Dermatitis (Eczema) in Older Adults
Understanding Skin Changes and Finding Relief
As we age, our skin naturally becomes thinner, less elastic, drier and more fragile. It also produces less oil and is slower to heal. These changes can increase the risk of developing dermatitis, also known as eczema, which causes redness, itching and irritation. Eczema is common in older adults and can look and feel different than in younger people. While dermatitis can be uncomfortable, the good news is that it is manageable. With the right skin care routine and guidance from your healthcare professional, you can reduce symptoms and improve your skin’s health.
What Is Dermatitis?
Dermatitis is a general term for skin inflammation. It is not contagious, but it can cause considerable discomfort. There are several types of dermatitis seen in older adults:
● Atopic dermatitis can start for the first time in older people or continue from earlier in life. It often causes dry, itchy patches, sometimes with thickened or rough skin. In older adults, eczema may appear on the hands, arms, legs and is often more widespread.
● Contact dermatitis happens when irritation is caused by something contacting the skin, like soaps, creams, chemicals, fragrances or metals. Allergic reactions to similar substances can also cause contact dermatitis. Older adults are at risk to these because their skin is more sensitive, the protective barrier of the skin is thinner and they may use more skin products or medications.
● Seborrheic dermatitis causes flaky, greasy patches, often on the scalp, face or chest. It is especially common in older adults. Seborrheic dermatitis may also itch.
● Asteatotic dermatitis also known as “winter itch,” causes dry, cracked and itchy skin, particularly in colder weather or lower humidity. The legs are most often affected.
● Stasis dermatitis commonly affects the lower legs in people with poor blood circulation, causing fluid to build up and leak into surrounding tissues. Over time, this leakage can contribute to inflammation and skin irritation. As people age, leg veins are more prone to this for a variety of reasons.
Why are Older Adults at Higher Risk?
As we grow older, our skin undergoes changes that make it more prone to irritation and inflammation.
Factors include:
● Dryness: Less oil production can lead to cracked or flaky skin.
● Thinning skin: The outer layer becomes more delicate and easily damaged.
● Slower healing: Skin takes longer to repair itself after injury or irritation.
● Changes in the immune system: Increases vulnerability to infection and makes the skin more likely to be affected by immune reactions to things in the environment.
● Other medical issues: Some health conditions, like diabetes, incontinence or kidney disease, can trigger or worsen dermatitis.
● Medication use: Certain medications may dry out the skin or trigger reactions. Examples include certain blood pressure medications, antihistamines and some antidepressants, among others.
Signs and Symptoms
Dermatitis symptoms can vary, but commonly include:
● Dry, itchy skin
● Red, inflamed patches
● Scaling or flaking
● Thickened or cracked areas
● Clear or yellowish discharge if infected
On lighter skin, dermatitis can appear red or pink. On darker skin, it may look gray, purple or brown.
Getting a Diagnosis
Your healthcare professional can diagnose dermatitis through a skin exam and a review of your symptoms and medical history. The spreading of the dermatitis, your occupation and hobbies may offer clues to help identify potential allergens or irritants. Sometimes, allergy testing may be recommended to identify environmental allergens that could be contributing to your symptoms, such as dust mites or animal dander. Irritants can be identified by reviewing all products coming in contact with the skin. Patch testing is sometimes used to help identify sources of contact allergy. An allergist / immunologist is helpful to guide testing and management.
There are several other skin conditions that can be confused for dermatitis in older adults and would not respond to normal dermatitis treatment. These include drug allergies, infections and certain skin cancers, among others. It is important to consult a healthcare professional to help you make a diagnosis and guide treatment. In some cases a low risk, in office skin biopsy may be recommended to exclude other causes.
Treatment and Management
The goal of treatment is to relieve symptoms, heal the skin and prevent flare-ups. Common strategies include:
Gentle Skin Care & Miniaturization (Foundation of Management)
● Use fragrance-free, gentle cleansers and rich moisturizers or emollients applied right after bathing to lock in moisture, protect the skin and prevent dryness. Look for moisturizers free of irritants such as lanolin, fragrances, propylene glycol, glycerin and other topical alcohols, among others.
● Apply moisturizer at least once or twice daily to keep the skin protected and to help restore the skin barrier.
● Take warm (not hot) short baths or showers (five to 10 minutes), then gently pat skin dry. Do not rub.
● Additional tips are using indoor humidifiers during dry seasons; wearing soft, protective undergarments such as those made with cotton; and avoiding vigorous scrubbing of the skin, particularly with brushes or loofah sponges.
● A healthcare professional may also recommend compression garments for the legs if poor circulation is a contributor. Gentle walking and moving the legs also helps improve blood flow. Even small movements can make a difference for those with limited mobility.
Avoiding Irritants and Allergens
● Identify and eliminate triggers such as scented products, wool clothing or household cleaners. Some people can also be sensitive to certain topical antibiotics, such as bacitracin and neomycin.
● Identify and reduce exposure to allergens identified through testing with your allergist / immunologist.
● Wear gloves when doing dishes or cleaning or contacting solvents/gasoline/oils.
Using Medications when Moisturizers are not Enough
● Start with low-to-moderate potency topical corticosteroids, in addition to moisturizers, as advised by your allergist / immunologist.
● Your health professional may recommend using non-steroidal topical anti-inflammatories for sensitive areas like the face.
● If itch is still a problem, there are a number of over-the-counter topical itch products that can be helpful and give temporary relief. Ingredients like menthol, camphor, pramoxine and hypochlorous acid may be useful. Some patients find using cold packs on the itchy spots can also calm the itch, at least temporarily.
● Oral antihistamines may help reduce itching (with caution, as some may cause drowsiness). Antihistamines can contribute to drying the skin, so if they are not helpful for itch then they should be stopped.
● Phototherapy (narrow-band UVB) can be helpful but requires frequent clinic visits, which may not suit everyone. Phototherapy may also increase the risk of developing actinic keratosis, a precancerous skin condition.
● In more severe cases, advanced treatments like biologic immunomodulators or immunosuppressants may be considered.
Tips for Living with Dermatitis
● Maintain your skin care routine, even when your skin is clear. Continued moisturizing helps prevent flares.
● Be gentle: avoid hot showers, harsh scrubbing or tight clothing.
● Keep fingernails trimmed to avoid damaging the skin from scratching.
● Use a humidifier in dry areas, ensuring the device is cleaned regularly.
● Track flare-ups in a diary to help identify patterns and triggers, like new soaps, weather, skin care products or clothing.
● Seek timely professional care if signs of infection appear, such as increased warmth, pain, swelling, discharge, locally enlarged lymph nodes or fever.
● Follow your health professional’s treatment plan and ask questions when something is not working.
● Older adults may have trouble applying creams if they have arthritis or stiffness. Memory problems or vision changes can also make it harder to follow treatment plans. Health professionals and caregivers may need to help with reminders or simplify routines. Assistance devices like back applicators can also be helpful.
● Malnutrition is more prevalent in older adults and can contribute to dermatitis and poor healing. A healthy diet should be encouraged. Food allergies are almost never the cause of dermatitis. Restrictive or elimination diets are not recommended for treatment and can be harmful to vulnerable people.
● There are no legal standards of what ‘hypoallergenic’ means. Any company can use that label for any reason. Read ingredient labels and look for irritants or allergens even when a product is advertised as “hypoallergenic.”
You are Not Alone
Dermatitis in older adults is common and treatable. With proper care and medical support, you can keep your skin healthy and reduce flare-ups. Every person is different. Treatments should be tailored to each person’s needs, health conditions and lifestyle. Do not hesitate to reach out to an allergist / immunologist, dermatologist or your primary care professional if you are experiencing persistent symptoms or visible skin changes. Support groups can also be helpful in learning more about your skin condition and how to manage it.
When to See an Allergist / Immunologist
An allergist / immunologist is specifically trained in dermatitis, including allergy-related skin conditions. Call your Board-Certified allergist / immunologist if:
● Your symptoms persist and/or worsen despite at-home care.
● The skin becomes cracked, swollen or starts oozing; these may be signs of infection.
● If your symptoms interfere with sleep or daily activity.
● You have difficulty applying creams or maintaining your routine.
The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.
Find out more about skin allergies.
References
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Photos courtesy of Peter Lio, MD, FAAD and Pexels.
11/13/2025