Skin Diseases - Skin Dryness (Xerosis)

Skin Dryness (Xerosis)

Are You Confident of the Diagnosis?

Xerosis is dry skin resulting from dehydration of the stratum corneum. The outer keritanized skin layers require 10-20% of water by volume to compensate for evaporative loss and maintain structural integrity. Pathological loss of lipids in the stratum corneum results in dramatic trans epidermal dehydration, up to 75 times that of healthy skin.

Dry skin may appear at any age, and provides the basis for the development of atopic dermatitis (AD). Scratched, itchy skin tends to develop eczema.

  • Eczema comes in various manifestations.
  • Three common forms are nummular eczema, asteototic eczema, and xerotic eczema, or xerosis.
  • They commonly present in the elderly.
  • A common manifestation of xerosis is pruritus.

Who is at Risk for Developing this Disease?

Eczema, in its various manifestations is a common dermatologic condition that affects people in all age groups, and is related to a defective skin barrier. Eczema involves damage to the intercellular lipids and can be exacerbated by irritating skin care products.

Prevalence and predisposing factors:

May appear at any age, it is most common in the elderly, and occurs most frequently during the winter months. (indoor heating has an intrinsic dehumidifying effect) Patients with xerosis may experience an intense pruritus, often involving the anterolateral lower legs, the back, flank, abdomen, and waist.

What is the Cause of the Disease?

In healthy skin, skin cells called corneocytes detach from neighboring cells and are replaced by younger cells from deeper skin layers. This orderly process, called desquamation, leads to corneocyte or skin cell loss from the skin surface. Desquamation is controlled primarily by two intercellular components - corneodesmosomes and lipids. This process is disturbed in the case of xeroticskin.This disturbed process is manifested by the formation of visible, powdery flakes on the skin surface.

There is deficits in both skin hydration and lipid content play a key role in xerosis. Consequently, the skin’s inability to retain moisture and provide an effective barrier directly impacts the development of xerosis in aged skin.

These processes are in dynamic equilibrium with other mechanisms in the skin, such as keratin production, sweat gland activity, fatty acid metabolism, and sebaceous excretion. Diseases that alter this dynamic equilibrium ( thyroid disease, neurologic disease, and certain forms of cancer) may cause xerosis.

Systemic Implications and Complications

Elderly patients are more susceptible to xerosis because of preexisting disease states, therapies, and medications.

Treatment

General Measures:

  • Proper hygiene of nails.
  • Wearing light and loose clothing.
  • Humidification.
  • Reduction of bathing/shower time and temperature.
  • Stopping the use of alcohol-based soap (clear soaps and gels) on affected areas.

Topical Treatments:

  • Moisturizers, emollients, or barrier creams with low pH.
  • Topical corticosteroids.
  • Topical immunomodulators.
  • Menthol.
  • Capsaicin.
  • Local anesthetics.
  • Topical salicylic acid.

Systemic Treatments:

  • Antihistamines.
  • Antidepressants.
  • Topical immunomodulators.
  • Opioid Agonists and antagonists.
  • Neuroleptics.

Physical Treatment:

  • Phototherapy.

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