Dermatoporosis

Specialty: Geriatrics.

• skin fragility in the elderly
• chronic skin failure syndrome
• extreme senile skin
• senile cutaneous atrophy

Why it occurs

• Severe physiological atrophy of the dermis and epidermis due to intrinsic and extrinsic skin aging (prolonged photoaging)
• Continuous and chronic use of topical or systemic corticosteroids for respiratory or rheumatic pathologies
• Peripheral vascular insufficiency predominantly venous or arterial that causes chronic tissue hypoxia in the extremities
• Chronic protein malnutrition and severe deficiency of collagen cofactors (Vitamin C, zinc)
• Repeated trauma due to friction, shear or inadequate handling in patients with dependence for transfers

Initial workup

Clinical evaluation and classification of dermatoporosis (Stages I to IV according to the presence of skin atrophy, senile purpura, stellate pseudoscars, dissecting hematomas and impossibility of healing); determination of total proteins and serum albumin to assess nutritional status; complete blood count, prothrombin time (PT), and activated partial thromboplastin time (aPTT); Arterial or venous Doppler ultrasound if signs of peripheral vascular disease are associated.

Standard management

• Emollient creams rich in fragmented hyaluronic acid and mild topical retinoids for dermatological use — applied twice a day to try to regenerate the dermal extracellular matrix and increase the thickness of the epidermis, avoiding vigorous massages that could tear the skin
• Vitamin C — 500 mg orally per day to act as a cofactor in the hydroxylation of proline for collagen synthesis in wound healing phases
• Zinc Sulfate (220 mg orally per day for a maximum of 3 weeks if a proven deficiency and delayed healing of skin lesions are associated).