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Important pruritic dermatoses in the elderly Scabies Localised itch may also occur as a consequence of chronic scratching, resulting in a focal area of lichenification and hyperkeratosis (lichen simplex). It is typical for there to be a predominance on the non dominant side. In chronic scratching, characteristic eroded nodules may develop (nodular prurigo), which are commonly seen on the legs and arms. In generalised pruritus with excoriations, sparing of the central back is typical because the patient is unable reach this area to scratch without the use of an implement (Figure 1). senile pruritus).Īqueous cream with 1% menthol is useful in relieving itch in most cases whereas treatments such as phototherapy may be appropriate in specific cases. Treatment of pruritus relies on the identification of the underlying cause, although this may not always be possible (eg.
ITCHING RASH ON BUTTOCKS CRACK SKIN
It is critical to distinguish cases of widespread itch with primary skin disease (usually inflammatory) from those with secondary skin disease caused by trauma from chronic scratching (Box 3).
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The commonest cause of generalised pruritus is xerosis (dry skin), which is easily treated by avoidance of soap products and increased use of emollients. Generalised itch (pruritus) is a common complaint among the elderly. Older skin: how does it affect your management decisions? More than just skin deep: considerations when managing ageing skin.Yet sleep loss due to itch is characteristic of eczema. Psoriasis may often be associated with slight itch, but will rarely cause sleep loss due to scratching. Premalignant or malignant conditions such as Bowen’s disease will usually be asymptomatic. Infectious disease and drug reactions are likely to give a short history whereas psoriasis and eczema are likely to have been present for longer (Box 1).Īn additional distinction that provides useful diagnostic information is the presence and quality of itch (Box 2). The time-course of a rash can give a useful guide to the likely differential diagnosis. It is therefore unsurprising that the prevalence of different skin disorders varies with age. Langerhans cellnumbers within the basal layer of epidermis drop, increasing the propensity towards cutaneous infection. Characteristic wrinkles develop and the skin becomes increasingly fragile. The epidermis thins and the amount of collagen previously abundant within the dermis steadily falls. With ageing skin, there is a gradual decline in the skin’s ability to adequately sustain these processes. Our skin is a complex structure of cells and proteins that constantly act to protect and maintain the body’s normal function. Revised: June 2020 Published: February 2013 Introduction