# Skin Dryness and Pruritus in Older Adults With and Without Heart Failure and Implications for Home Care Nursing

## TL;DR

Older adults with heart failure experience more severe skin dryness and itching than those without, suggesting that skin care could help improve their quality of life.

## Contribution

This study identifies reduced sebum content as a key local skin factor linked to pruritus in older adults with heart failure.

## Key findings

- Heart failure patients had significantly lower skin moisture and higher pruritus prevalence compared to non-HF controls.
- Forearm sebum content and heart failure diagnosis were independently associated with pruritus.
- Lipid deficiency, not hydration, was found to be a key contributor to pruritus in this population.

## Abstract

Background: Pruritus is a common but under-recognized symptom in patients with heart failure (HF), particularly among older adults. While systemic factors have been implicated, the role of local skin conditions remains unclear.

Objective: The objective of this study is to investigate the prevalence and severity of pruritus in older adults with HF compared to older adults without HF and identify local skin parameters associated with pruritus.

Methods: We conducted a cross-sectional study including older adults with HF and non-HF controls. Skin assessments were conducted on the forearm and lower leg, including measurements of moisture, sebum content, and pH. Pruritus was evaluated using a visual analog scale (VAS). Multivariate logistic regression was performed to determine factors independently associated with pruritus.

Results: A total of 100 older adults (≥65 years) were included in the analysis (HF: n=74; non-HF: n=26). There were no differences in age, sex, BMI, or occupation. Compared with the non-HF group, the HF group had significantly lower skin moisture on both the forearm and the lower leg (p<0.001), although this may have been influenced by measurement conditions. Pruritus prevalence was higher in the HF group (44/74, 59.5%) compared with the non-HF group (6/26, 23.1%; p=0.001), and median VAS itchiness scores were significantly higher (15.0 mm vs. 0.0 mm, p<0.001). Multivariate analysis revealed that HF diagnosis (OR 7.15, 95% CI 1.17-43.69), forearm sebum content (OR 0.07, 95% CI 0.01-0.52), and use of moisturizers (OR 7.09, 95% CI 1.35-37.4) were independently associated with pruritus, while moisture content, antihistamine use, age, and BMI were not.

Conclusion: Older adults with HF exhibited a higher prevalence and severity of pruritus than non-HF older adults. Reduced sebum content, rather than reduced hydration, was independently associated with pruritus, suggesting that lipid deficiency played a key role in its pathogenesis. These findings underscore the importance of addressing local skin factors in addition to systemic contributors. Incorporating lipid-replenishing emollients into home and community care may represent a practical strategy to reduce pruritus and improve the quality of life in older adults with HF.