Urticaria in Elderly Patients
Definition and Pathophysiology
- Pruritus in the elderly, also known as Willan's itch, is defined as chronic itching occurring in patients aged over 65 years, and is commonly associated with xerosis, generalized pruritus of unknown origin, malignancy, aging nerve fiber changes, drug-induced pruritus, or bullous pemphigoid, according to the British Journal of Dermatology guidelines 1
Management
- The British Journal of Dermatology recommends initial treatment with emollients and topical steroids for at least 2 weeks to treat asteatotic eczema, with high lipid content moisturizers preferred 1
- Elderly patients with pruritus should not receive sedating antihistamines, as stated by the British Journal of Dermatology guidelines 1
- Gabapentin may benefit elderly patients with pruritus who have not responded to initial treatment, according to the British Journal of Dermatology 1
Clinical Distinctions
- Urticaria in elderly patients presents with typical wheals lasting 2-24 hours without the distinctive ecchymotic centers, whereas urticaria multiforme presents with large polycyclic annular wheals with characteristic dusky centers, as noted in a study cited by Praxis Medical Insights 2
- The British Journal of Dermatology guidelines state that pruritus/urticaria in the elderly often reflects chronic skin changes, systemic disease, or age-related alterations in nerve function 1