Eczema in older adults

Eczema in older adults

While eczema is traditionally thought of as a children’s condition, it’s almost as common in adults over 60 as it is in children under the age of 18. It may get better in childhood but come back with age, or it may come and go throughout life. Older adults, especially those over 50, can also get eczema for the first time.

Drug-induced eczema is also more common in older adults. This is partly due to older adults tending to need more medication and partly due to the side-effects of drugs used to treat arthritis and targeted drugs for certain cancers, which are more common later in life.

Common types of eczema in later life

Atopic dermatitis

While most common in childhood, atopic dermatitis can strike at any age. This type of eczema is associated with a weakened skin barrier function, this reduces the skin’s ability to maintain moisture and protect against allergens.

The pattern of atopic dermatitis (AD) changes with age. Recent research has shown that the over 60s tend to have more severe and active disease, with more intense itching and increased levels of lichenification (thickened patches of eczema)1. Unlike younger age groups, the extensor surfaces tend to be affected rather than the flexural surfaces (e.g. the outside rather than the inside of the elbow). Typically, the trunk and arms are most affected2. UK data suggests that eczema is more likely to affect older men than older women3.

It’s often not clear what triggers late onset AD-type eczema. As we age the skin thins and becomes drier, which can lead to roughness, scaling and itchiness. This, in turn, can lead to increased sensitivity to allergens like house dust mites and pollens. In women, the effect of falling oestrogen levels during menopause can make the skin drier and more prone to eczema. Many older AD sufferers have a history of other atopic diseases including hayfever (40%) and asthma (20%)4.

Stress is a well documented eczema trigger throughout life and some cases of eczema in later life can be attributed to a particularly stressful event or period. Older people also seem to be more prone to Staphylococcus aureus related eczema flare-ups.

Asteatotic eczema

Asteatotic eczema usually affects the shins but can also affect other areas including the thighs, arms and trunk. The skin becomes very dry, rough and scaly, and sometimes resembles crazy paving or a dried-up riverbed. Asteatotic eczema is typically associated with warm, dry air and commonly occurs in the winter, when the central heating is on.

Applying emollients regularly, keeping the home well ventilated and using a humidifier will usually improve symptoms.

Varicose (gravitational/venous) eczema

Varicose eczema is associated with high blood pressure and varicose veins, often related to decreased mobility and only affects the lower legs and feet. The affected skin becomes itchy and inflamed. On white skin it looks red or brown, on darker skin tones it tends to look dark brown, purple or grey and can sometimes be more difficult to see. The skin will become dry and flaky. When severe, varicose eczema can have weeping, crusted areas. In varicose eczema, the skin becomes very thin and fragile on the lower legs and can easily break down, leading to an ulcer.

Treatment options

Emollients

As with all eczema, the mainstay of eczema treatment of older eczema sufferers is emollient treatment. This aims to replace the moisture that has been lost, allowing the skin to repair itself and create a protective film to exclude allergens. Finding an effective emollient is a case of trial and error. It needs to be comfortable on the skin and practical to apply as well as improving symptoms. You may need to vary the emollient depending on the sea

Trigger Avoidance

In the case of atopic dermatitis, trigger avoidance is also important. That said, as dust mites and pollen are common triggers in this age group, this can be impractical. In these cases regular washing (with gentle toiletries or emollients) can help to keep the skin clear of allergens.

Steroid treatments

Topical steroid creams are the front-line treatment for inflammation in eczema. They are typically prescribed by your GP and you should start to see an improvement within a few days. If you don’t see improvements within 1-2 weeks, you should book another appointment as there are other options.

Varicose treatments

As varicose eczema is related to poor circulation, increasing activity levels can help, when possible. Walking more (or more briskly), taking the stairs rather than lift and swimming can all help. If this is too much, seated cycling and ankle rotations can help. When you’re resting, try to have your feet up - ideally above the level of the heart. Your GP may also recommend compression socks.

Other treatments

Most other eczema treatments, have not been adequately tested on older adults so your doctor may not be keen to prescribe them

How can we help?

As we age our skin becomes more delicate and prone to irritation from clothing. The Tepso range has been designed specifically for delicate skin. Using the unique, super-smooth Tepso fibres, the range includes PJs, base layers, underwear, socks and gloves. All of these are either seamless or have enclosed seams to minimise irritation and maximise comfort.

The Tepso sock range can be a helpful addition to the management of both varicose and asteatotic eczema. Not only are the fibres super-smooth, minimising abrasion of delicate skin, but they also don’t absorb emollients, making topical treatments more effective. The range includes both short and knee length options.

Our sources

  1. Maurelli, M, et al. “Atopic Dermatitis in the Elderly Population.” Acta Dermato-Venereologica, U.S. National Library of Medicine, Dec. 2023, pmc.ncbi.nlm.nih.gov/articles/PMC10753596/.

  2. Williamson S;Merritt J;De Benedetto, S, et al. “Atopic Dermatitis in the Elderly: A Review of Clinical and Pathophysiological Hallmarks.” The British Journal of Dermatology, U.S. National Library of Medicine, Jan. 2020, pubmed.ncbi.nlm.nih.gov/30895603.

  3. Chan, Leslie N, et al. “The Epidemiology of Atopic Dermatitis in Older Adults: A Population-Based Study in the United Kingdom.” PloS One, U.S. National Library of Medicine, 6 Oct. 2021, pmc.ncbi.nlm.nih.gov/articles/PMC8494374/.

  4. Wang, HY, et al. “Characterization of Atopic Dermatitis in Older Adults: A Retrospective Study.” JAAD International, U.S. National Library of Medicine, Apr. 2024, pubmed.ncbi.nlm.nih.gov/38957841/.

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Revlutionary eczema clothing made with super smooth Tepso fibres

Here at Tepso, we don't just share our experiences of living with eczema, we also sell our unique clothing ranges, designed specifically for eczema and psoriasis sufferers

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