I. Physiological characteristics of the skin of the elderly
The skin of the elderly has a weakened sense of touch, pain and temperature, a reduced defense function against adverse stimuli, and a weakened regeneration and healing ability. The main manifestations are.
① Scalp hair papillae gradually decrease, metabolic function decreases, endocrine disorders, nutritional deficiencies, resulting in thinning hair and even baldness.
②Finger (toe) nail due to insufficient blood supply, easy to become brittle, thinning, loss of luster, become yellow or cloudy, easy to fall off.
③The skin surface is gradually rough, the epidermal keratinized layer is slightly thick, the granular layer and the spiny cell layer become thin and have vacuolation degeneration, and the cell regeneration ability is weakened. Skin wrinkles appear due to increased water loss, gradual reduction of subcutaneous fat and elastic tissue and subcutaneous muscle pulling.
④ The dermis decreases in subcutaneous fat with ageing, and the dermal papillae are reduced, thinned and atrophied. The connective tissue decreases, the elastin of the elastic fibers degenerates causing the elastic fibers to lose their elasticity and the collagen fibers to become more solid, resulting in sagging skin and reduced elasticity.
⑤ In the elderly, sebaceous glands atrophy, sebum secretion decreases, and skin and hair lose their luster and crack easily. The size, number and sweat secretion of sweat glands are reduced, resulting in dry and itchy skin.
(6) Due to arteriosclerosis, thickening of blood vessel walls and narrowing of lumen, peripheral blood circulation is obstructed in the elderly, and the skin vessels are slow to respond to cold and heat, thus the thermoregulatory function of the skin decreases, resulting in capillary dilation and small varicose veins.
(7) With age, the density of skin nerve endings is significantly reduced, tactile vesicles are significantly reduced and sensory dullness.
Second, the elderly are prone to eczema reasons
Eczema is an inflammatory, allergic skin disease, clinically manifested by recurrent itching and symmetrical distribution of polymorphic damage, tendency to moist, recurrent, easy to become chronic. Although eczema can occur in both men and women regardless of age or gender, the body functions of the elderly are declining, and the ability to adapt to the environment, defend against external evil and resist harmful substances is poorer than that of young people. In addition, because of the increased sensitivity of the skin of the elderly, they are unable to tolerate many common stimuli in life. For example, climate changes such as dry, humid, high temperature, cold and other environmental changes to stimulate skin lesions; diet, spicy food, fish, shrimp, mutton and other animal xenoproteins easily lead to skin allergies in the elderly; pollen in the air, dust mites, chemical smells, daily skin contact cosmetics, detergents, fur and chemical fabrics, etc., may trigger eczema. Thus, the elderly are prone to eczema.
The Chinese medicine understanding of eczema in the elderly
Eczema is called “wet sores” in Chinese medicine, and it is believed that eczema in the elderly is mostly due to endowment intolerance, wind-damp-heat guest in the skin; or due to spleen failure or blood deficiency, damp-heat retention, resulting in blood deficiency and wind dryness, wind-dry damp-heat stagnation, skin loss of nourishment. The disease moves Ting, damp-heat stays, dampness obstructs into stasis, or wind-heat hurts Yin and dryness, stasis obstructs the meridians, blood does not camp the skin or both Qi and Yin are deficient or blood is deficient and wind is dry.
Fourth, the clinical manifestations of eczema in the elderly
Eczema according to the course of the disease and the characteristics of the lesions, generally can be divided into acute, subacute, chronic three categories. Eczema in the elderly is mostly chronic and subacute eczema. Chronic cases are often confined to the lower legs, hands, feet, vulva, anus and other areas. The main manifestations are local skin thickening, infiltration, surface roughness, moss-like changes, dark red or gray-brown, there may be pigmentation, a little scales, scratches and crusts. In subacute cases, the lesions are mainly erythematous, small papules, crusts and scales, there may be a few papules, mild vesicles, and longer lesions may have mild infiltration.
Five, the treatment of eczema in the elderly
Western medicine treats eczema with symptomatic treatment, including the use of antihistamines, glucocorticosteroids, sedatives and other drugs, and when combined with infection, add antibiotics. Although western medical treatment has good efficacy, it is easy to relapse after stopping the medication and there are certain side effects. Chinese medicine treatment of eczema advocates more evidence-based treatment, reducing the slow, but the efficacy of lasting and stable. In recent years new treatment methods in recent years topical immunosuppressants for eczema dermatitis, such as domestic currently with tacrolimus ointment, its efficacy can reach the level of glucocorticoids, but without the side effects of hormones. Immunomodulators such as levamisole, BCG polysaccharide square acid, etc.
Six, the elderly eczema treatment precautions
(1) Use glucocorticosteroids with caution
Glucocorticosteroids have powerful anti-allergic and anti-inflammatory effects, and are undoubtedly very effective for internal use in the treatment of eczema. But the serious side effects of glucocorticoids, longer use can lead to atrophy of the adrenal cortex and cause dependence on exogenous corticosteroids, resulting in repeated aggravation of eczema, especially for elderly patients more obvious. Secondly, the elderly are often accompanied by hypertension, diabetes, coronary heart disease, osteoporosis and other diseases, the use of hormones may induce or aggravate their condition.
(2) Rational selection of topical drugs
Different topical preparations should be reasonably selected for different stages and different lesions. In the acute stage, more solutions are used for more exudation. In the subacute stage, glucocorticoid emulsions and pastes can be used. In the chronic stage, ointment, hard cream and coating agent should be used. In addition, topical glucocorticoids should not be used together with internal medicine to avoid increasing drug resistance. Elderly people with thin skin should use weak hormones and should not use them in a large area or for a long time.
(3) Selection of antihistamines
If the eczema area is large, it is best to add 1 or 2 antihistamines along with the topical medication. In order to increase the efficacy and reduce side effects, it is better to use 2 different drugs rather than 1 drug doubled. Elderly eczema combined with cardiovascular disease or diabetes and other disorders, should be careful to use the second generation of antihistamines, so as not to trigger or aggravate the underlying disease, more than the first generation of antihistamines.
Seven, elderly patients with eczema prevention and conditioning
(1) elderly eczema itching, patients like to scratch, easy to form a vicious cycle of itching – scratching – itching, scratching will aggravate the lesions, and even erosion, water, secondary infection. Therefore, avoiding excessive scratching is one of the key points of prevention and regimen. When the rash is itchy, you can apply local medicine, or use the liquid wet compress to stop the itch.
(2) Avoid the stimulation of triggering factors, in terms of diet, patients should stop smoking and drinking, do not eat spicy hair, such as fish, shrimp, crab, mutton, fresh mushrooms, leeks, etc..
(3) The living environment should be soothing and fresh air. Avoid humidity, dryness, odor stimulation.
(4) clothes, bed sheets, covers clean, preferably silk or pure cotton. Avoid using chemical fibers, fur fabrics, down and other clothing that irritate the skin.
(5) Bathing should be moderate, avoid hot water scalding the affected area or excessive bathing, avoid the stimulation of very strong alkaline bath soap or soap, you can choose a mild nature of the children’s bath.
(6) To regulate the mood, regular life and living, to prevent colds.