Skin and
soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and
therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities include
antiseptics, topical and systemic antibacterials, dressings and
biotherapy. Skin
infections presenting with
erythema,
blisters, pustules, and ulcerations or in body folds are described in detail.
Cellulitis and infected
ulcers are the most commonly encountered cutaneous
infections in the elderly. Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality. Appropriate antibacterials,
antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns. Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than
infection of the skin.
Cellulitis should be clinically distinguished from
erysipelas and necrotising
fasciitis. The latter is a life-threatening condition, which in the majority of cases requires surgical
debridement of the infected tissue.
Blisters and honey-coloured crusts are typical features of
impetigo. It is very contagious and close contacts should be examined.
Folliculitis is a commonly seen skin
infection, which often responds to the use of
antiseptics and topical antibacterials. More severe pustular skin eruptions, such as
furunculosis and carbunculosis, usually require treatment with systemic antibacterials.
Intertrigo and
erythrasma have a predilection for the body folds, especially the axillae and groin, and topical
therapy is usually sufficient. Secondary skin
infections are often the result of persistent
pruritus associated with increasing dryness of the aging skin.
Emollients and
antihistamines are useful measures. Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy. Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous
infections.