Geriatric Psychodermatology Approaches
Özet
Geriatric psychodermatology addresses the complex interaction between the skin and the psyche in older adults, shaped by aging-related physiological changes, multimorbidity, and psychosocial factors. Management in the geriatric population is particularly challenging due to polypharmacy, drug interactions, and the high prevalence of neurological and psychiatric comorbidities. Chronic pruritus and xerosis are among the most common dermatological complaints in older adults and often have multifactorial etiologies, including systemic diseases, inflammatory dermatoses, and psychogenic factors. Chronic itch significantly impairs quality of life and may contribute to increased morbidity. Common psychodermatological disorders in the elderly include psychogenic pruritus, lichen simplex chronicus, prurigo nodularis, delusional infestation, neurotic excoriations, and scalp dysesthesia. Effective management requires a multidisciplinary approach integrating dermatological care with psychopharmacological and psychotherapeutic interventions, with careful consideration of treatment safety in older patients.
Referanslar
Jafferany M, Franca K. Psychodermatology: Basics Concepts. Acta Derm Venereol. 2016;96(217):35-7.
Ferreira BR, Vulink N, Mostaghimi L, Jafferany M, Balieva F, Gieler U, et al. Classification of psychodermatological disorders: Proposal of a new international classification. J Eur Acad Dermatol Venereol. 2024;38(4):645-56.
Marshall C, Taylor R, Bewley A. Psychodermatology in Clinical Practice: Main Principles. Acta Derm Venereol. 2016;96(217):30-4.
Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol. 2023;13:20451253231195274.
Kratz T, Diefenbacher A. Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy. Dtsch Arztebl Int. 2019;116(29-30):508-18.
Chang AL, Wong JW, Endo JO, Norman RA. Geriatric dermatology review: Major changes in skin function in older patients and their contribution to common clinical challenges. J Am Med Dir Assoc. 2013;14(10):724-30.
Jafferany M, Huynh TV, Silverman MA, Zaidi Z. Geriatric dermatoses: a clinical review of skin diseases in an aging population. Int J Dermatol. 2012;51(5):509-22.
Chung BY, Um JY, Kim JC, Kang SY, Park CW, Kim HO. Pathophysiology and Treatment of Pruritus in Elderly. Int J Mol Sci. 2020;22(1).
Berger TG, Shive M, Harper GM. Pruritus in the older patient: a clinical review. JAMA. 2013;310(22):2443-50.
Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol. 2022;86(1):1-14.
Garibyan L, Chiou AS, Elmariah SB. Advanced aging skin and itch: addressing an unmet need. Dermatol Ther. 2013;26(2):92-103.
Kini SP, DeLong LK, Veledar E, McKenzie-Brown AM, Schaufele M, Chen SC. The impact of pruritus on quality of life: the skin equivalent of pain. Arch Dermatol. 2011;147(10):1153-6.
Clerc CJ, Misery L. A Literature Review of Senile Pruritus: From Diagnosis to Treatment. Acta Derm Venereol. 2017;97(4):433-40.
Steinhoff M, Al-Khawaga S, Buddenkotte J. Itch in elderly patients: Origin, diagnostics, management. J Allergy Clin Immunol. 2023;152(1):42-9.
Mack MR, Kim BS. The Itch-Scratch Cycle: A Neuroimmune Perspective. Trends Immunol. 2018;39(12):980-91.
Grinnell M, Price KN, Shah A, Butler DC. Antihistamine safety in older adult dermatologic patients. J Am Acad Dermatol. 2022;87(2):381-6.
Fourzali KM, Yosipovitch G. Management of Itch in the Elderly: A Review. Dermatol Ther (Heidelb). 2019;9(4):639-53.
Sreekantaswamy SA, Mollanazar N, Butler DC. Gabapentinoids for Pruritus in Older Adults: A Narrative Review. Dermatol Ther (Heidelb). 2021;11(3):669-79.
Cao T, Tey HL, Yosipovitch G. Chronic Pruritus in the Geriatric Population. Dermatol Clin. 2018;36(3):199-211.
Kaur J, Kalsy J. Study of pruritus vulvae in geriatric age group in tertiary hospital. Indian J Sex Transm Dis AIDS. 2017;38(1):15-21.
Ju T, Vander Does A, Mohsin N, Yosipovitch G. Lichen Simplex Chronicus Itch: An Update. Acta Derm Venereol. 2022;102:adv00796.
Williams KA, Roh YS, Brown I, Sutaria N, Bakhshi P, Choi J, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021;14(1):67-77.
Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol. 2020;83(6):1567-75.
Le L, Gonski PN. Delusional parasitosis mimicking cutaneous infestation in elderly patients. Med J Aust. 2003;179(4):209-10.
Ozten E, Tufan AE, Cerit C, Sayar GH, Ulubil IY. Delusional parasitosis with hyperthyroidism in an elderly woman: a case report. J Med Case Rep. 2013;7:17.
Reich A, Kwiatkowska D, Pacan P. Delusions of Parasitosis: An Update. Dermatol Ther (Heidelb). 2019;9(4):631-8.
Suparmanian A, Cardona NJ. A Longitudinal Perspective Case Study of Delusional Parasitosis in a Geriatric Psychiatry Unit. Cureus. 2023;15(5):e39434.
Sani G, Gualtieri I, Paolini M, Bonanni L, Spinazzola E, Maggiora M, et al. Drug Treatment of Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-picking) Disorder, and Nail-biting (Onychophagia). Curr Neuropharmacol. 2019;17(8):775-86.
Deepmala, Slattery J, Kumar N, Delhey L, Berk M, Dean O, et al. Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review. Neurosci Biobehav Rev. 2015;55:294-321.
Ju T, Vander Does A, Yosipovitch G. Scalp dysesthesia: a neuropathic phenomenon. J Eur Acad Dermatol Venereol. 2022;36(6):790-6.
Geetha AA, Abdul Latheef EN, Sukumarakurup S, Devi K, Jafferany M. Psychiatric morbidity, stress and quality of life among geriatric dermatology patients: Therapeutic considerations from an Indian perspective. Dermatol Ther. 2021;34(4):e15018.