Skin infections and ageing.

Elderly individuals have an increased susceptibility to skin infections due to age-related anatomical, physiological and environmental factors. The types of organisms that cause primary skin and soft tissue infections are diverse, and include bacterial, viral and fungal pathogens as well as parasites. In the elderly, these infections and infestations may present with atypical signs and symptoms or may complicate underlying chronic skin disorders. Clinical features, investigations and management of the following important and common skin infections are described in more detail: cellulitis, erysipelas, necrotizing fasciitis, impetigo, folliculitis, furunculosis and carbunculosis, erythrasma, herpes zoster and postherpetic neuralgia, herpes simplex, warts, molluscum contagiosum, dermatophytosis of the skin, hair and nails, candidiasis, and scabies. Treatment should be based on the results of the appropriate diagnostic tests. Correct diagnosis and therapy of skin infections lead to satisfactory outcome in the majority of elderly patients.

Treatment of resistant port wine stains with the V Beam pulsed dye laser.

BACKGROUND AND OBJECTIVES: Pulsed dye lasers (PDL; 585 nm, 0.45 millisecond) are the treatment of choice for port wine stains (PWS). However, clearance rates vary widely and are in many patients incomplete. The objective of this prospective pilot study was to investigate the effects of a long pulse-duration 595 nm PDL (V Beam, Candela Laser Corporation, Wayland, MA) on previously treated PWS to ascertain whether further lightening can be obtained. Treatment response was assessed subjectively (photographs) and objectively with noninvasive techniques (reflectance spectrophotometer and spectrophotometric intracutaneous analysis scope (SIAscope)). STUDY DESIGN/MATERIALS AND METHODS: Twelve adult patients with congenital PWS each had four test patches with different spot sizes, fluences, and pulse widths carried out. The test area with the best response was selected and two laser treatments were performed at weeks 8 and 16. Photographs and measurements with a reflectance spectrophotometer and SIAscope (Astron Clinica, Cambridge, UK) were performed at baseline, before each treatment and at final review at week 24. RESULTS: Of the nine patients who completed the study three patients showed a good response (51-75% lightening), which was supported by measurements with the reflectance spectrophotometer and the SIAscope. A further three patients had fair improvement (26-50% lightening) and three patients had a minor or no response (0-25% lightening). In two patients a discrepancy between the degree of clinical response and some of the objective measurements was noticed. CONCLUSIONS: The 595 nm V Beam PDL appears to achieve further lightening of therapy-resistant PWS in the majority of patients (67%). Both reflectance spectrophotometer and SIAscope appear to permit assessment of objective treatment responses. Results require confirmation in larger studies.

Bacterial skin infections in the elderly: diagnosis and treatment.

Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities include antiseptics, topical and systemic antibacterials, dressings and biotherapy. Skin infections presenting with erythema, blisters, pustules, and ulcerations or in body folds are described in detail. Cellulitis and infected ulcers are the most commonly encountered cutaneous infections in the elderly. Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality. Appropriate antibacterials, antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns. Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than infection of the skin. Cellulitis should be clinically distinguished from erysipelas and necrotising fasciitis. The latter is a life-threatening condition, which in the majority of cases requires surgical debridement of the infected tissue. Blisters and honey-coloured crusts are typical features of impetigo. It is very contagious and close contacts should be examined. Folliculitis is a commonly seen skin infection, which often responds to the use of antiseptics and topical antibacterials. More severe pustular skin eruptions, such as furunculosis and carbunculosis, usually require treatment with systemic antibacterials. Intertrigo and erythrasma have a predilection for the body folds, especially the axillae and groin, and topical therapy is usually sufficient. Secondary skin infections are often the result of persistent pruritus associated with increasing dryness of the aging skin. Emollients and antihistamines are useful measures. Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy. Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous infections.