Psychocutaneous disease in older adults: A clinical review

Geriatric psychodermatology encompasses conditions influenced by the skin and mind in older adults (individuals aged ≥65 years). As the population ages, recognition of these disorders has become increasingly important. This clinical review summarizes the clinical presentation and therapeutic interventions of the most common psychocutaneous conditions in older adults, including delusional infestation, lichen simplex chronicus, prurigo nodularis, psychogenic pruritus, and skin-picking disorder. Treatment options include first- and second-generation antipsychotics, antiepileptics, antidepressants, topical antipruritic agents (eg, capsaicin), topical glucocorticoids, antihistamines, and immunosuppressants such as methotrexate, N-acetylcysteine, and biologics. However, management in older adults requires special consideration, as these therapies may be associated with side effects that could be potentially more worrisome in older patients, such as the anticholinergic effects associated with antipsychotics or increased sedation and fall risk from antihistamines. These risks are compounded by the high burden of comorbid medical conditions and polypharmacy in older adults, highlighting the need for careful dosing, close monitoring, and interdisciplinary collaboration. Effective management requires addressing both the acute dermatologic symptoms and the underlying psychiatric component. Larger, geriatric-specific studies are necessary to better inform management of these patients.