xerosis (dry skin)

Etiology

• asteatotic dermatitis (xerotic eczema)
• atopic eczema
• nummular eczema
• Ichthyosis vulgaris
• excessive bathing, use of soaps that remove sebum from skin

Epidemiology

• up to 1/3 of elderly individuals

Pathology

• sources of moisture to epidermis
  • diffusion from underlying cutaneous vasculature
  • perspiration from sweat glands
• moisture loss from evaporation from skin
• sebum helps maintain hydration by preventing moisture loss
• stratum corneum of epidermis contains natural moisturizing factors including urea & lactic acid
• net loss of moisture from epidermis in xerosis
• stratum corneum becomes less pliable & prone to cracking & cracking
• elderly at risk for dry skin because of reduction in the number & activity of sebaceous glands & decreased perspiration Clinical manifestation
• rough, flaky or scaly skin
• dry skin commonly occurs on extremities, but may affect trunk & face
• dry skin is exacerbated by cold, dry weather & low humidity associated with central heating & air conditioning
• associated hyperpigmentation of skin may occur
• pruritus
• inflammation, erythema & fissures associated with xerotic eczema

Laboratory

No specific testing

Management

• pharmacologic agents (moisturizing agents)
  • ammonium lactate lotion
    • Lachydrin lotion 12% (prescription)
    • Lachydrin Five lotion 5% (over the counter)
    • stinging may occur if any open fissures
    • effective of severe xerosis
  • ointments: mixtures of water in oil (lanolin or petrolatum)
    • Vaseline
    • Aquaphor
    • hydrocortisone 1%
  • creams: mixtures of oil in water, more effective than lotion
    • Eucerin
    • Moisturel
    • Pen-Kera
    • apply after shower
  • Lotions (suspensions)
    • Lubriderm
    • Keri-lotion
    • Vaseline intensive care
  • foams (leave oily residue)
  • oils
    • bath oil (caution, may result in slippery surfaces)
    • mineral oil
    • baby oil
  • oatmeal baths
• glucocorticoids (topical triamcinolone 0.1%) useful for atopic eczema, asteatotic dermatitis & nummular eczema (see Etiology:)
• patient education
  • moisturizing agents work by preventing evaporation from skin
  • the greasier & more occlusive the emollient (moisturizer) the more effective
  • room humidifiers help increase humidity & may help dry skin
  • avoid excessive bathing
  • use of mild soaps such as Dove or Cetaphil may help
  • moisturizers applied daily immediately after bathing help trap moisture in stratum corneum of epidermis
  • bath oils may increase risk of slipping in the tub, particularly of concern in the elderly

More general terms

• sign/symptom

Additional terms

• pruritus (itching)