Ageing causes a decline in the function of human skin, while factors such as medical conditions, drugs and environmental irritants add to the compromised skin and predispose it to certain conditions. Superimposed on the changes of physiological ageing are changes characterised by chronic sun exposure. Skin neoplasia, whether benign, premalignant or malignant, is more common in the elderly. It is important to identify benign conditions, as it is crucial that lesions with a malignant potential be recognised so that timeous treatment can prevent serious malignancies. Ultraviolet radiation is the major aetiologic factor for the development of skin cancer. Pruritic conditions result from a combination of a declining barrier function and the effects of environmental irritants. Pruritus due to scabies is common in institutionalised older persons. Infective conditions as a result of a combination of altered immunity, predisposing medical conditions (e.g. diabetes) and a variety of drugs used to treat these conditions may affect immune function and homeostasis. Regular scrutiny of the skin will ensure early identification of problems and implementation of a good skin care plan can compensate for failing physiologic function.