# 204 What's Wrong With The Old Bag?
Two things are certain. 1) The population is aging, individually and by proportion. 2) Ask most laymen what is the largest organ of the body? — very few will correctly say "the skin." Few also realize the important protective functions of skin – our sack of envelopment and homeostasis.
As emergency practitioners, we shall face skin problems in elders who come to the ED, sometimes as the chief complaint, but often as a "By the way …", or because of long-term care and debility.
While management of chronic lesions is not within emergency purview, acute detection of potential skin cancers is part of our alerting function. New drug rashes, life-threatening Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, and worsened pressure ulcers with potential infection and sepsis may confront us.
Aging changes include: thinning of skin; solar radiation; high HgbA1C's; estrogen deprivation; decreased circulation. Injury may be from polypharmacy; fall risk; easy wounding of fragile tissues; Immobility; incontinence; and shear forces in movement of bedridden patients.
Na, C. R., Wang, S., Kirsner, R., & Federman, D. G. (2012). Elderly adults and skin disorders. Southern medical journal, 105(11), 600-606. As seen in Medscape. Accessed 4/21/2017.
Fahim, Simone, MD FRCP(C). Aging and Common Skin Problems in the Elderly. [pdf of ppt]. Accessed 4/21/2017.
Fox, Lindy P., MD. (2017). Emergency Dermatology. [pdf of ppt]. Accessed 4/21/2017.
Marchenko, Steve, MD; Pavlis, Janelle, MD; Kelly, Kristen, MD. Common Dermatologic Issues in the Geriatric Population. POGOe - Portal of Geriatrics Online Education; 2013. [ppt]. Accessed 4/21/2017.
Chen, Amy Y-Y, MD FAAD. 2013. Dermatologic Emergencies. [ppt] Accessed 4/21/2017.
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