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Research Article - (2017) Volume 8, Issue 1
Background and objective: As the life expectancy increases, diseases in the elderly also increase. Senile atopic dermatitis is atopic dermatitis (AD) which persists until elderly or the onset first occurs in elderly. The prevalence of senile AD remains unclear and in Indonesia, there have not been any study regarding senile AD yet. Therefore, it is needed to conduct a study regarding this topic in geriatric outpatient clinic Dermatovenereology Department, Cipto Mangunkusumo Hospital in 2011-2015.
Method: This is a descriptive study, using secondary data obtained from Cipto Mangunkusumo Hospital medical record.
Result: There were 54 patients with senile AD enrolled in five year period. Females were greater in number than males (59.3%). Most patients were in 60-69 years old group (63%) and most of the patients were already retired (57.4%). Seventeen of fifty-four patients had history of atopy or allergy. The most common comorbidity in subjects was hypertension. The most common type of onset was senile onset, which found in 45 patients (83.3%) and the most common type of skin lesion was sub-acute lesion (N=30, 55.6%).
Conclusion: This study describes the profile of patients with senile AD in geriatric outpatient clinic Dermatovenereology Department, Cipto Mangunkusumo Hospital in 2011-2015. On observation, the number of cases fluctuates each year.
Keywords: Geriatric; Profile; Senile atopic dermatitis
World Health Organization (WHO) estimates geriatric population will doubled in 2050 . This population shift may cause an even greater health problem and health system must adapt to fulfil the needs of this population.
In elderly, diagnosis and treatment of skin related diseases become a challenge to physicians as well as dermatologists because clinical manifestations may become not typical due to aging skin. Moreover, geriatric patients tend to have several health problems, altered body organ functions, and history of previous medications, which make diagnosing and treating skin-related diseases even more complicated [2,3].
Atopic dermatitis (AD) is an inflammation skin disease which is commonly found, characterized by itch, chronic and recurrent episodes, can involve skin only or as a manifestation of systemic disease including allergic rhinitis, asthma, and food allergy. The prevalence of AD is increasing two to three times in the last 30 years .
AD persist until elderly or with first onset on elderly is called senile AD. The prevalence data of senile AD remains limited until now. This may due to the number of cases that are not too much. Although the number is relatively small compared to childhood AD, the prevalence of adult AD is increasing in developing countries [5-7]. One study shows that the prevalence of AD in adult and elderly is 1% to 3% . In other study, the prevalence of AD in >50 years old patients is 1.5% to 10% .
In Indonesia, the prevalence of senile AD is not available yet. During the period of January 2013 to December 2014 in geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital Jakarta there were 68 cases of senile AD with 11 of them were new cases. Throughout writers’ knowledge, there have not been any studies regarding senile AD yet. Therefore, it is needed to conduct a study regarding this topic in geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital in 2011-2015 [10-17].
This is a descriptive study, using secondary data obtained from Cipto Mangunkusumo Hospital medical record. Data was taken from February 2015 until all was obtained. All patients with senile AD who came to geriatric outpatient clinic dermatovenereology department Cipto Mangunkusumo Hospital during 2011-2015 were chosen as subjects.
The inclusion criteria are male and female ≥ 60 years old and clinically diagnosed as senile AD patients. Those below 60 years old and with inactive medical record were excluding from this study.
The obtained data is then processed, analyzed, and critically appraised without statistical tests using IBM SPSS Statistic v.21. The data is described as socio-demography data which consist of year of visit, sex, age, age group, education, occupation, and comorbidity. Data is also described as special characteristics, such as type of onset and classification of the lesion. Data is presented in tables and diagrams form with narrative description.
There were 54 cases of senile AD in geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital during 2011-2015. The most number of cases was established in 2012, which is 20 cases, followed by 2015, 2014, 2011, and the least is 2013 (Table 1). Table 2 describes sociodemographic characteristic of subjects.
Table 1: Cases of senile AD in geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital in 2011-2015
|Age group for male patients|
|Age group for female patients|
|History of atopy/allergy|
Table 2: Overview of the Sociodemographic Characteristics of Senile AD Patients in Geriatric Outpatient Clinic Dermatovenereology Department Cipto Mangunkusumo Hospital in 2011-2015.
The youngest subject in this study is 60 years old and the oldest is 92 years old. The most number of cases belong in age group 60-69 years old (N=34, 63%). Thirty two of the 54 subjects (59.3%) are female and the rest, 40.7%, are male.
The education background of most subjects (37 subjects) is unknown. Six subjects (11.1%) are secondary school graduates, eight subjects have diploma or bachelor degree, and three subjects didn’t have any educational background. Thirty one of 54 subjects are unemployed or already retired, 19 subjects are still doing domestic work as housewives, and only four still have active occupation.
Forty subjects were also diagnosed with comorbidities, such as non-dermatology chronic diseases or other skin-related diseases. Top 10 comorbidities are shown in Table 3.
|4||Others (BPPV, OA, tumor, etc)||6|
Table 3: Top 10 comorbidities in subjects.
Seventeen of the fifty four subjects (31.5%) have history of atopy or allergy, while the rest, 37 subjects (68.5%), don’t have it. However, the history of previous treatment for those who have history of atopy is unclear.
Senile AD is classified into three groups based on the type of onset, which is senile onset, recurrent or continuation from adult AD, and recurrent with classical AD in childhood. In this study, majority of the cases were senile onset AD (N=45, 83.3%). Eight cases (14.8%) were continuation from adult AD and only one case (1.9%) was a recurrent case with history of classic AD in childhood (Figure 1).
Based on skin lesion efflorescence, senile AD is classified into acute, subacute, and chronic. The percentage is shown in Figure 2.
From fifty four subjects, 30 of them (55.6%) were subacute lesions, 15 (27.8%) were chronic lesions, and only 9 (16.7%) were acute lesions.
All patients aged 60 years and older who came to geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital and diagnosed with atopic dermatitis become the subject of this study. Most of them came with itch as the chief complaint. There were fifty four patients in five years period, from January 2011 to December 2015. The most number of cases was recorded in 2012, as many as 20 cases (37%).
The age of subjects varied from 60 years old, as the youngest, and 92 years old, as the oldest. More than half of the total subjects belong to the age group 60-69 years old (N=34, 63%). From the results, the number of female patients is more than male patients with almost 3:2 ratios. This result is different from Tanei , which most senile AD patients found are male with 3:1 ratio to female. This is probably because in Indonesia, the number of female elderly is higher than male .
Through this study, it is shown that most of the cases happened to unemployed/ not working population (57.4%), followed by housewives (35.2%), and entrepreneurs or employees (7.4%). The level of education were not identified in 37 subjects, 14.8% of the subjects have diploma or bachelor degree, 11.1% of the subjects have graduated from secondary school, while 5.6% of them were uneducated.
Like most elderly, the majority of subjects also diagnosed with comorbidities. Ten most common comorbidities are shown in Table 3 and hypertension is the most common comorbidities suffered by the subjects. Some diseases have relevance with AD, such as those associated with allergy, for example: asthma, allergic rhinitis, etc. However, this type of disease was only in the ninth position. Only 17 (31.5%) of the 54 subjects have history of atopy or allergy on him/ herself or on the family.
From these result, the senile AD patients’ profile in geriatric outpatient clinic Dermatovenereology Department Cipto Mangunkusumo Hospital during 2011-2015 is shown. On observation, the amount of case remains fluctuating each year. Along with the increasing number of geriatric population every year, so does the related disease and AD should not be underestimated.
The data obtained in this study can be used as information, as well as advice, both for clinicians and patients to improve the management of patients. The research data could also be used as a baseline for further research on senile AD.