Prevalence and Comorbidities of Dermatoporosis: a French Prospective Observational Study in General Medicine Consultation

The term dermatoporosis (DP) was proposed by JH. Saurat in 2004 and detailed in 2007 to describe a chronic cutaneous insufficiency and fragility syndrome.

The concept of DP, the positive diagnosis and the complications are well identified in the literature. However, while the consequences of skin aging are a growing concern, knowledge of DP is stagnant.

DP is clinically defined by the combination of three clinical signs: skin atrophy, white pseudo-scars, and senile purpura. It mainly sits on photo-exposed regions: posterior face of the forearms and back of the hands in 92 to 100% of cases; but also the pre-tibial, pre-sternal, and cephalic regions.

DP appears at around 60 years old and can worsen with advancing age. Complications of varying severity can occur during its development: skin tears, delayed healing, infection, hematomas including dissecting hematomas that are sometimes life-threatening.

DP is classified into four stages defined in 2004 and revised in 2012. The autonomy of the DP entity or its integration as a marker in multi-organ failure has not yet been determined. It is a condition on the borders of several specialties requiring good coordination between them (dermatologists, general practitioners, geriatricians, nurses, etc.)

The few published epidemiological studies report a prevalence ranging from 4% to 37.5% in patients aged 50 years and over. These epidemiological data are very heterogeneous (age of recruitment, patients hospitalized or seen on an outpatient basis in consultations of different specialties, sample of the population, etc.).

Among these studies, three clinical studies, two on a French hospital cohort, the other on outpatients in Dermatology in Finland, estimated the prevalence of DP between 27 and 32% in adults aged 60 years and older. In all three studies, DP was associated with advanced age, with a risk of DP up to double in patients aged 85 and older compared to younger patients. In two of these studies, a link was suggested with the status of chronic renal failure, either independently for one, or concomitant with taking anticoagulants and corticosteroids for the other. For Kluger et al., DP was also associated with the independent use of very strong local or systemic corticosteroids. For Chanca et al., an independent link between DP and tobacco consumption, taking anticoagulant treatment, and chronic recreational sun exposure has been observed.

Study Overview

• Status: Completed
• Conditions: Dermatoporosis

Detailed Description

No clinical study has evaluated the prevalence of DP and the comorbidities often cited in adults aged 60 and over in general practice consultations.

The primary objective of this study is to assess the prevalence in a population aged 60 and over followed in a general practice in the North East of France (Lorraine). In addition, as it has been shown an association between DP and comorbidities or drug intake, the secondary objective is to investigate the possible existence of such associations.

Study design:

An observational, descriptive, transversal, multicenter study was conducted in the North East of France (Lorraine) between May and October 2022. We included by half-day, consecutively, all patients aged 60 and over presenting to a general medical consultation with 20 volunteer practitioners from the 4 Lorraine departments. Each practitioner was trained in the diagnosis of DP through a 27-minutes E-learning video and phone contacts.

Clinical and biological variables:

For each patient, the general practitioner performed his usual clinical examination, with a dermatological examination of the upper limbs. He completed an anonymous online questionnaire with data collected from the interrogation, medical files, and clinical examination.

The following data were reported: demographic data, active or former smoking, diabetes, dermatological history (atopic dermatitis, bullous dermatosis, psoriasis), chronic renal failure (MDRD < 60ml /min/m2), past sun exposure, Fitzpatrick phototype, treatments (anticoagulant, antiplatelet, systemic, local, inhaled corticosteroid therapy (cumulative duration >= 1 month)).

Finally, the signs of DP and the stage were filled in. For this study, we used the clinical staging of DP as proposed by Kaya and Saurat in 2012.

When signs of DP were present, photos of the dorsal aspect of the forearms and back of the hands (usual practice) were reviewed by the investigator and a dermatologist to confirm the diagnosis. The questionnaires were analyzed by the principal investigator.

As Chanca et al., we divided past sun exposure into three types: recreational, occupational, and childhood exposure. To assess chronic recreational sun exposure, patients were asked about past outdoor activities, such as walking or cycling at least 2 times/week. Occupational sun exposure was defined based on whether patients had an indoor or outdoor occupation. Childhood sun exposure was defined by a history of childhood sunburn.

Fitzpatrick phototype distinguishes six skin types based on tone, from very light skin that never tans (phototype 1), to dark skin, which never gets sunburn (phototype 6). According to this classification, we divided the patients into two categories: light skin (phototypes 1 to 3) and dark skin (phototypes 4 to 6).

• Study Type: Observational
• Enrollment (Actual): 370

Contacts and Locations

Study Locations

• France
  • Ancerville, France, 55170
    • Stéphanie Chevalier
  • Basse-Ham, France, 57970
    • Wissam Al Shouaib
  • Bulgnéville, France, 88140
    • Sophie Delaporte
  • Bénaménil, France, 54450
    • Sophie LARUELLE
  • Cattenom, France, 57570
    • Cédric Berbé
  • Hayange, France, 57700
    • Sandra Pacini
  • Hettange-Grande, France, 57330
    • Anais Leclerc
  • Hettange-Grande, France, 57330
    • Benoit Nicolas
  • Le Val-d'Ajol, France, 88340
    • Mathieu Zimmermann
  • Longuyon, France, 54260
    • Mélanie Damervalle
  • Longwy, France, 54400
    • Patrick Vauthier
  • Raon-l'Étape, France, 88110
    • Aurelie François
  • Thaon les vosges, France, 88150
    • Jean-Louis Autissier
  • Tronville-en-Barrois, France, 55310
    • Cabinet Tronville en Barrois
  • Varangéville, France, 54110
    • Cabinet Varangéville

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

All patients aged 60 or over presenting to their general practitioner.

Description

Inclusion Criteria:

• Patient presenting to his general practitioner
• Patient aged 60 or over

Exclusion Criteria:

• Refusal of participation

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Patient aged 60 or over presenting to their general practitioner; Patient aged 60 or over presenting to his general practitioner (among the 20 general practitioners recruited in Lorraine (eastern France))

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence or absence of dermatoporosis on the forearms or back of the hands	Presence or absence of dermatoporosis on the forearms or back of the hands in patients aged 60 or over in general practice	At admission, Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement of phototype	Measurement of phototype as a risk factor for dermatoporosis	At admission, Day 1
Childhood sun exposure	Childhood sun exposure as a risk factor for dermatoporosis	At admission, Day 1
Lifetime sun exposure Measurement of phototype	Lifetime sun exposure as a risk factor for dermatoporosis	At admission, Day 1
Tobacco consumption	Tobacco consumption as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of diabetes	Diabetes as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of chronic renal failure	chronic renal failure as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of antiplatelet consumption	antiplatelet consumption as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of anticoagulant consumption	anticoagulant consumption as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of systemic corticosteroid therapy	systemic corticosteroid therapy as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of topical corticosteroid	topical corticosteroid on the forearms or back of the hands as a risk factor for dermatoporosis	At admission, Day 1
Presence or absence of inhaled corticosteroid	inhaled corticosteroid as a risk factor for dermatoporosis	At admission, Day 1

Collaborators and Investigators

• Sponsor: University of Lorraine
• Collaborators: Study Director: Anne Claire Bursztejn, PHD-MD, CHU Nancy - University of Lorraine; Study Chair: Christophe Goetz, MD, CHR Metz-Thionville - University of Lorraine
• Investigators: Principal Investigator: Antoine Truchetet, MD, University of Lorraine; Study Director: Anne Claire Bursztejn, PHD-MD, CHU Nancy - University of Lorraine; Study Director: Cédric Berbé, MD, University of Lorraine; Study Chair: Christophe Goetz, MD, CHR Metz-Thionville - University of Lorraine

Publications and helpful links

General Publications

• Kaya G, Saurat JH. Dermatoporosis: a chronic cutaneous insufficiency/fragility syndrome. Clinicopathological features, mechanisms, prevention and potential treatments. Dermatology. 2007;215(4):284-94. doi: 10.1159/000107621.
• Mengeaud V, Dautezac-Vieu C, Josse G, Vellas B, Schmitt AM. Prevalence of dermatoporosis in elderly French hospital in-patients: a cross-sectional study. Br J Dermatol. 2012 Feb;166(2):442-3. doi: 10.1111/j.1365-2133.2011.10534.x. Epub 2011 Dec 5. No abstract available.
• Chanca L, Fontaine J, Kerever S, Feneche Y, Forasassi C, Meaume S, Colboc H. Prevalence and risk factors of dermatoporosis in older adults in a rehabilitation hospital. J Am Geriatr Soc. 2022 Apr;70(4):1252-1256. doi: 10.1111/jgs.17618. Epub 2021 Dec 17.
• Kluger N, Impivaara S. Prevalence of and risk factors for dermatoporosis: a prospective observational study of dermatology outpatients in a Finnish tertiary care hospital. J Eur Acad Dermatol Venereol. 2019 Feb;33(2):447-450. doi: 10.1111/jdv.15240. Epub 2018 Oct 1.

Study record dates

Study Major Dates

• Study Start (Actual): May 23, 2022
• Primary Completion (Actual): May 23, 2022
• Study Completion (Actual): October 3, 2022

Study Registration Dates

• First Submitted: January 17, 2023
• First Submitted That Met QC Criteria: January 17, 2023
• First Posted (Actual): January 26, 2023

Study Record Updates

• Last Update Posted (Actual): May 1, 2023
• Last Update Submitted That Met QC Criteria: April 27, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: purpura; sun exposure; skin ageing; skin tears
• Other Study ID Numbers: University of Lorraine

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No