Rebecca F Wang1, Benjamin H Kaffenberger1, Jessica A Kaffenberger1. 1. Ms. Wang and Drs. B. Kaffenberger and J. Kaffenberger are with the Department of Internal Medicine, Division of Dermatology, at The Ohio State University Wexner Medical Center in Columbus, Ohio.
Abstract
Background: New-onset dermatitis in the elderly can be attributed to a variety of disease processes. We defined new-onset dermatitis in which the etiology is attributed solely to age-related processes as "dermatitis of immune senescence"-a diagnosis of exclusion based on clinical presentation and further diagnostic testing. Objective: Retrospective cohort of elderly patients with new-onset dermatitis to examine the differences in demographics, work-up, and treatments between patients with dermatitis of immune senescence and those patients ultimately given more specific diagnoses. Methods: Four hundred and thirty-three patients aged 60 years and older with new-onset dermatitis from 2011 to 2016 at Ohio State University were identified by chart review and categorized as "dermatitis of immune senescence" or "alternate diagnosis" based on patch testing, biopsy, and physician documentation. Results: In this subset of patients, 10.2 percent (44/433) underwent patch testing and 16.2 percent (70/433) underwent biopsy. Furthermore, 86.4 percent of patients who underwent patch testing (38/44) and 57.1 percent who underwent biopsy (40/70) were given a more specific diagnosis following their test. Use of intramuscular steroids (p<.001), oral steroids (p=.004), and antihistamines (p=.002) were significantly higher in the alternate diagnosis group. Conclusion: The low rate of patch testing and biopsy and the high rate of diagnosis change post-procedure demonstrate an underutilization of diagnostic testing in this population.
Background: New-onset dermatitis in the elderly can be attributed to a variety of disease processes. We defined new-onset dermatitis in which the etiology is attributed solely to age-related processes as "dermatitis of immune senescence"-a diagnosis of exclusion based on clinical presentation and further diagnostic testing. Objective: Retrospective cohort of elderly patients with new-onset dermatitis to examine the differences in demographics, work-up, and treatments between patients with dermatitis of immune senescence and those patients ultimately given more specific diagnoses. Methods: Four hundred and thirty-three patients aged 60 years and older with new-onset dermatitis from 2011 to 2016 at Ohio State University were identified by chart review and categorized as "dermatitis of immune senescence" or "alternate diagnosis" based on patch testing, biopsy, and physician documentation. Results: In this subset of patients, 10.2 percent (44/433) underwent patch testing and 16.2 percent (70/433) underwent biopsy. Furthermore, 86.4 percent of patients who underwent patch testing (38/44) and 57.1 percent who underwent biopsy (40/70) were given a more specific diagnosis following their test. Use of intramuscular steroids (p<.001), oral steroids (p=.004), and antihistamines (p=.002) were significantly higher in the alternate diagnosis group. Conclusion: The low rate of patch testing and biopsy and the high rate of diagnosis change post-procedure demonstrate an underutilization of diagnostic testing in this population.
Entities:
Keywords:
Dermatitis; aging; biopsy; elderly; immune senescence; patch test