Caregiver Guide: Skin Problems

Understanding the Problem

Wrinkles and age spots are normal skin conditions that occur as a person ages. These are natural processes. Nevertheless, some older people can develop skin disorders that may turn into serious medical problems. Older skin is less oily, less elastic, and thinner. It bruises easily and can take a long time to heal when cut.

Older people will need to give their skin more care than it needed when they were younger.
 

It is important to use sunscreen before going outdoors at any age, even on cloudy or foggy days. This will protect against most kinds of skin cancer.  When buying sunscreen, look for a “broad-spectrum” UVA/UVB sunscreen with a sun protection factor (SPF) of 15 or higher.  Look for ingredients such as Parsol 1789 (avobenzone), titanium oxide, or zinc oxide. The sunblock needs to be reapplied after three to four hours, more often if the person is sweating a lot or is swimming.

Wearing a long-sleeved shirt and shady hat also gives good protection from the sun. It is also helpful for the older person to avoid the outdoors during the sunniest hours between 10 am and 3 pm.

 Your goals are to:

  • Encourage good skin care
  • Prevent pressure ulcers and skin infections
  • Be on the alert for skin cancers
  • Call for professional help when needed

Click on each of the topics below to read more.

When to Get Professional Help

Call a healthcare provider immediately or go to the emergency room if any of the following symptoms occur

Sudden, severe all over itching

Itching that occurs all over the body or in many places could be a sign of liver or kidney disease, thyroid disorder, or an allergy.

Blisters, or a rash on the forehead or temple, accompanied by inflammation or pain in the eye

This could be a sign that shingles is involving the eye. This is an emergency, and must be treated right away.

Call a healthcare provider during office hours to discuss the following problems

Severe itching on underarms, abdomen, hands, wrists, and groin

This could be a sign of scabies or mites. These are sometimes picked up during a hospital stay. Scabies is easily treated.

Moles that have the “ABCD” signs

  • Asymmetrical shape

  • Borders with irregularities

  • Color: pearly blue, black, or red

  • Diameter growing over ¼ inch

These could be caused by one kind of skin cancer and should be seen by a doctor or other healthcare provider.

Red areas on the skin that don’t turn white when you press on them, especially on areas over the hips, buttocks, elbows, and heels

This could be a sign of pressure sores developing, especially if the older person is bedridden, uses a wheelchair, or wears a brace.

A skin problem starts or becomes worse just after starting a new medicine, increasing the dose, or finishing the course of a medicine  

The healthcare provider can change the dosage, change the medicine, or treat the reaction. Skin reactions to medicines can include hives, eczema, blisters, swelling, itching, and burning or stinging after being in the sun.

A skin ulcer that grows in size or stays longer than two weeks without healing

This could be one of several kinds of skin cancer. A biopsy might be needed. Fortunately, many forms of skin cancer can be cured.

Red, hot, irritated, and painful skin

This could be the signs of cellulitis, a common skin infection caused by bacteria.  Any infections should be seen by a healthcare provider; antibiotics may be necessary.

Know the answers to the following questions before calling the healthcare provider

  • When was the last skin exam? (This should be a part of a physical examination.)

  • What medicines is the older person taking? Include non-prescription, herbal, and other remedies as well as prescription medicines.

  • If the problem is a mole, what does it look like? Describe the appearance of the mole in detail including size, color, shape, and if it is raised or flat.

  • If the problem is a skin ulcer that is not healing, describe how long it has been there, its size, whether it is getting bigger, and whether it ever bleeds.

  • Is there a history of previous skin cancer?

  • If the problem is itching, where is it affecting the body most?

  • If the problem is a rash, where is it? (chest, abdomen, back, arms, or legs?) Is it in more than one place?

  • What does it look like? Note the color, size, shape (round, raised, blister-like, wavy, sharp edges, several spots grouped together, or a straight line)

What You Can Do to Help

There are several kinds of skin problems that an older adult can need your help with.

Dry, itchy skin

This happens more often in winter when there is less humidity. Severe itchy skin (pruritus) can be very uncomfortable and can cause sleep loss and other symptoms of skin problems. The following are suggestions to prevent or treat dry, itchy skin:

Moisturize the skin

After a shower or bath, don’t rub skin dry.  Instead, gently pat it with a towel but still leave the skin moist. Then apply a lotion, body oil, or moisturizer that is high in petroleum (brand names such as Aquaphor™, Eucerin™, Vaseline™). Avoid moisturizers with perfume or alcohol since these can dry and irritate the skin.

Take fewer showers and keep them short

Water and heat draw moisture away from the body. So keep an older adult’s baths and showers warm (not hot), and short. Don't scrub skin roughly. Use a soft cloth or sponge instead of a rough washcloth. Soap should be a glycerin soap or one with moisturizing cream like Tone™ or Dove™. Make sure to rinse well.

Use petroleum jelly

For problem dry spots, apply petroleum jelly to troubled areas after a bath. When using petroleum jelly, make sure pajamas and/or socks are worn to protect bedding and clothing.

Keep bed sheets and clothing clean and change them often

Wash clothes and sheets in detergents free of perfumes and fabric softeners.  These can irritate the skin. Also make sure you rinse laundry thoroughly. The older person should wear cotton as much as possible since synthetic (artificial) fabrics can be irritating to skin.

Fluids

Drinking a lot of water can help prevent dry, itchy skin.  However, older adults should stay away from drinking caffeine or alcohol.  These can dry out the skin. (Some older adults take diuretic medicines.  Those are medicines that can cause someone to urinate more than usual.  In that case, check with the healthcare provider about how much liquid the older adult should drink.)

Use a humidifier with fresh water

A humidifier can keep the air moist, which can help prevent dry, itchy skin. Change the water daily to slow down the growth of bacteria.

 Severe itching

If the person you are caring for has severe itching, try colloidal oatmeal bath treatments (Aveeno™  or Sarna™ brands).  Use calamine lotion or cortisone creams on the itchy areas. Let older adults rub in the lotion themselves. Nails should be trimmed and they should not scratch, since this will only increase the itchiness.  For severe, persistent itching, ask the healthcare provider for advice since there are several types of medicines that can help.

Fungal infections

Fungal infections are another problem that older adults can have. Anyone can have fungal infections, but they happen the most to people with poor circulation, weak immune systems, diabetes, and who are taking antibiotics or corticosteroid drugs.

Fungus tends to grow in warm, moist areas of the body.  These include armpits, the mouth, scalp, behind the ears, genitals, under large breasts, folds in the abdomen, and between toes. The skin appears cracked, is very itchy, and can become very inflamed.

Here are some tips for coping with a fungal infection:

  • Keep skin clean and dry

  • Change socks and shoes once a day

  • Wear loose, cotton clothing

  • Use antifungal powder or cream

If the older adult does get a fungal infection, it can be treated with over-the-counter medicines.  Use antifungal powders or creams, such as clotrimazole (Lotrimin™) or miconazole (Micatin™). It can be effective to apply the antifungal cream to the affected area, then sprinkle the antifungal powder over the cream. Vicks VapoRubTM can be applied twice a day to toenails that have a fungal infection. such as clotrimazole (LotriminTM) or miconazole (MicatinTM), both available over-the-counter.  

Shingles

Shingles is a disease of the nervous system that affects the skin and causes small blisters to form. It is caused by the same virus that causes chicken pox (herpes zoster). Before the blisters form, the disease causes fatigue, chills, and headaches. Pain can be felt in the areas of the body supplied by the affected nerve. When the blisters open and then form crusts, they can be painful. Healing takes two to four weeks, and the skin is very sensitive during this time. As the rash progresses towards healing, itching can be troublesome.

Keep the affected area of skin clean and dry until it heals

The older adult’s healthcare provider can give you a soothing dressing to apply to the sensitive areas, and recommend treatment if itching is a problem.

Use Tylenol™ and other pain medicines to ease the symptoms

Healthcare providers often prescribe an anti-viral drug, such as acyclovir (Zovirax™), valacyclovir (Valtrex™), or famciclovir (Famvir™). These are most effective if given early in the disease.

Pressure Sores

If older adults spend most of their time in a bed, chair, or a wheelchair, they are in danger of getting something called pressure sores. When there is constant pressure on a bony area such as the tailbone, heels, elbows, or back of the head, the blood flow is blocked and blisters or open sores appear on the skin. Sores can also be caused by friction damage; for example, if a patient in bed is pulled over a sheet rather than carefully lifted. Skin that has become too moist because of sweating or that is covered in urine due to lack of bladder control can also develop cracks or sores.

The following are preventive measures you can take:

Change the position every one to two hours

Do not turn the person onto the reddened areas.  Protect heels and elbows from rubbing on sheets as well as from pressure. Pressure can be reduced in these areas by moving pillows or pads so that the heel or elbow isn’t pressing on the bed. Frequent repositioning is needed to keep blood flowing to lower back and sides of hips. Pillows wedged behind the back will help keep the older person on their side. While lying sideways, a pillow between knees protects the knees from rubbing against each other. Big turns aren’t needed during the night; small position changes will help and do not interrupt sleep.

Keep sheets pulled flat without wrinkles

This is important because wrinkles in a sheet can press on the skin, causing pressure sores. Avoid dragging the person along the bed sheets when turning or moving them. Using a lifting sheet or draw sheet will help.  (A draw sheet is a small bedsheet that covers the area between a person's upper back and thighs.)

Help the person practice movement

Movement helps to keep blood flowing and helps prevent pressure sores. Get the older person to stand or walk around. If they are unable to do this, encourage squeezing the toes, moving arms, raising legs or other movements that can be done sitting or lying down.  Encourage an older adult in a wheelchair to do “push-ups”. This means pushing down against the wheelchair arms, which raises the body and allows the person to change position.

 Keep skin clean and dry

Sheets should be changed daily, especially if the older person is sweaty or incontinent (cannot control urine). Avoid plastic coated materials under the person, since they cause sweating. Cotton or sheepskin pads are best because they allow air to circulate next to the skin.

Massage, but not on sore areas

A gentle massage is great for circulation. Do not massage red areas, since friction may do more damage to the area, but do massage around the reddened area to increase circulation.

Use pads or protectors

Heels and elbows can be protected by putting a cotton-covered foam pad on the feet or over the arms. These are called "heel protectors" or "elbow protectors" and can be purchased at medical supply stores.

Make sure the older person eats a good varied diet, including enough protein

Four to six ounces of meat or fish is a good estimate of the amount of protein the older adult should eat. If protein intake is poor, you can try offering a protein shake as a snack once to twice a day. The older person should also consider taking a daily multi-vitamin pill containing zinc and magnesium.

Carrying Out Your Plan

Problems you might have carrying out your plan

Even when you have excellent plans, there may be obstacles or problems that can prevent you from carrying them out. You or the older person may have beliefs that might get in the way of carrying out your plan.

Here are some examples and responses:

"Dry skin is just a problem of old age."

Yes, it is true older skin is less oily and it is thinner than that of a younger person. However, if it is left untreated, dry skin can turn into severe itchy skin or pressure sores.  Those can cause discomfort and disruption of normal daily activities such as sleeping. Preventing dry skin can greatly reduce the chances of severe skin problems happening.

"It's too difficult to reposition my father every one to two hours, since he is bedridden."

Repositioning a bedridden older adult is very important and must be done to avoid bedsores. A visiting nurse can provide pointers on how to accomplish the turning more easily, or a home health aide might be needed to help you.

Think of other problems you might have carrying out your plan

Think of other problems could get in the way of doing the things suggested in this section. For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?

You need to make plans for solving these problems.

Checking on Progress

Prevention is your first goal. Remember the following tips:

  • Keeping the skin clean and moisturized is the way to prevent dry, itchy skin and rashes.

  • Frequent repositioning helps prevent pressure sores.

  • Be alert for the development of new rashes, slow-to-heal skin ulcers, or other skin growths.

  • Never let the older person go outdoors without applying sunblock of at least 15 SPF to all exposed skin, even on a cloudy or foggy day.

  • When a skin problem happens, develop a plan and follow it. It is important to do each step regularly and to persist, since skin problems often take time to heal.

Always be on the lookout for early signs of skin problems. When treating a skin problem, ask the healthcare provider how long it typically takes to return to normal so that you can judge if you are making progress.

If skin problems become worse in spite of what you do, contact the healthcare provider and ask for advice.

Last Updated July 2015