A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin
- Wrinkles
- Sagging
- Yellowish discoloration
- Irregular pigmentation
- Dryness
- Roughness
- Loss of elasticity
- Age spots
- Age warts
- Angiomas (hematomas)
- Hairiness
- Nails
- Thick nails
- Brittle nails
- V. a. the nail of the big toe often changes its direction of growth and becomes misshapen thick
- Skin
- Inspection and palpation (palpation) of the thyroid gland [due todifferential diagnoses: hypothyroidism (hypothyroidism)].
- Inspection (viewing).
- Dermatological examination [due todifferential diagnoses:
- Atopic eczema (neurodermatitis).
- Bullous pemphigoid (synonyms: parapemphigus, senile pemphigus, erythema bullosum chronicum, dermatitis herpetiformis senilis) – chronic, blistering disease with bulging, subepidermal blisters that form on reddened or normal skin; the disease occurs in the elderly and occasionally in children.
- Eczema (dermatitis (inflammation of the skin), especially with pruritus (itching) and erythema (areal redness of the skin)).
- Elastosis (degeneration of the elastic fibers of the skin, which occurs with age).
- Ichthyoses (genetic disease that leads to cornification disorders of the skin).
- Keratosis senilis (horn and wart-like brown growths (skin patches) that occur mainly in the elderly after chronic exposure to light, with possible transition in squamous cell carcinoma).
- Nevus cell nevi (birthmark)
- Psoriasis vulgaris (psoriasis)
- Pruritus senilis (itching of aging skin).
- Purpura senilis (spontaneous skin bleeding due to vulnerable skin).
- Seborrheic keratosis (age wart)
- Senile angiomas (tumor-like vascular neoplasm).
- Senile lentigines (brown sharply demarcated spots that appear with age (age spots)).
- Xeroderma (dry, brittle skin) (hypersensitivity of the skin and mucous membrane to environmental influences)]
[due topossible secondary diseases:
- Eczematous manifestations (asteatotic eczema, exsiccation eczema, eczema craquelé) – especially on the extremities and often with excruciating itching (pruritus senilis).
- Impaired wound healing due todecreasing immunocompetence (“immunosenescence).
- Skin inflammation with thin vulnerable skin
- Skin irritations
- Purpura senilis (areal hemorrhages, especially on the upper extremities (aging skin is more sensitive to friction and shear trauma)).
- Xereosis cutis (dryness of the skin).
- Increase in inflammatory dermatoses such as bullous pemphigoid (characterized by bulging subepidermal blisters usually localized on an erythematous base)]
- Cancer screening [due topossible sequelae: Increase in benign skin tumors such as seborrheic keratoses (Verrucae seborrhoicae), solar lentigines (Lentigines seniles; age spots) or senile angiomas; Increase in malignant skin tumors such as basaliomas, actinic keratoses as well as squamous cell carcinomas. Furthermore, the lentigo maligna, this is a pre-invasive melanoma]
- Health check respectively anti-aging check.
Square brackets [ ] indicate possible pathological (pathological) physical findings.