Forgotten Skin: What do our geriatric patch test findings reveal?

Area of Science:

• Dermatology
• Immunology
• Geriatrics

Background:

• Allergic contact dermatitis (ACD) in the elderly is complex, influenced by aging immune systems, cumulative exposures, and skin changes.
• Limited data exists comparing sensitization patterns across different elderly subgroups.

Purpose of the Study:

• To compare patch test reaction patterns and severity in younger elderly (65-74) versus older elderly (75+) patients.
• To identify prevalent allergens in these geriatric populations using the European Standard Series (ESS).

Main Methods:

• Retrospective analysis of 128 patients aged 65+ undergoing patch testing with the ESS.
• Reactions assessed at 48 and 96 hours using International Contact Dermatitis Research Group (ICDRG) criteria.
• Patients divided into young-old (65-74) and old-old (75+) groups.

Main Results:

• Preservative and fragrance allergens were most common in both groups.
• Young-old group: propolis, fragrance mix I, methyldibromo glutaronitrile, peru balsam, nickel sulfate were frequent.
• Old-old group: methylchloroisothiazolinone/methylisothiazolinone, methylisothiazolinone, propolis, textile dye mix were prevalent. Reactions were less frequent and intense in the old-old group.

Conclusions:

• Preservatives, propolis, and fragrances are key triggers for ACD in the elderly.
• Metal sensitization appears to decrease with advanced age.
• Reduced reaction severity in the oldest group may indicate immunosenescence and decreased T-cell response.