In this study it was found that the prevalence of dermatological disorders among the elderly in Ilala Municipality was 85.4%. This finding was comparable to those from a cross-sectional study conducted in Northern Finland involving 552 elderly aged 70 and above whereby an overall prevalence of skin diseases was found to be 80%, and the most common dermatological conditions were fungal skin infections(9). Similarly, a previous multicenter study conducted in the federal state of Berlin, Germany among aged nursing home residents found that skin diseases were common, and almost every participant had at least one dermatological diagnosis(10). However, our findings are different from other findings reported in literature. For instance, a systematic analysis that included electronic database searches in MEDLINE, and PubMed in Australia that screened 61 reports from countries showed that the nature and prevalence of skin disease among the elderly varies widely between clinical environments. Indeed, we discovered during our literature review that the prevalence of skin problems reported by the elderly at dermatological clinics rarely exceeds 25% (11) .
The observed discrepancies could be explained by the fact that our study took place during a period of significant seasonal change in the frequency of skin disease, particularly infectious disease, which is common in tropical and subtropical climate zones(12). The findings are also consistent with the earlier report that dermatological disorder trends do vary from country to country and from region to region within a country as a result of differences in ecological, ethnic, economic and social factors(1) .
In our study, the most frequent disease group was skin infections and infestations (36.1%). These findings were similar to those of two other studies, which found that the most common dermatological disorders in older individuals were skin infections (38.61%) and (23.7%), respectively(13, 14). However, the study conducted at a tertiary hospital in Northern Tanzania, reported that skin infections and infestations were less prevalent (11%) in elderly patients(5). This disparity in findings could be explained by the fact that the high frequencies are likely due to the warm and highly humid climate, overcrowding, and poor personal and skin hygiene in the city(15) .
This reflects a slowed healing process due to compromised immunological function, skin thinning, dryness, and decreased blood flow. Furthermore, bacterial entry into the skin is facilitated by epidermal degradation caused by itching, which is more common in the elderly (8, 26).
In our study 20.7% of people had fungal infections, 7.8% had viral infections, and 1.2% had scabies. In a research on the elderly in Benghazi-Libya dermatological clinics, the frequency of fungal and viral infections was 49.6% and 11.3%, respectively(16). In a cross-sectional study conducted in nursing homes in southern Taiwan, the fungal infection rate was 61.6%(17). The fact that the Taiwan study looked at resident of nursing facilities, whereas ours looked at a general community of elderly individuals could explain the disparity in results. The significant prevalence of dermatophytosis (13.1%) and onychomycosis (7.3%) that we found can be explained by changes in environmental conditions(18). Our findings back up previous findings that fungal skin infections are more common in the elderly (16, 17).
Eczemas were the second-most-commonly observed disorders (34.7%). This contrasts with earlier data from previous studies, which showed that eczema was the most frequent skin illness in most hospital-based investigations, with rates ranging from 11.9–58.7%(5). The prevalence of eczematous diseases in the elderly in the community-based study reported a higher prevalence similar to our study by 28.7% among 101 African Americans in the United States(19). The disparity in prevalence could be attributed to a variety of factors, including socioeconomic class, geographical or living conditions, ethnicity, or population location(2).
The third most prevalent disorder was papulosquamous disorders, which were similar to other regions. Papulosquamous disorders are also more common than previously thought, with rates of between 4 and 11.5%. Papulosquamous disorders were the third most common disorder which is similar to other regions(20, 21). Our study indicated that cutaneous vascular and tumor groups were less common, similar to prior studies in the African region(5).
In our study the wealth index class 1 (poorest) was independently associated with dermatological disorders. Similar outcomes were observed in a cross-sectional study of Finnish adults aged 70 to 93 as part of the Northern Finland Birth Cohort 1966 Study(9). In a study evaluating the prevalence of skin disorders and their relationship to socioeconomic status, researchers reported that the prevalence of skin infection was higher in low-income Asian countries(2). The burden of skin cancer in Asia was relatively low similar to our study findings. Another study showed skin disorders in the Elderly Population Attending Tertiary Care Hospital in Karachi were associated with socioeconomic status (wealth status) similar to our study (22). The similarity might be due to lower socioeconomic status playing its role in forcing people to live in small overcrowded houses, which forms the basis of the spread of some dermatological disorders through close contact(22)(23).
It was further found that elderly with a low socioeconomic status had poorer health than those with a high socioeconomic status. These findings were similar to those from the EDEN fragrance study (EFS) conducted by the European Dermato-Epidemiology Network (EDEN) and involved five European countries (24).
In our study, systemic diseases were not associated with dermatological disorders in the elderly in a manner that was statistically not significance. However there are studies that have reported an association of dermatological disorders with specific systemic diseases like diabetes or cardiovascular conditions in the general population, but not specifically in the geriatric age group(25). Similarly, results from a prospective randomized study that involved a group of 260 consecutive patients aged 60 years in Egypt found that there was a significant correlation between the number of systemic diseases and the number of dermatological disorders observed in (21). This big difference is thought to be because of the self-report of systematic diseases in our study and the low awareness of health issues among the elderly in general(25) .
It has been found in this study that dermatological conditions have a detrimental impact on quality of life. The proportion of elderly with dermatology life quality index scores of > 10 was 61.0% with the mean DLQI score (SD) being 15.1(± 7.1), indicating a large effect of skin diseases on patients’ quality of life (QoL).A study conducted among the elderly in the United Kingdom found that skin disease seems to have a larger impact on patient quality of life, similar to our findings (26). This might explain the inadequate social interaction, as well as poor economic and education levels among the elderly attributing to a large effect of skin disorders on patients’ quality of life (QoL)(27).
Keratinization disorders, autoimmune disorders and papulosquamous disorders were associated with high mean DLQI scores. This is most likely related to the highly symptomatic nature of such conditions(28). As reported in another study the majority of elderly had severe illnesses associated with higher symptomatic impairment on quality of life(29). This might explain the high proportion of elderly with high DLQI scores and sleep disturbance as compared to outpatients.
In this study, there was no significant difference between the quality of life scores of males versus those of females regarding dermatological disorders. This was similar to findings of a study done in the U.K involving patients aged 65 and over aiming to asses quality of life and determine the type and extent of skin disease(26).In line with some worldwide research, which found that gender had no impact on quality of life (30).However, gender disparities were not constant across all research. These variations could be attributable to differences in populations, sample methodologies, study sites, and the diseases studied(31).