Elsevier

Clinics in Dermatology

Volume 29, Issue 1, January–February 2011, Pages 24-30
Clinics in Dermatology

Contact sensitization in the elderly

https://doi.org/10.1016/j.clindermatol.2010.07.003Get rights and content

Abstract

Contact dermatitis from irritant and allergic sources is the reason for 6% to 10% of all dermatologic visits with considerable morbidity and economic impact. Allergic contact dermatitis is a T-cell–mediated inflammatory reaction and develops in predisposed individuals as a consequence of environmental exposure to allergens. Aging is correlated with the rate and type of contact sensitization because of “immunosenescence.” The number of old people is growing around the world. This contribution reviews the main findings from published epidemiologic studies on contact allergy in elderly populations. In all examined studies, patch testing was performed in patients with cutaneous manifestations possibly related to contact dermatitis; the prevalence of contact dermatitis in the elderly was from 33% to 64%. Establishing the most frequent allergens responsible for allergic contact dermatitis in the elderly is a hard task. The commonest allergens reported were nickel sulfate, fragrance mix, diamino diphenylmethane, lanolin alcohols, paraben mix, Euxyl K400, quinoline mix, and balsam of Peru. We emphasize that allergens surveillance is needed to realize an “elderly series” for having a useful adjunct to contact allergy that may help the treatment of each patient.

Introduction

Life expectancy in industrialized countries has increased consistently in recent decades. In the United States of America, the proportion of people aged 65 or older increased from 4% in 1900 to about 12% in 2000. In 1900, only about 3 million of the country's citizens had reached 65. By 2000, the number of senior citizens had increased to about 35 million. It is estimated that more than 50 million Americans—about 17 % of the population—will be 65 or older in 2020.1 The number of elderly people is growing around the world, so that provision and standards of health care are increasing too.

Section snippets

Pathogenesis of allergic contact dermatitis

Allergic contact dermatitis (ACD), one of the most common skin diseases with a great socioeconomic impact, is a T-cell–mediated inflammatory reaction (delayed-type hypersensitivity reaction) occurring at the site of challenge with a contact allergen (hapten) in sensitized individuals.2 As in all delayed-type hypersensitivity reactions, the pathophysiology of ACD consists classically of two distinct phases: the sensitization and the elicitation phases, which are considered to be temporally and

Immunosenescence

The immune system of older people is usually perceived as declining in fidelity and efficiency with age, resulting in an increased susceptibility to infectious diseases and pathologic conditions relating to inflammation or autoreactivity.14 Immunosenescence is a term used to represent changes to the immune system associated with aging.15

Immunity is classically conceptualized as two distinct but interacting systems: innate and adaptive. Innate immunity may be thought of as the basal or first

Prevalence of contact sensitization in the elderly

Contact dermatitis from irritant and allergic sources is the reason for 6% to 10% of all dermatologic visits, with considerable morbidity and economic impact. This is aggravated by the fact that contact sensitization is not curable and necessitates lifelong avoidance of the allergens for secondary prevention.30, 31

Aging is correlated with the rate and type of contact sensitization, but only a few studies have evaluated patch test reactivity in elderly individuals with an adequately large

Allergens

Establishing the most frequent allergens responsible of ACD in the elderly is a hard task. Here we report the prevalence of previously published studies on contact dermatitis in the elderly, focusing on the commonest allergens. The age and sex distribution of positive patch test reactions in 234 children, 1200 adults, and 295 elderly patients was investigated. Nickel sulfate and balsam of Peru were the most represented haptens, with 11.2% and 6.7% of positive reactions in old men, whereas they

Contact sensitization in elderly patients with leg ulcers

Leg ulcers represent a chronic condition affecting more than 1.7% of the population aged older than 65 years.47 Many topical medications are used for leg ulcers, so some have proposed that patients with chronic leg ulcers should be tested because they have a very high risk of contact allergy. Their sensitization rate increases with the duration of the chronic leg ulcers. In 1185 cases published from 1991 to 2003, 72% had a positive patch test. This meta-analysis was undertaken on studies from

Features of contact sensitization in the elderly

This section summarizes the main findings from published epidemiologic studies on contact allergy in old populations. Contact allergy is caused by skin contact with low-molecular-weight haptens and may evolve to allergic contact dermatitis if exposure exceeds the individual's threshold. It can be a distressing skin problem for those who have it and may cause sick leave as well as an increase in national health expenses. The diagnosis of contact allergy is mainly determined by the outcome of

Conclusions

Apart from the controlled and retrospective studies of a large population reviewed here, several reports about ACD in older patients have highlighted that contact sensitization is also a burden problem in the elderly. Allergens surveillance is needed to realize an “elderly series” for having a useful adjunct to contact allergy, which may help in tailoring the treatment for each patient.

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