Skin infections in the elderly

The diagnosis and management of viral diseases of the skin are significant issues in the elderly population. With advances in these areas, there are new tools to combat these diseases and limit morbidity. It is important for clinicians to monitor and treat these diseases aggressively in the elderly because of the potential for immunosuppression in this population. Further advances in antiviral therapy and the potential for the development of antiviral vaccines will aid in the therapy of these diseases. Onychomycosis is found more frequently in the elderly. In this population, the most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great or first toe) and white superficial onychomycosis (which generally involves the third or fourth toes). Over the past several years, new treatments for this disorder have emerged that offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria, such as MRSA and drug-resistant pneumococci. Although vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw a rise in vancomycin-resistant bacteria, including VRE. With treatment options limited, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin-dalfopristin.