A CROSS-SECTIONAL STUDY ON DRUG PRESCRIBING PATTERNS FOR DERMATOLOGICAL CONDITIONS IN GERIATRIC PATIENTS AT A TERTIARY CARE TEACHING HOSPITAL

Dermatological diseases constitute a major global health concern, accounting for nearly one-third of all non-fatal disease burden [1-2]. Despite their high prevalence, these conditions remain significantly underrecognized, often overshadowed by more visibly acute illnesses [2-3]. India is undergoing a demographic transition from a population with high fertility, high birth rates, and higher death rates to a population with low fertility, low birth, and death rates. As this happens, we see a steady increase in population of elderly in India with 8.6% of the population above age of 60 years as per 2011 census which is projected to go over 10% by 2020. The decadal growth rate of elderly population between 2001 and 2011 census has increased for the first time since independence. Also, the absolute number of elderly women has outnumbered elderly men in the last two decades.[4]

 In India, skin disorders represent a substantial proportion of outpatient consultations, driven by complex interplays between climatic diversity, socio-cultural practices, environmental exposures, and healthcare access disparities. Among affected populations, the geriatric group presents unique diagnostic and therapeutic challenges, primarily due to physiological skin aging, immunosenescence, and the frequent coexistence of systemic comorbidities [4-7].

Aging skin undergoes both intrinsic and extrinsic changes. Intrinsic aging is mediated by mechanisms such as telomere shortening, oxidative DNA damage, microRNA dysregulation, and decreased collagen synthesis, while extrinsic aging is accelerated by cumulative ultraviolet (UV) radiation, environmental pollutants, smoking, and nutritional deficiencies [8]. These factors result in xerosis, barrier dysfunction, dyschromia, pruritus, atrophy, and increased vulnerability to infections and neoplasms. Geriatric patients frequently suffer from chronic dermatological conditions, many of which require prolonged pharmacological interventions [9-10].

The prescribing of dermatological medications in elderly individuals demands particular caution. Age-associated alterations in drug pharmacokinetics and pharmacodynamics, polypharmacy, and organ function decline collectively heighten the risk of adverse drug reactions [11-13]. Inappropriate prescribing (IP)—including both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs)—is prevalent and detrimental. The irrational use of fixed-dose corticosteroid combinations, empirical antibiotic use, and polypharmacy are especially concerning, contributing to increased morbidity, antimicrobial resistance, and avoidable healthcare costs [14-15]. Implementation of structured tools such as the Beers Criteria and STOPP/START guidelines can facilitate rational prescribing in geriatric dermatology. Recent regional studies from across India highlight varying dermatological morbidity patterns in older adults [3,16].  In Northern India, elderly patients (≥60 years) account for approximately 4.7% of dermatology OPD visits, with erythemato-squamous disorders (38.9%), infections (29.9%), and senile pruritus (9%) predominating. Southern India reports high rates of dermatitis (44.3%) and infections (40.6%) among rural elderly populations. Common age-related conditions include xerosis (61.6%) and seborrheic keratosis (76.6%). [17-18]

 Despite these observations, there remains a paucity of region-specific, systematically collected data on geriatric dermatological prescribing. In light of India's rapidly expanding elderly population—projected to exceed 227 million by 2036—this study was conducted at a tertiary care teaching hospital in Greater Noida, Uttar Pradesh, to evaluate drug prescribing patterns in elderly dermatology patients.

Rationale of the Study

With the rising geriatric population in India, dermatological disorders in older adults are becoming increasingly common, yet remain underreported and understudied. Elderly patients often present with age-related skin changes compounded by chronic comorbidities, necessitating complex pharmacotherapy. This study aims to evaluate prescribing patterns for dermatological conditions in geriatric patients to promote safer, evidence-based treatment. By identifying prevalent skin conditions, commonly prescribed drugs, polypharmacy trends, and associated adverse drug reactions, the study seeks to improve clinical decision-making, minimize inappropriate prescribing, and enhance therapeutic outcomes in this vulnerable population.

Study Design

This was a hospital-based, cross-sectional observational study conducted to analyze prescribing patterns in geriatric patients with dermatological conditions. A purposive sampling method was adopted for patient selection.

Study Setting and Duration

The study was conducted in the Department of Dermatology, Venereology, and Leprosy at Sharda Hospital, Greater Noida Data collection was carried out over a period of four months, from July 2025 to October 2025.

Study Population

Geriatric patients aged 65 years and above presenting with dermatological conditions during the study period were included.

Inclusion Criteria

·       Patients aged ≥65 years.

·       Patients presenting with dermatological complaints and seeking treatment in outpatient or inpatient settings.

Exclusion Criteria

·       Patients presenting solely with non-dermatological or unrelated systemic conditions.

·       Patients with significant comorbidities likely to alter dermatological management or interfere with drug prescribing patterns.

Sample Size Determination

The sample size was calculated using the standard formula:

N=z^2× P (100-P)/d^2

Where:

Z = 1.96 (Z-value for 95% confidence)

P = 85 (estimated prevalence)

d = 5 (margin of error)\

N= (1.96) ^2 × 85 × 15/(5)^2

N=3.8416 ×1275/25

 N=196

Thus, the final sample size was 196 patients.

Ethical Considerations

The study received approval from the Institutional Ethics Committee of Sharda University (Ref. No.: SU/SMS&R/76-A/2025/192). Written informed consent was obtained from all participants prior to data collection. Patient confidentiality and data integrity were maintained throughout the study.

Data Collection Procedure

Data were collected prospectively from geriatric patients (aged 65 years and above) attending the Dermatology, Venereology, and Leprosy outpatient and inpatient. After obtaining written informed consent, patient demographics, clinical history, diagnosis, and details of all dermatological medications prescribed were recorded using a structured, prevalidated Case Record Form. Information on drug name (brand and generic), category, route, frequency, dosage, strength, and duration of therapy was documented. Additional data on comorbidities, past medications, and substance use were also captured. Only new patients diagnosed with dermatological conditions were included, while those with primary non-dermatological diagnoses or significant unrelated comorbidities were excluded.

Statistical Analysis

Data were entered and analyzed using Microsoft Excel. Descriptive statistics were used to summarize findings, including frequencies and percentages. Graphical representation (bar charts and pie diagrams) was used where appropriate. No specialized statistical software was employed.

 

Table1: Distribution of Patients According to Age Groups

Table 2: Distribution of Patients According to Gender

Table 3: Urban-Rural Distribution of Patients

Figure 1: - Bar chart showing patient counts by age group

 

Figure 2:- Pie chart showing male and female proportions

 

Figure 3:- Pie chart showing Urban/Rural distribution

 

 

 

 

 

 

The average number of drugs per prescription was 2.4 ± 0.5. Importantly, no adverse drug reactions were reported throughout the study, suggesting safe and rational prescribing practices.

Importantly, no adverse drug reactions (ADRs) were reported in the study population despite multiple drug therapies being common. This may reflect cautious prescribing practices, judicious drug selection, and possibly good tolerance among the geriatric cohort.

 

The present study evaluated dermatological and systemic health characteristics in 196 geriatric patients, emphasizing the relationship between cutaneous disorders, comorbidities, and therapeutic patterns.Papulosquamous disorders were the most common presentations (31.5%), with eczema (9.1%) and seborrheic dermatitis (7.6%) leading, followed by chronic plaque psoriasis and lichen planus. Infective dermatoses accounted for 22.8%, predominantly fungal infections, likely attributable to warm climatic conditions, reduced immunity, and comorbid diabetes. Pruritus was the most frequently reported symptom (56.4%), influenced by xerosis, systemic illnesses, and impaired skin barrier with aging. Vesicobullous and autoimmune dermatoses were relatively less frequent but clinically relevant. Connective tissue diseases such as systemic lupus erythematosus, systemic sclerosis, discoid lupus erythematosus, and dermatomyositis were present in a minority of cases, consistent with previously documented low prevalence in geriatric cohorts [19,22]. The observed disease pattern indicates a transition from infectious to chronic inflammatory dermatoses with aging, a trend aligned with global dermatogeriatric observations.Comorbidities were nearly universal, present in 95.4% of patients [20–21]. Hypertension (58.7%), diabetes mellitus (48.5%), and hyperlipidemia (42.9%) predominated, highlighting the strong contribution of cardiovascular and metabolic disease to geriatric dermatology. Thyroid disorders, though less frequent, were associated with xerosis and occasional lichen planus, reflecting an autoimmune overlap. The high prevalence of systemic illness shaped both clinical expression and therapeutic decision-making, particularly in minimizing risks of adverse drug interactions. Prescription analysis reflected rational practices in accordance with WHO recommendations [23–25]. The mean drug count was 2.4 ± 0.5 per encounter, notably lower than reports of six or more medications in comparable studies. Polypharmacy was uncommon, with very few prescriptions exceeding four drugs. Antibiotic prescribing was minimal (5.01%), and injectables were rarely used (0.97%). Topical therapy predominated, aligning with the safety considerations necessary in elderly skin, reducing systemic exposure and adverse drug reactions.

Oral antihistamines, mainly levocetirizine (34.9%), were the most frequently used systemic agents, reflecting the predominance of pruritic dermatoses. Topical corticosteroids, including mometasone (23.5%) and clobetasol (16.4%), were prescribed for inflammatory disorders with due regard to potency and safety in fragile elderly skin. Antifungal agents, both topical and systemic, were selectively used depending on disease severity. While prescribing was largely rational, only 0.3% of drugs were prescribed by generic name, and 32.2% were drawn from the essential drug list, reflecting limited integration of cost-effective prescribing practices. Dependence on branded formulations and prescriber familiarity likely account for this observation, consistent with reports from other developing regions. The findings demonstrate a high prevalence of chronic inflammatory dermatoses and pruritic conditions among elderly patients, closely linked to systemic comorbidities such as diabetes and hypertension. Rational prescribing patterns, minimal polypharmacy, and emphasis on topical agents highlight an age-appropriate therapeutic approach. However, the low rate of generic and essential drug prescribing underscores the need for policy and educational initiatives to optimize cost-effective dermatological care.

ACKNOWLEDGMENTS

The authors sincerely thank all the patients for their cooperation and support during the data collection process. Their willingness to participate was indispensable for the successful completion of this study. The authors also extend their gratitude to the management and staff of Sharda Hospital for facilitating this research.

ETHICAL DECLARATION

Written informed consent was obtained from all participants prior to data collection, ensuring a comprehensive understanding of the study’s objectives and procedures. Participant confidentiality and privacy were strictly maintained throughout the study. The research protocol was reviewed and approved by the Institutional Ethics Committee of Sharda University (Ref. No.: SU/SMS&R/76-A/2025/192).

CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest in relation to this study.

FUNDING

This study did not receive any external financial support. All research activities were conducted using the resources available to the authors.

AUTHOR CONTRIBUTIONS

SG and ANJ were responsible for conceptualization and study design. RA and SVG contributed to patient recruitment and data collection. RA and AFC performed data tabulation and preliminary analysis. ANJ and AKG drafted and critically revised the manuscript. All authors read and approved the final version of the manuscript for submission.