Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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45 JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • number 6 R E v I E W perception, and decreased immune and inflammatory responses. 7 In addition, the incidence of skin disorders increases with age. 8,9 among patients 65 years of age or older in one study (n=198), all had one or more dermatologic conditions. these included solar lentigines, senile angiomas, xerosis, seborrheic keratoses, varicose veins, and pruritus. 10 Patients 75 years of age or older were more likely to suffer from solar lentigines, clavi, solar keratoses, and onychomycosis. 10 Unfortunately, the overall incidence of skin disorders is likely to increase as the world population continues to age. In the United states, it is estimated that the number of people 65 and older will double from 41 million in the year 2010 to 86 million by the year 2050. 11 consequently, there will be a substantial increase in age-related dermatologic diseases and conditions in the future. ACTINIC PURPURA Mature skin is often prone to significant bruising due to reduction in connective tissue, loss of subcutaneous fat to support the skin structure, flattening of the dermal junction, and effacement of the dermal papillae. the connective tissue of the dermis is no longer able to adequately support the microvasculature. consequently, minor trauma can rupture blood vessels, leading to extravasation of blood. this age-related condition is called actinic purpura. also known as senile purpura, 1 2 solar purpura, 1 3 traumatic purpura, and Bateman's disease, 14 it is characterized by unsightly ecchymoses and purple patches on the arms or legs of elderly persons caused by blood extravasation following minor trauma. actinic purpura occurs almost exclusively among the elderly population, although it may occasionally occur in younger people. similar to other skin conditions, the incidence of actinic purpura increases with advancing age and occurs with equal frequency among men and women. One source suggests actinic purpura affects approximately two percent of people 60 to 70 years old, increasing to as many as 25 percent of people in the 90- to 100-year age group. another suggests actinic purpura affects less than 10 percent of people over 50 years old. It is closely associated with photoaged skin 15 and may be worse among people taking aspirin, nonsteroidal anti- inflammatory drugs, or anticoagulants. treatment is usually unnecessary and complications are rarely reported. 16 Following extravasation, blood is typically resorbed in 10 to 14 days. 17 Delayed resorption for as long as three weeks may be due to the absence of a normal phagocytic response. Post-inflammatory hyperpigmentation may occur. ACTINIC PURPURA AND QUALITY OF LIFE the consequences of photodamaged skin include increased rhytides, pigmentary changes, skin laxity and roughness, and telangiectasias, which may have a negative impact on overall quality of life including interpersonal interactions and self-esteem. 1 8 similarly, actinic purpura is a cosmetic condition that can also be associated with significant psychological distress. 12 Its unattractive appearance may lead to aversion by others. 19 While not a dangerous condition, effective treatment of actinic purpura is of great clinical importance for the wellbeing of the elderly patient. PRIOR TREATMENTS FOR ACTINIC PURPURA Published work describing available treatments for actinic purpura are limited. In one small, double-blind study (n=14), healthy subjects 60 to 80 years old with at least two actinic purpura lesions of approximately equal size on each forearm were enrolled. subjects were randomized to receive twice-daily treatment with 0.1% retinoic acid cream or non-medicated vehicle on each arm for 16 weeks. 17 after two weeks of treatment, there were fewer lesions on the retinoic acid-treated arm (p<0.05); however, there were no significant differences after that time. More recently, a small open- label study assessed the effectiveness of human epidermal

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