Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : September | Volume : 17 | Issue : 9 | Page : WC01 - WC06 Full Version

Spectrum of Skin Changes in the Elderly Population at a Rural Tertiary Care Hospital in Northern India: A Cross-Sectional Study

Published: September 1, 2023 | DOI:
Rachna Verma, Rupinder Kaur, Jasmine Chhillar, Gaurav Chhillar, Mahesh Kumar, Usha Kataria, Mohit Duhan

1. Assistant Professor, Department of Dermatology, BPSGMC, Khanpur Kalan, Sonipat, Haryana, India. 2. Senior Resident, Department of Dermatology, BPSGMC, Khanpur Kalan, Sonipat, Haryana, India. 3. Intern, Department of Dermatology, NCRIMS, Meerut, Uttar Pradesh, India. 4. Intern, Department of Dermatology, NCRIMS, Meerut, Uttar Pradesh, India. 5. Assistant Professor, Department of Paediatric, BPSGMC, Khanpur Kalan, Sonipat, Haryana, India. 6. Professor and Head, Department of Dermatology, BPSGMC, Khanpur Kalan, Sonipat, Haryana, India 7. Junior Resident, Department of Dermatology, BPSGMC, Khanpur Kalan, Sonipat, Haryana, India.

Correspondence Address :
Usha Kataria,
D5, Sec-36, Sun City, Rohtak, Haryana, India.


Introduction: Ageing is a complex, natural process. Due to structural and physiological changes that occur as a consequence of intrinsic and extrinsic aging, the elderly population is highly susceptible to dermatological disorders. These changes are associated with significant morbidity and stress. Hence, it is important to have a better understanding of the dermatological needs of elderly patients.

Aim: The aim of this study was to investigate the pattern and frequency of geriatric dermatoses in patients attending the Skin Outpatient Department (OPD) at a tertiary care centre.

Materials and Methods: This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. A total of 300 patients aged 60 years and above, of either sex, who consented to participate were enrolled. Detailed history taking and dermatological examinations were performed, and relevant investigations were carried out. Data was collected, entered into a Microsoft Excel sheet, and analysed for frequency, percentage, and mean of variables.

Results: Out of the total 300 patients, 155 (51.66%) were males and 145 (48.33%) were females. The majority of patients belonged to the age group of 60-69 years (n=171, 57%). Wrinkling (n=287, 95.66%) was the most common physiological skin finding, followed by dry skin (n=157, 52.33%). Among pathological dermatoses, infectious dermatoses were present in (n=134, 44.66%) patients, followed by eczemas (n=92, 30.66%). Papulosquamous disorders were seen in (n=17, 5.66%) patients. Hypertension was the most common systemic illness present in (n=53, 17.66%) patients.

Conclusion: Physiological and pathological skin changes in the elderly are a common cause of consultation in dermatology OPD. Physiological changes were seen in all patients. Among pathological changes, infections were the leading dermatoses, followed by eczemas and papulosquamous disorders.


Dermatological disorders, Geriatric, Haryana, Infectious dermatoses

Aging is an inevitable biological reality. India is a developing nation and in 2001 entered the group of aging countries, with the population of people aged 60 years and above exceeding 7% (1). By 2026, the geriatric population is expected to double due to an increase in life expectancy as well as a decline in birth rates (1). According to World Health Organisation predictions, the global population of people aged over 60 years will reach two billion in 2050 (2). This hike in the elderly population can also be seen in hospital outpatient departments. As age progresses, various intrinsic and extrinsic changes occur in the skin, making it more prone to cutaneous diseases (3). Geriatric dermatoses account for a significant proportion of morbidity seen in the elderly and are one of the commonest causes for everyday consultation in the elderly (4). These dermatoses are rarely fatal but can lead to significant morbidity and affect the quality of life (5).

There are only a few studies about the skin dermatoses of the elderly in India (3),(4),(5),(6),(7). A thorough knowledge of the pattern of prevalent dermatoses in this geographic region will help healthcare providers make better healthcare policies. There is limited regional data addressing geriatric dermatological issues in this area. Hence, the present study was conducted with the aim to study the pattern and frequency of dermatological conditions in geriatric patients attending the outpatient department in the tertiary care centre.

Material and Methods

This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. Institutional Ethics Committee vide letter no. BPSGMCW/RC758/IEC/22 was obtained.

Inclusion criteria: Patients aged 60 years and above, of either sex, presenting with skin problems in the skin OPD or those referred from other departments for dermatological complaints, and who provided a detailed history, allowed the conduct of necessary investigations if required, and gave consent for participation in the study, were included.

Exclusion criteria: Patients who refused to give consent and those with genodermatoses, albinism, or disorders of Deoxyribonucleic Acid (DNA) stability that are likely to interfere with changes of aging in the skin were excluded.

Sample size: The sample size was calculated based on the proportion formula, assuming an unknown prevalence of cutaneous conditions in the geriatric population (estimated as 50%) with a 95% confidence interval and a relative error of 7%. The required sample size was 196, approximately 200.


A total of 300 patients were enrolled in the study. Informed consent was obtained from patients after explaining in the local language. After taking a history, a detailed dermatological examination was done, and all findings were noted in a pre-designed proforma. Routine blood investigations, like haemoglobin, complete blood counts, urine routine, blood sugar estimation, etc., were carried out whenever necessary. Necessary skin investigation like skin scrapings, nail clippings for fungus, Tzanck smears, and skin biopsies, were performed wherever indicated to support clinical findings. Co-morbidities and physiological skin changes were also noted. Clinical images of the dermatoses were taken and recorded with the consent of the patient.

Statistical Analysis

The data was collected in a Microsoft Excel sheet and entered into the Statistical Package for Social Sciences (SPSS) software version 22.0. Frequencies, percentages, and means of the variables were calculated.


A total of 300 patients were recruited for the study: 155 (51.66%) were males, and 145 (48.33%) were females. The male-to-female ratio was 1.07. Out of the total, 215 (71.66%) patients belonged to rural regions. The age distribution of patients was as follows: the largest group was in the age range of 60-69 years with 171 patients (57%), followed by the age range of 70-79 years with 113 patients (37.66%), and the age range of 80-89 years with 14 patients (4.66%) (Table/Fig 1). The oldest patient was 92 years old. The mean age of the study population was 69.05±6.23 years. Regarding systemic diseases, hypertension was the most common, affecting 53 patients (17.66%), followed by diabetes mellitus in 37 patients (12.33%). The associated systemic illness is tabulated in (Table/Fig 2).

The most common physiological skin condition was wrinkling, observed in 287 patients (95.66%). This was followed by xerosis/dry skin in 157 patients (52.33%) as shown in (Table/Fig 3),(Table/Fig 4).

Among viral infections, herpes zoster (Table/Fig 5) was the most common, with 15 cases (5%), followed by post-herpetic neuralgia with 10 cases (3.33%). Pyoderma was the most common bacterial infection, affecting 10 patients (3.33%). One case of BT Hansen’s was also noted. Infection and infestations were the largest group of dermatoses, present in 134 patients (44.66%), followed by eczemas in 92 patients (30.66%) as shown in (Table/Fig 6).

There were a total of 17 cases (5.66%) with papulosquamous disorders. Among them, 11 cases (3.66%) were diagnosed with psoriasis, including eight cases of psoriasis vulgaris, two cases of erythroderma (Table/Fig 7), and one case of pustular psoriasis.

Generalised pruritus not attributable to any skin lesions was observed in 28 cases (9.33%). Among them, three patients had diabetes, two had hypothyroidism, and one had chronic kidney disease.

The rest were diagnosed with senile pruritus. Photodermatitis was seen in 11 patients (3.66%) (Table/Fig 8). Connective tissue disease was present in four cases, including two cases of discoid lupus erythematosus and one case each of extragenital and genital lichen sclerosus et atrophicus (Table/Fig 9). Only one patient presented with bullous pemphigoid among immuno-bullous disorders (Table/Fig 10). Miscellaneous conditions included three cases each of corn and keloid, two cases of vasculitis, and one case each of traumatic ulcer, diabetic ulcer, and aphthous ulcer. Additionally, one case each of sebaceous hyperplasia, alopecia areata, lichen amyloidosis, delusion of parasitosis, fixed drug eruption, erythema ab igne, and angina bullosa hemorrhagica (Table/Fig 11) were recorded. No cases of skin malignancy were observed. The frequency of various non-infectious pathological dermatoses is shown in (Table/Fig 12).


Ageing is a natural process with many physiological and pathological changes. These changes are a result of intrinsic aging along with cumulative extrinsic environmental insults, like sun exposure. Although these changes are mostly harmless, they can lead to high morbidity and decreased quality of life in the elderly.

Hence, aged skin requires special attention and care to prevent complications secondary to cutaneous changes (3),(4). In this study, a geriatric population aged 60 years and above was enrolled, similar to studies done by Agarwal R et al. and Simin MK et al. (3),(4). The majority of patients were in the age group of 60-69 years, which is comparable to studies done by Agarwal R et al. and Raveendra L (3),(6). This can be explained by the fact that as age increases, it becomes very difficult to access health services due to poor health conditions.

In this study, 300 patients were enrolled, of which 155 (51.66%) were males and 145 (48.33%) were females. This male preponderance was consistent with studies done by Raveendra L, Patange VS, Fernandez RJ, and Jha HK et al. (6),(7),(8). In a study done by Simin MK et al., female predominance was seen, which can be attributed to a higher literacy rate in females and good healthcare facilities in that region (4). The most common co-morbid condition was hypertension, present in 53 (17.66%) of patients, followed by diabetes mellitus in 37 (12.33%). This is consistent with the studies done by Raveendra L and Kumar D et al. (6),(9).

The most common presenting complaint was itching in 230 (76.67%) patients. A similar incidence of pruritus (78.5%) as a presenting complaint was seen in a study done by Patange VS and Fernandez RJ (7). Raveendra L noted pruritus in 44% of patients (6). In most cases, itching was attributable to cutaneous dermatoses. Patients presenting with complaints of chronic generalised pruritus (9.33%) without any lesions suggestive of specific dermatoses were further investigated to rule out underlying causes. Senile pruritus was a diagnosis of exclusion. Out of these, three patients had diabetes, two patients had hypothyroidism, and one had chronic kidney disease, and (7.3%) were diagnosed with senile pruritus. Patange VS and Fernandez RJ noticed senile pruritus in 3.8% of cases (7).

All patients showed signs of aging, with wrinkling being the most common physiological skin change seen in (95.66%) of cases. Simin MK et al. and Raveendra L reported wrinkling in 98.5% and 88% of cases, respectively (4),(6). With increasing age, the skin becomes less elastic, there is a reduction in the secretion of natural oils leading to decreased moisture. This, along with chronic sun exposure and personal habits like smoking, leads to decreased collagen production, leading to skin wrinkling (4). Agriculture, which leads to chronic sun exposure, is the main occupation in this area, and hookah smoking is also quite common. These factors also accelerate photoaging. Xerosis was observed in 157 (52.33%) cases in the present study, similar to Paliwal G et al. (55.9%) and Chopra A et al. (50.8%) (10),(11). A higher incidence of xerosis was noted in Beauregard S and Gilchrist BA (85%) and Tindall JP and Smith JG (77%) (12),(13). This can be explained by differences in geographical conditions and climatic factors. Cherry angiomas were seen in 122 (40.66%) patients in the present study, while Agarwal R et al. noted cherry angiomas in 91.8% (3). Seborrheic keratoses were seen in (30.33%) of cases in the present study, comparable to Patange VS and Fernandez RJ (37.5%) (7). In the study done by Simin MK et al., the incidence of seborrheic keratoses was 54.5% (4). The incidence of senile lentigines in the present study was 22.33%, comparable to Simin MK et al. (4). A higher incidence was reported by Beauregard S and Gilchrest BA (70.6%) (12). This may be due to differences in Fitzpatrick skin type and racial factors. Fissuring of the soles was observed in 29.67% of cases in the present study. A higher incidence of sole fissuring was seen in a study conducted in Libya by Alramaity Omer N et al. (14). Idiopathic Guttate Hypomelanosis (IGH) was recorded in 26.33% of cases. A study by Grover S and Narsimhalu C reported a higher incidence of IGH (76.5%) (15). Senile comedones were observed in (13.66%) cases, similar to Agarwal R et al. (13.2%) (3). 9.3% of the participants had senile purpura. Almost a similar incidence was reported by Patange VS and Fernandez RJ (9%) and Raghvendra BN and Rajesh G (9.67%) (7),(16).

Among pathological dermatoses, infections and infestations were the most frequent (44.66%), followed by eczema (30.66%). Scabies was the only infestation observed, seen in (14%) of patients. A lower incidence of scabies was observed in the study done by Simin MK et al. (1.5%) and Darjani A et al. (4.3%) (4),(17). The higher number of scabies cases in the present study may be due to overcrowding, poor living conditions, and poor hygiene. Fungal infections accounted for the highest proportion of infections, with (16.67%) of cases. Dermatophytic infections were the most common fungal infections. This is comparable to the study done by Jindal R et al. (18%) (18).

The high prevalence of fungal infections may be due to age-related changes in immunity and other predisposing factors like humidity, use of topical corticosteroids, and poor skin care. The incidence of viral infections in the present study was 8.66%, which is similar to the study done by Jindal R et al. (7.6%) (18). Herpes zoster was the most common viral infection observed. One case presented with disseminated herpes zoster. The higher incidence of herpes zoster in old age is due to a decrease in cell-mediated immunity with advancing age, which can reactivate the varicella-zoster virus. A total of 5.33% of cases were diagnosed with bacterial infections, which is similar to the study done by Patange VS and Fernandez RJ (8.5%) (7). A higher incidence of bacterial infections was seen in Agarwal R et al. (29.2%) and Simin MK et al. (24.5%) (3),(4). One case (0.33%) of Hansen’s disease (Borderline lepromatous) was noted. The incidence of Hansen’s disease was 6% in the study done by Raveendra L (6). No cases of cutaneous tuberculosis were recorded.

The increased susceptibility of older individuals to infections, including dermatological infections, probably arises from functional changes driven by the aging process of the immune system, known as immunosenescence, as well as poor personal care due to declining health (19). Immunosenescence is an umbrella term that describes the failing of the immune system with age. With advancing age, the adaptive immunity weakens due to a low number of CD8+ naïve T cells and an increased number of memory cells, resulting in a correspondingly reduced diversity of the T Cell Antigen Receptor (TCR) repertoire. Additionally, an increased pro-inflammatory status contributes to the morbidity and mortality seen in the elderly (19).

Among the non-infectious dermatoses, eczema formed the major group (30.66%). The incidence of eczema was comparable to studies done by Agarwal R et al. (30.6%), Raveendra L (31%), and Thapa DP et al. (35.8%) (3),(6),(20). Allergic contact dermatitis (5.66%) was the most common. The higher incidence of eczema is due to agricultural practices in this region, like long hours of work in heat and sun, the use of chemical sprays, which is further worsened by the use of self-medications with various over-the-counter products containing different allergens, as well as the use of soaps and detergents. Xerosis, along with age-related barrier dysfunction, also predispose the elderly to eczemas. The prevalence and pattern of eczema in different regions also differ due to genetic predisposition and environmental allergens in the locality (21).

Psoriasis was present in (3.66%) of patients. Two cases of psoriasis presented as erythroderma. The higher incidence of psoriasis was seen in studies by Simin MK et al. (8.5%) and Sanyogita S et al. (15%) (4),(22). A 2% of cases of lichen planus were noted, which is similar to Sahoo A et al. (2.4%) (23). Among vesicobullous disorders, a single case (0.33%) of bullous pemphigoid was recorded, which is similar to the study done by Sanyogita S et al. (0.33%) (22). The incidence of bullous pemphigoid was higher in the study done by Agarwal R et al. (2%) (3). No cases of pemphigus and dermatitis herpetiformis were seen. The incidence of vesicobullous disorders in studies done by Sharma A et al. and Mehra M et al. were 5.71% and 3.2%, respectively (24),(25).

In connective tissue diseases, two cases of lichen sclerosus atrophicus and two cases of discoid lupus erythematosus were reported. Raghavendra BN et al. reported 0.33% of cases of discoid lupus erythematosus in his study (16). No cases of cutaneous malignancy were observed. Due to Fitzpatrick skin types 3 and 4, the incidence of skin cancer is low in the Indian population compared to Caucasians (26).

Among other conditions, the incidence of vitiligo is 1%. The incidence of vitiligo was higher in Agarwal R et al. (6.6%) (3). A comparison of observations in geriatric studies from different regions is shown in (Table/Fig 13) (3),(4),(6),(8),(9),(16),(18),(23),(24),(25).


This was a single-centre hospital-based study, so the results may not be representative of the general population. Due to the limited duration of the study, seasonal variations were not studied. More studies with a better sample size need to be done to study the effects of co-morbidities, socio-economic status, the effect of exposure to the sun, etc.


This study provides us with information about the patterns of physiological and pathological changes in aging skin. In the present study, infectious diseases and eczema formed a major group. These conditions are manageable with proper skincare practices. A comprehensive understanding of these dermatoses helps in early diagnosis and treatment, thereby reducing morbidity and improving quality of life.


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DOI and Others

DOI: 10.7860/JCDR/2023/66325.18340

Date of Submission: Jun 30, 2023
Date of Peer Review: Jul 21, 2023
Date of Acceptance: Aug 03, 2023
Date of Publishing: Sep 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 03, 2023
• Manual Googling: Jul 12, 2023
• iThenticate Software: Aug 02, 2023 (14%)

ETYMOLOGY: Author Origin


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