Why do the elderly get itchy?

A very sprightly 94-year-old arrived with her favourite cab driver. While she was using a walker, she was fit for her age and mentally she was as sharp as a person 50 years younger. She was living with her daughter in a retirement village in their own self-maintained unit. The cafeteria supplied their main meals but they did some cooking themselves.

This delightful woman was currently taking prescribed medication for a variety of conditions and had been for over 10 years: Metformin for diabetes, Crestor for hypercholesterolaemia, warfarin and Astrix (aspirin) as blood thinners, Aldactone as a diuretic and Panadol Osteo for spinal pain. Quite a pharmaceutical cocktail.

To re-establish healthy skin barrier mechanisms, she was encouraged to eliminate the use of soaps and detergents, and to limit showers to 10 minutes.

She was managing quite well on this regime until about three years ago, when she developed a severe itch (pruritis) mainly on her back (she couldn’t reach it). This was much worse when she was warm at night, and she likes being cosy in bed. It was driving her crazy and was significantly disrupting her sleep.

Studies have shown that chronic itch has an impact comparable to that of chronic pain on quality-of-life measures. The effect of chronic itchy skin in the elderly, by impairing sleep, can be a major factor in the development of clinical depression and has been shown to not only affect morbidity but also to increase mortality.

Why do the elderly get itchy?

Itching is the most common skin complaint in people over the age of 65, with one study showing that nearly two-thirds of more than 4000 patients considered itching a major complaint. It’s most commonly associated with dry skin (xerosis). Dry skin is caused by a reduction in both fluids (lack of hydration) and lipids (fats), this having a close association with low levels of anti-inflammatory essential fatty acids, particularly omega-3s. Dry skin is associated with “dry eye syndrome”, which she also suffered.

Unfortunately, this woman was suffering all the medical conditions implicated in the development of itchy skin, such as diabetes, hypertension and hyperlipidemia, and the 10 years she has been taking the prescribed medications is the timeframe for itch onset mentioned in the research. Despite this potentially being a major factor, drug removal was not an option.

Dysfunctional states that can induce itching

There are many other recorded dysfunctional conditions that can trigger itchy skin, most of which we eliminated, except for liver dysfunction and yeast intolerance. These can both lead to severe itching, especially at night. Degenerative spinal changes can trigger a persistent itch, especially on the back, which was determined as another contributing factor.

What to do?

Over the years, this lady had been to her doctors and tried numerous creams and a variety of medications, none of which had had any impact at all. In desperation, she was encouraged to consult with a naturopath.

On testing — blood tests and cytotoxic food allergy testing — the results showed a high level of IgG reactions to yeast. This is common with blood sugar abnormalities such as diabetes. Her glutathione levels were low, indicating liver dysfunction.

First, to re-establish healthy skin barrier mechanisms, she was encouraged to eliminate the use of soaps and detergents and to limit showers to 10 minutes and use only cool to warm water. She was also encouraged to go out in the sun for short periods, as phototherapy has shown benefit.

Aloe vera gel applied topically was cooling at night and reduced the itch, and emu oil or hemp oil was applied topically immediately after washing to moisturise the skin and reduce inflammation.

As for dietary advice, she was advised to avoid sugars: she had a sweet tooth and daily enjoyed several glasses of red wine. Reducing/removing these was the most difficult dietary change for her.

Minimal supplements were recommended because of potential interactions with her medications, but chromium and lipoic acid were suggested to manage blood sugar, and zinc for skin repair. She tested her blood sugar daily and INR weekly, but there were no adverse reactions.

She was prescribed a low dose of herbs with pau d’arco, turmeric, fenugreek, cat’s claw and gotu kola — to reduce cravings for sugars and reduce the yeast reactions and the skin inflammation.

Over the next few months, her condition went up and down, but overall improved significantly and she had only occasional “attacks” of the itching — usually associated with sugar and red wine consumption.

This was a very positive outcome and, while we didn’t change her medication at all, the most difficult thing was to maintain the diet. It was also interesting for her to learn (and therefore manage) at least some of the triggers for the itch.