluzeau MT, Sayag M, Cacciapuoti M, Akiba H et al. Contact dermatitis I. Pathophysiology of contact sensitivity. Eur J Dermatol. 1999;9(1):65–77.

  39. Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clin Dermatol. 2011;29(1):24–30. https://doi.org/10.1016/j.clindermatol.2010.07.003.

    Article  PubMed  Google Scholar 

  40. Buckley DA, Rycroft RJ, White IR, McFadden JP. The frequency of fragrance allergy in patch-tested patients increases with their age. Br J Dermatol. 2003;149(5):986–9.

    Article  CAS  PubMed  Google Scholar 

  41. Mahler V. Contact allergies in the elderly. Hautarzt. 2015;66(9):665–73. https://doi.org/10.1007/s00105-015-3668-z.

    Article  CAS  PubMed  Google Scholar 

  42. Wohrl S, Hemmer W, Focke M, Gotz M, Jarisch R. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns. Pediatr Dermatol. 2003;20(2):119–23.

    Article  PubMed  Google Scholar 

  43. Piaserico S, Larese F, Recchia GP, Corradin MT, Scardigli F, Gennaro F, et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res. 2004;16(3):221–5.

    Article  PubMed  Google Scholar 

  44. Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization of older patients in an academic department in Naples. Italy. Dermatitis. 2008;19(4):209–12.

    Article  Google Scholar 

  45. Nanda A, Wasan A. Allergic contact dermatitis to balsam of Peru. Ann Allergy Asthma Immunol. 2016;117(2):208–9. https://doi.org/10.1016/j.anai.2016.06.012.

    Article  CAS  PubMed  Google Scholar 

  46. Wakelin SH, Smith H, White IR, Rycroft RJ, McFadden JP. A retrospective analysis of contact allergy to lanolin. Br J Dermatol. 2001;145(1):28–31.

    Article  CAS  PubMed  Google Scholar 

  47. Bordel-Gomez MT, Miranda-Romero A. Contact sensitization to Euxyl K-400. Actas Dermosifiliogr. 2009;100(3):201–4.

    Article  CAS  PubMed  Google Scholar 

  48. Tennvall GR, Andersson K, Bjellerup M, Hjelmgren J, Oien R. [Treatment of venous leg ulcers can be better and cheaper. Annual costs calculation based on an inquiry study]. Lakartidningen. 2004;101(17):1506–10, 12–3.

  49. Maddox D. Effects of venous leg ulceration on patients’ quality of life. Nurs Stand. 2012;26(38):42–9. https://doi.org/10.7748/ns2012.05.26.38.42.c9111.

    Article  PubMed  Google Scholar 

  50. Saap L, Fahim S, Arsenault E, Pratt M, Pierscianowski T, Falanga V, et al. Contact sensitivity in patients with leg ulcerations: a North American study. Arch Dermatol. 2004;140(10):1241–6. https://doi.org/10.1001/archderm.140.10.1241.

    Article  PubMed  Google Scholar 

  51. Machet L, Couhe C, Perrinaud A, Hoarau C, Lorette G, Vaillant L. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975–2003 data. Br J Dermatol. 2004;150(5):929–35. https://doi.org/10.1111/j.1365-2133.2004.05917.x.

    Article  CAS  PubMed  Google Scholar 

  52. Kulberg A, Schliemann S, Elsner P. Contact dermatitis as a systemic disease. Clin Dermatol. 2014;32(3):414–9. https://doi.org/10.1016/j.clindermatol.2013.11.008.

    Article  PubMed  Google Scholar 

  53. Veien NK. Systemic contact dermatitis. Int J Dermatol. 2011;50(12):1445–56. https://doi.org/10.1111/j.1365-4632.2011.05104.x.

    Article  CAS  PubMed  Google Scholar 

  54. Koch L, Aberer W. Allergic contact dermatitis of the scalp. Hautarzt. 2017;68(6):466–71. https://doi.org/10.1007/s00105-017-3975-7.

    Article  CAS  PubMed  Google Scholar 

  55. Cohen DE, Heidary N. Treatment of irritant and allergic contact dermatitis. Dermatol Ther. 2004;17(4):334–40. https://doi.org/10.1111/j.1396-0296.2004.04031.x.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University Hospital Jena, Erfurter Straße 35, 07740, Jena, Germany

    Ana Luiza Lima, Vanessa Timmermann, Tanja Illing & Peter Elsner

Authors
  1. Ana Luiza Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vanessa Timmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tanja Illing
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Elsner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana Luiza Lima.

Ethics declarations

Funding

No funding was received for the preparation of this manuscript.

Conflict of interest

AL. Lima, V. Timmermann, T. Illing, and P. Elsner declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lima, A.L., Timmermann, V., Illing, T. et al. Contact Dermatitis in the Elderly: Predisposing Factors, Diagnosis, and Management. Drugs Aging 36, 411–417 (2019). https://doi.org/10.1007/s40266-019-00641-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-019-00641-4

Search

Navigation