The study was conducted at Himalayan Institute of Medical Sciences, Dehradun, (Uttarakhand), India, which is a tertiary care hospital situated in sub-Himalayan region. In this retrospective study hospital patient records from august 2012-2014 were analysed. These registers were maintained in out patient department of Department of Dermatology, Venereology and Leprosy and contained information regarding age, sex and diagnosis of patients. Ethical clearance was taken from ethical committee of institute and the data was anonymized. From these records data of geriatric patients (60 years and above) was extracted. Three age groups were created: 60-69 years, 70-79 years and ≥ 80 years. The diseases were categorized into seven broad categories namely erythemato-squamous disorders, infectious diseases, benign neoplasms, precancerous lesions, cutaneous malignancies, age related skin changes and others. Descriptive statistics for the prevalence of skin diseases was calculated.

Total number of patients seen in Dermatology out patient department during the study period were 29422 and out of these 1380 (4.7%) were aged 60 years and above. There were 921 (66.7%) males and 459 (33.3%) females. Age of patients ranged from 60 years to 95 years with a mean age of 66.30±6.37 years. 69.6% patients were in the age group 60-69 years. The distribution of patients in the different age groups is shown in [Table/Fig-1].

Erythemato-squamous disorders taken collectively constituted the major skin disorder seen in 38.9% patients. This was followed by infections and infestations (29.9%), senile pruritus (9.0%) and age related skin changes (3.7%). Benign neoplasms were seen in 1.1% patients followed by cutaneous malignancies in 0.8% and precancerous lesions in 0.4%. The distribution of skin diseases according to gender and age group is shown in [Table/Fig-2].

Among the various erythemato-squamous disorders contact dermatitis was the most prevalent seen in 7.3% patients. This was followed closely by psoriasis (5.4%), endogenous eczema (4.1%), lichen planus (3.3%) and urticaria (3.0). Fungal infections were encountered in 18.0% patients. Out of this cutaneous dermatophytosis were seen in 76.3%, onychomycosis in 14.9% and candidiasis in 8.8% (n=249). 4.1% patients had presented with herpes zoster and 3.5% patients had post herpetic neuralgia. Pyodermas including folliculitis, furunculosis and cellulitis were seen in 2.7% patients. Scabies was encountered in 2.5% patients and 1.6% patients had Hansen’s disease.

Senile pruritus was also a common diagnosis seen in 9.0% of the total cases. Seborrheic keratoses were the most common benign neoplasms seen in 5 patients and actinic keratosis most common precancerous lesion seen in 4 patients. Among the cutaneous malignancies basal cell carcinoma were seen in 7 patients followed by cutaneous metastasis in 2 patients and squamous cell carcinoma and melanoma in one patient each.

Elderly population aged 60 and above constitutes a large and rapidly growing segment of Indian population. Dermatological diseases in elderly are increasing and thus put a great burden on health care system. It is important to identify the patterns of geriatric skin disorders for effective delivery of health care services. Aim of the study was to determine the frequency and distribution of skin diseases in elderly.

A high prevalence of infections and infestations was seen in our study (29.9%). This reflects the decrease in immunological functions of skin in elderly persons associated with a decrease in personal care. Fungal infections were the most common infections seen in 18% patients. Various other studies have reported variable rates ranging from 8.2% to 38.0% [3–7]. This wide variation can be explained because of differences in environmental conditions. High prevalence in our study probably reflects high humidity in our region. Among other infections herpes zoster and pyodermas were next in frequency. Scabies was seen in 2.5% of patients. In eczema-dermatitis group 7.3% patients had contact dermatitis, mostly allergic in nature. Most of the elderly population in this region is actively involved in farming increasing their exposure to various environmental allergens. Variable rates of dermatitis have been reported by other studies ranging from as low as 1.5% to as high as 58.7% [4,8–15].

Age related skin changes including senile pruritus were also seen in a substantial number of patients forcing them to seek dermatological consultation. A multitude of factors are responsible for senile pruritus. Most important among others being xerosis, intake of multiple drugs by elderly persons and co-morbidities including chronic kidney disease, chronic liver disease and diabetes mellitus. Due to lack of adequate information we could not identify patients with pruritus of systemic origin from those having idiopathic senile pruritus. A 9% of our patients sought consultation for pruritus. This is much lower than reported in another Indian study but comparable to that reported in a study from Turkey [4,5,8]. Precancerous lesions and malignancies collectively constituted 1.2% cases. This rate is much lower than that reported from Iran, Turkey and America, while is comparable to that reported from other Indian studies [3,4]. This probably reflects the influence of regional and ethnic factors. Comparison of prevalence of skin disorders among geriatric population in various studies is depicted in [Table/Fig-3].

Being a retrospective study, the major limitation of our study was lack of adequate information regarding the systemic co-morbidities in patients. Further only the diagnosis for which patient sought consultation was noted thus other asymptomatic age related changes must have been missed.

Geriatrics constitutes an important group of the total population having different spectrum of cutaneous diseases. Knowledge about diseases prevalent in this age group helps in better management thus improving the quality of life of elderly persons. This study strengthens the opinion that infections, eczema-dermatitis and senile pruritus are the major dermatological disorders in geriatrics. Larger studies in different regions of the country should be undertaken to analyse the effects of environment on disease frequencies.