photos of skin conditions in elderly photos of skin conditions in elderly

Also known as moles, melanocytic nevi are small, pigmented spots on the skin that usually appear during childhood or adolescence. In elderly adults, skin conditions may become more numerous and more noticeable as the skin continues to thin and lose fat, elasticity, and moisture. Dermatosis papulosa nigra (DPN) is a benign cutaneous condition common among blacks. To prevent more warts, cover them with bandages, keep them dry, and dont pick them. Treatment isn't easy. In some cases, prescription creams and procedures can remove them or make them less noticeable, according to the Mayo Clinic. There are several serious skin conditions. These have a red border and a shiny, yellowish center, and they probably won't go away. 10) DermNet NZ / www.dermnetnz.org 2022 As you get older, your skin gets thinner and loses fat, which can make you bruise more easily. You are leaving AARP.org and going to the website of our trusted provider. The skin is constantly renewing itself. En espaol | If you have wrinkles, you don't need to be told the skin the body's protective outer layer is susceptible to the effects of aging. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Chickenpox (varicella): About chickenpox. Such symptoms can include blisters from new shoes or chafing from tight pants. (2022). This small flap of flesh-colored or slightly darker tissue hangs off your skin by a stalk. Other factors contributing to skin aging include the loss of fatty tissue between your skin and muscle, stress, gravity, daily facial movement (smiling and frowning, for example), and obesity. Others require medical attention. An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting. Numbers of moles vary by person from a handful to hundreds. All rights reserved. These include xerosis, pruritis, eczematic dermatitis, purpura, and chronic venous insufficiency. Liver spots are harmless and dont need treatment. But it won't work. Contact with the oily coating from poison ivy, oak, or sumac causes a rash in many people. Sun exposure is the main cause of skin damage. Slather on moisturizer to soothe dry skin and drink plenty of water to stay hydrated. 2005 - 2023 WebMD LLC. If your age spots bother you, a skin care provider can treat them. Small, raised, red spots -- usually on your shins -- slowly grow into larger, flatter patches. It feels like something is crawling on, stinging, or biting you. Melasma (chloasma) is tan or brown patches on your cheeks, nose, forehead, and chin. Dry, scaly and itchy skin are the norm, and constant scratching may lead to a thickened area. Dark brown, rough seborrheic keratoses may be found on any skin area, even inside the ear rim. (2018). man with skin condition. Sort by: Most popular. ", The National Rosacea Society, "All About Rosacea. 2005-2023 Healthline Media a Red Ventures Company. Large, dark bruises may spring up out of nowhere. Elbows, knees, knuckles, and armpits are typical places to get them. Here are some tips for preventing some noninfectious skin disorders: Learning about proper skin care and treatment for skin disorders can be very important for skin health. Atopic dermatitis can appear on the face (especially in infants), hands, feet or in the creases and folds of the skin. Get vaccinated for infectious skin conditions, such as chickenpox. (2022). Some are spread over the skin, and others are taken by mouth or as a shot. 1. "Necrobiosis Lipoidica," British Association of Dermatologists, June 2019. Darker skinned people. Different antibiotics are used depending on the severity of the infection. Any exposed skin including the eyes and tissues around the eyes are susceptible. Here are the 10 most common conditions I see in black skin: 1. Oil glands produce less oil as people age. Skin discoloration refers to any change in your natural skin tone. Waters Edge Dermatology is a leading full service dermatology practice providing medical dermatology, surgical dermatology, pediatric dermatology, cosmetic dermatology, skin cancer treatment, and plastic surgery, and Vein Centers. 4) Interactive Medical Media LLC The skin may feel hot and tender to the touch. Doctors can treat broken blood vessels and red or thickened skin with lasers. Your doctor will figure out the cause so you can avoid it and will probably prescribe drugs to soothe the itch. Common senile purpura symptoms appear such as: Thinning of skin. Dry skin in elderly adults is very common; in fact, more than half of older adults have it. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Prescription or over-the-counter medication can help soothe the itch. In most cases, doctors can treat childhood skin disorders with topical creams, medicated lotions, or condition-specific drugs. Older adults have older skin. Many people with it also have arthritis and eye problems, and some get kidney disease. Treatment can include medicine spread on the skin or taken by mouth. It's like having lifelong sunburn, where you can pull up a sheet of the top layer of skin. Most moles are harmless, but they can, on rare occasion, become cancerous. Warts spread when you touch something used by a person with the virus. Dark colored lesions on hands, forearm, face & neck. However, most skin conditions reappear due to certain triggers, such as stress or illness. See your doctor if you spot them: They can turn into cancer if not treated. Men had higher proportions of fungal skin infections and women had more benign tumors. (2022). Skin in the middle of the ring might appear clear and healthy, and the rings edges may spread outward. They may hang from the skin on small stalks. Over-the-counter antifungal medications are recommended. Apply a cold compress for up to 20 minutes a time. It is the last stage in the progression of acne rosacea. These small bundles of broken blood vessels often pop up on your legs, ankles, feet, and maybe even your face. Each specific type of trauma or wound may present with different discoloration patterns on the skin. Color variations in the lesions due to different stages of blood . In most cases, common warts appear on the fingers or hands. Use a moisturizing ointment or cream daily. Some of the more common causes of pruritus include dry skin, seborrheic dermatitis, allergic reactions, and fungal infections. Treatment isnt necessary, but medicated creams can improve skin appearance. This causes a red, painful, and irritated lump under your skin. In bed, reposition every two hours. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Some skin disorders have situational causes, while others may be genetic. Xerosis Xerosis is characterized by pruritic, dry, cracked, and fissured skin with scaling. 2) Interactive Medical Media LLC The researchers recommend whole-body skin examinations as a way to reveal hidden cutaneous symptoms and it ensures timely diagnoses and appropriate treatment.". Related searches: aging skin eyes asian aging skin aging skin face anti aging skin aging skin cells Skin cell turnover decreases dramatically, which slows wound healing. Search from 1598 Elderly Dry Skin stock photos, pictures and royalty-free images from hands of an elderly woman with eczema or allergic skin problems. If one bothers you, the doctor might cut it off, freeze it off, or burn it off with an electric current or laser. Please return to AARP.org to learn more about other benefits. Often melasma is uniform and symmetrical along both sides of the face. Join today and save 25% off the standard annual rate. It can be caused by conditions that range from mild, Learn all about dark circles under your eyes. Diabetes-related skin conditions include: Lupus is a chronic inflammatory disease that can damage the skin, joints, or organs inside the body. Tan C, et al. All rights reserved. Several medications treat eczema. Seborrheic dermatitis. A Closer Look at Common Foot Problems in Older Adults These have a red border and a shiny, yellowish center, and they probably won't go away. As we get older, our skin undergoes a number of changes. This group of conditions is related by an abnormal protein called amyloid that builds up in your skin. Depending on the type of skin cancer, you may need chemotherapy or other kinds of treatment, as well. Take an over-the-counter pain medication for pain and use cool compresses, calamine lotion and lukewarm baths with colloidal oatmeal (oats ground into a fine powder) for itching. They dont hurt, but they might bleed if they get hit or scraped. ", American Academy of Allergy, Asthma & Immunology: "All About Hives (Urticaria). An outbreak usually lasts up to 2 weeks. New cells are formed on the lower They can heal and come back throughout your life. Rosacea (roe-ZAY-she-uh) is a common skin condition that causes blushing or flushing and visible blood vessels in your face. Your doctor may cut away the loose skin, but the condition often returns. Skin Cancer Foundation: Actinic Keratosis (AK), Skin Cancer Facts & Statistics, Skin Cancer Information, Skin Cancer Treatment Glossary, Treatments for Actinic Keratosis., American Academy of Dermatology: Contact dermatitis, Seborrheic keratoses., Mayo Clinic: Age spots (liver spots): Diagnosis, Age spots (liver spots): Overview Easy bruising: Why does it happen, Healthy aging, Itchy skin (pruritus): Diagnosis, Itchy skin (pruritus): Overview, Skin Cancer, Varicose Veins: Diagnosis, Varicose Veins: Overview, Warfarin side effects: Watch for interactions., Cleveland Clinic: Common Benign Growths, Moles, Freckles, Skin Tags, Lentigines, & Seborrheic Keratoses, The Aging Skin, Varicose & Spider Veins., DermNet New Zealand: Leg ulcers, Solar elastosis., American Society for Dermatologic Surgery: Sagging Skin, Varicose Veins, Wrinkles., Womenshealth.gov: Varicose veins and spider veins., Circulation Foundation: Leg Ulcers.. The rash may be in the shape of a Christmas treespread across your body. Katherine Brind'Amour, Rachael Ajmera, MS, RD. Skin problems due to sun exposure. To prevent shingles, get both doses of the Shingrix vaccine. The condition is benign but can affect the skin of the trunk, face, and scalp. And exercises for your neck, jaw, and throat muscles may also help. Our website services, content, and products are for informational purposes only. Antibiotic Treatment. Dont try to remove a skin tag yourself. Ichthyosis vulgaris may be passed down from a parent or be related to an illness like cancer, thyroid disease, or HIVor AIDS. Please enable Javascript in your browser and try Avoid direct contact with the skin of other people who have an infection. We avoid using tertiary references. Sometimes people are able to force incurable conditions into remission. Sunlight exposure may cause or aggravate the following conditions: Many skin disorders are treatable. A severe allergy to latex can cause swelling and. All rights reserved. Can you get psoriasis if you have skin of color? This genetic disease makes your immune system overreact with too much inflammation. They might show up alone or in groups and generally appear before age 20. It is characterised by red patches with a white, scaly. A wound care nurse may be needed to coordinate care. Conditions like psoriasis cause an overgrowth of skin cells that pile up on the surface of the skin. Dont share personal items like blankets, hairbrushes, or swimsuits. Also, see your doctor if you notice suspicious changes in your skin, such as sores or growths that grow rapidly, bleed and don't heal. It usually starts before age 4 with a scaly rash on your trunk, arms, or legs, sometimes with hard bumps you can feel under your skin. Develops fish-like scales. (2022). It might also cause fluid-filled blisters that pop easily and form a honey-colored crust. Viral Skin Diseases 2005 - 2023 WebMD LLC. You will be asked to register or log in. It causes a rash with visible borders and appears where your skin touched the irritating substance. For older adults, however, intrinsic and extrinsic changes in the skin make it more prone to disease. The front of the shins are mainly involved, with the skin becoming very dry, cracked and quite itchy. Skin changes in pregnancy. Skin damage from the sun is due to the sun's ultraviolet (UV) light, which breaks down elastic tissue (elastin) in the skin and causes the skin to stretch, sag, wrinkle, and become blotchy, occasionally with pre-cancerous growths and even skin cancer. This chronic skin disease goes through cycles of fading and relapse. ", National Institute of Neurological Disorders and Stroke: "Shingles Information Page. Slower-growing basal cell and squamous cell cancers also become more common. There's no evidence colloidal silver has any health benefits, and it may also slow absorption of medicines like thyroxine and antibiotics. "Stress is a skin-wrecker," says Zeichner. Rosacea is a common skin condition that dermatologists frequently treat. (2022). Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. In many cases, it affects the scalp, which develops red, scaly, dry patches. Protect your skin from excessive cold, heat, and wind. Affected areas might also appear red, purple, gray, or dark brown. Petroleum jelly, to soften skin, and medicines you put on warts and calluses might make it feel and look better, but other typical skin treatments don't help and could even be harmful. It also causes warm, itchy wheals at the site of contact, which may take on a dry, crusted appearance with repeated exposure to latex. There are many causes of skin bruising in the elderly. Try cool compresses and oatmeal baths, too. You might have the mistaken belief that you're "infested." Healthline Media does not provide medical advice, diagnosis, or treatment. If the itching doesnt subside, tell your doctor. Pictures and symptoms of the red, scaly rash. It may go away on its own within a year or may become permanent. Even women with no history of acne or blemishes can suddenly get unstable skin at 50. Middle age brings telltale wrinkles. They can bleed if scratched, rubbed or cut open. Avoid contact with harsh chemicals or other irritants. The doctor will keep the wound clean,and in most cases, put pressure on the area. Its often called the "pregnancy mask" because it happens in half of all pregnant women. To prevent it, don't share shoes with an infected person or walk barefoot in areas like locker rooms or near pools. Diabetes: Diabetes and your skin. Keratoacanthoma on the forehead of a 77-year-old woman. If it doesnt go away on its own after the baby comes, you can treat it with prescription creams, over-the-counter products, or with laser treatments. See a dermatologist to rule out serious problems like melanoma, a type of skin cancer. Ultraviolet light from the sun or from a manmade source like a tanning bed causes these raised, crusty growths. Cherry angiomas are noncancerous skin growths made up of blood vessels that give them a reddish appearance. On light skin, eczema can cause a red rash. Age-Related Changes of the Skin Skin becomes drier, thinner, less elastic, and finely wrinkled with normal aging. People with diabetes easily get skin infections, so they should see a doctor as soon as anything unusual appears on their feet, according to Harvard Medical School. Redness, crusting, fluid leaking, and hair loss on the footpads, face, genitals, and lower legs are indications of this skin disorder. Oakley A, et al. These plaques can burn, sting, and itch. It can also cause skin crustiness or oozing. Here are eight skin conditions in elderly adults and what older adults, loved ones and caregivers should know. The condition won't hurt you, but it can be a sign of other problems like obesity, diabetes, hormone problems, a drug reaction, or even cancer. Macular amyloidosis usually shows up between your shoulder blades or on your chest, with flat, dusty-colored patches. Things like stress, smoking, dehydration, excess sun exposure, and dry air can make the problem worse. Cellulitis: All you need to know. Here are pictures of 25 different conditions, followed by a list of details for each. It also causes a red rash, which spreads from the face down the body. This skin condition often begins as small raised solid bumps that look like pimples. Though certain studies suggest a possible link to infection, many scientists believe it's a mental health issue. Symptoms on your skin that appear due to common problems arent always the result of a skin disorder. You may have thickened skin, bumps, and pus-filled pimples. Waters Edge Dermatology has 37 office locations throughout Florida. If bacteria get in the broken skin, the whole area can become infected. According to the Mayo Clinic, more than half of adults over age 40 have dry skin. ", NIH Genetic and Rare Diseases Information Center: "Peeling skin syndrome," "Elastoderma," "Primary cutaneous amyloidosis. Another common condition affecting the lower legs is venous eczema. If that doesnt help, your doctor might suggest a minor surgical procedure. On the other hand, in case of perianal abscess, the victim develops red-colored, warm and painful boil-like swelling around the anus. Your doctor may prescribe medication for a severe rash and antibiotics for an infection. An elevated bump that extends below the skin's surface that's filled with thick, yellow fluid ( keratin cyst ). These bumps arise when a hair follicle becomes plugged with keratin, a protein found in skin, hair, and nails. Worsening when seasonal changes cause low humidity and dry skin. It most often occurs on the face and neck but can happen anywhere that you shave or pluck. receive communications related to AARP volunteering. . A harmless rash, pityriasis rosea usually begins as a single scaly, pink patch with a raised border. (Avoid lotions, which contain more water.) The skin condition can be mistaken for acne, other skin problems or natural ruddiness. These signs and symptoms may flare up for weeks to months and then go away for a while. Actinic keratosis and non-invasive diagnostic techniques: An update. To help control acne, keep oily areas clean and don't squeeze (this may cause infection and scars).. In old age, melanoma rates spike. Cold sores last about 10 days and easily spread from person to person. If you think you have one of these common adult skin problems, have your doctor check it out. These substances can trigger a reaction that causes the skin to become itchy and inflamed. A few examples of chronic skin conditions include rosacea, psoriasis, and vitiligo. Most are minor, but others can signal something more serious. It begins with redness and swelling at the site, and then becomes itchy. Antibiotics usually cure it, and you should recover fully if you don't wait too long to treat it. Check yourself regularly for "changing moles" and new growths. This article reviews . Knowing if the sun causes or worsens your skin disorder is important for treating it properly. Sandpaper-like bumps resembling goose flesh. Learn more. Also, blood vessels are more fragile and easily broken. Rinse with cold water and apply moisturizer. Fever, chills, and red streaking from the rash might be symptoms of a serious infection requiring medical attention. How skin ages will depend on several factors: your lifestyle, diet, heredity, and other personal habits (such as smoking). It might also cause blisters that weep, ooze, or become crusty. (2021). related to AARP volunteering. (2017). What Really Happens When You Get a Sunburn? In general, poison oak grows west of the Rockies; poison ivy to the east. Your GP may be able to diagnose an actinic keratosis by its typical appearance alone. (2019). Your skin won't spring back when stretched, and it sags and folds. Most accidental bruises occur on the extremities, according to the National Institute of Justice, whereas bruises in abused elders are more likely to occur on the head, neck or torso, and they tend to be large. 18) Interactive Medical Media LLC Also, blood vessels are more fragile and easily broken. Here are 18 common (and a few less common) skin conditions with photos to help you ID them. An elevated pimple filled with pus or white fluid (pustule). More than 90% of all older people have some type of skin disorder. Skin irregularities that are typically symptoms of a skin disorder include: Common known causes of skin disorders include: Numerous health conditions and lifestyle factors can also lead to the development of certain skin disorders. Here, you'll find dermatologists' insight that can help you with the redness, acne-like breakouts, sensitive skin, along with other signs and symptoms. Airborne latex particles may cause cough, runny nose, sneezing, and itchy, watery eyes. This rash. The hair follicles may look darker than the surrounding skin on darker skin. Other conditions, such as skin cancer, can be life threatening. They can appear on many areas of the skin either alone or in groups. These small flaps of tissue hang from your skin by a kind of stalk. 3. Theyre harmless. (2018). It often goes away in 6 to 8 weeks without treatment. Talk to your doctor. (2022). DPN 's usually develops on darker skin as multiple . Use the AARP Auto Buying Program to find your next safe car! Prevention is critical. Skin can become so dry that it: Becomes rough and scaly. WebMD does not provide medical advice, diagnosis or treatment. You'll start receiving the latest news, benefits, events, and programs related to AARP's mission to empower people to choose how they live as they age. The multiple small, light brown freckles seen here reflect sun damage, but the darker, larger spot on the upper nose bridge is a rough, scaling seborrheic keratosis. They also are at risk for cancer of the eye and surrounding tissues. Discover how to lessen their appearance or get rid of them permanently. An elevated, pimple-like bump (papule or plaque). Aging skin is thinner, and theres less fat to act as cushioning. (2022). The most commonly occurring symptoms include constipation, fever, fatigue, bloody stools, pain and pus. A dermoscopic study of cutaneous warts and its utility in monitoring real-time wart destruction by radiofrequency ablation. Consider a gel or foam mattress topper or a mattress with alternating air pressure, which can help prevent pressure sores. It usually causes an irritating rash, which is often located in the area around the mouth, chin, and nose. The age-related reduction in oil and sweat gland function (which helps to keep the skin soft and hydrated) is the main cause of dry skin. Some medicines can make skin itchy. What causes them, and what you can do about them. See your doctor if it lasts more than 2 weeks or covers your body. Bed sores can be very difficult to treat once they develop, and they may become infected. Triggers include fever, too much sun, stress, and hormonal changes like periods. In people with darker skin, it tends to be, Warts are caused by many different types of a virus called the. Most cases of contact dermatitis arent severe, but they can be rather itchy. Causes include a backup of blood, hormone changes, or an injury. They can darken or enlarge during adolescence or pregnancy. A dermatologist will remove it for you. A loss of sweat and oil glands is one reason. These pesky brown or gray spots arent really caused by aging, though they do become more common as you get older. The drugs used to treat these diseases can cause certain skin conditions, such as: Many people with diabetes experience a skin problem due to their condition at some point. You can treat cold sores with antiviral pills or creams. Skin changes that accompany aging include: Nothing can undo sun damage, but the skin can occasionally repair itself. Well explain the few ways to do this. Skin infections and long-term nerve pain are possible complications. fleshy bumps, warts, or other skin growths, bacteria trapped in skin pores and hair follicles, fungus, parasites, or microorganisms living on the skin, contact with allergens, irritants, or another persons infected skin, illnesses affecting the thyroid, immune system, kidneys, and other body systems, a red, butterfly-shaped rash on the cheeks and nose, red, ring-shaped lesions on body parts exposed to sunlight, flat rash on the face and body that looks like a sunburn, red, purple, or black spots on fingers and toes, over-the-counter (OTC) skin care products, small lifestyle adjustments, such as making certain dietary changes. Urgent care may be required. A rash of raised dots that turns into painful blisters, shingles causes your skin to burn, itch, tingle, or become very sensitive. 2005 - 2023 WebMD LLC. Skin Problems in the Elderly The skin is constantly renewing itself. Whats Causing My Rash and Swollen Lymph Nodes? Eczema is characterized by yellow or white scaly patches that flake off. Picture of Keratoacanthoma 1. Other symptoms of autoimmune skin diseases include: Chronic fatigue. Extremely dry skin is common in people who have end-stage kidney disease, which requires dialysis or a kidney transplant. With time the spots or patches may become hard with a wartlike surface, and a small percentage can become skin cancer, according to the Mayo Clinic. They can go from flat to raised, grow hair, or change color. Scaling. Rosacea can be mistaken for acne, other skin problems or natural ruddiness. ", International Hyperhidrosis Society: "Chromhidrosis.". Whereas, as the name suggests, anorectal abscesses . Skin disorders vary greatly in symptoms and severity. Skin may become cracked and painful. Contact dermatitis. (2022). They can be small, round, ring-shaped, or randomly shaped. Remember to always reach out to your physician for a proper diagnosis and treatment. 19) Interactive Medical Media LLC, American Academy of Dermatology: "Hives," "Atopic Dermatitis/Eczema," "Lip and Mouth Care," "Poison Ivy: Signs and Symptoms," "Men's Skin Care," "Pityriasis Rosea," "Melasma," "Warts. Depending on appearance, some people may want to get rid of the keloids they have. 14) Interactive Medical Media LLC To prevent them, use sunscreen and avoid the sun. This Pictures of skin conditions in the elderly provides step-by-step instructions for solving all math problems. Article Written By:Jennifer L. Cook, an award-winning editor and writer whose work has appeared in Good Housekeeping, Prevention, Consumer Reports on Health, and Womans Day and on Investopedia.com and Bottomlineinc.com. Most skin conditions that arise during pregnancy go away after the baby is born. Pityriasis rosea is a fairly short-term rash that occurs most often in older children and young adults. WebMD does not provide medical advice, diagnosis or treatment. The skin might tear when you bump into something, or when a caregiver removes wound tape or dressing. The cause is not currently known, but it may be distinguished from some other skin conditions that cause skin plaques by the presence of a herald patch, a large and itchy patch that can be 1 to 5 inches in diameter, that occurs first. During treatment, youll need to keep your feet and the insides of your shoes clean and dry. Call your doctor if the sores contain pus, the redness spreads, you have a fever, or if your eyes become irritated. Use these tips to help keep your skin healthy at any age. Also known as razor bumps or shaving bumps, the irritation can cause pimples, and even scars. Learn about eight things you can do in the early stages of a cold sore to help manage symptoms and shorten duration. People with this have changes (mutations) in their genes that make it hard for their body to process a light-sensitive chemical called protoporphyrin. Apocrine chromhidrosis is a rare chronic condition involving the apocrine sweat glands, causing sweat to have color. 2005 - 2023 WebMD LLC. Aging skin gets drier. Youll usually find them on your chest, back, neck, armpits, or around your groin. People with permanent skin conditions often go through periods of severe symptoms. You can try bleach creams, acid peels, and light-based treatments to fade them. Contact dermatitis in skin of color. ", National Center for Complementary and Integrative Health: "Colloidal Silver. Men can get it, too. (2018). Wear long pants and a long-sleeved shirt or arm sleeves to protect the skin. Theyre harmless, but they can look like precancer growths or skin cancer, so get your doctor to check them out. This common skin condition causes dark patches to appear on the face and rarely the neck, chest, or arms. The bluish-gray skin color comes from tiny bits of silver that build up in your tissues. Once you confirm that subscription, you will regularly In fact, a recent study found 75.7 percent of adults 70 and older have at least one skin condition and 39.1 percent have at least three simultaneously requiring treatment either at home (43 percent) or by a physician (57 percent).