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xerosis (dry skin)

Etiology: 1) asteatotic dermatitis (xerotic eczema) 2) atopic eczema 3) nummular eczema 4) Ichthyosis vulgaris 5) excessive bathing, use of soaps that remove sebum from skin Epidemiology: - up to 1/3 of elderly individuals Pathology: 1) sources of moisture to epidermis a) diffusion from underlying cutaneous vasculature b) perspiration from sweat glands 2) moisture loss from evaporation from skin 3) sebum helps maintain hydration by preventing moisture loss 4) stratum corneum of epidermis contains natural moisturizing factors including urea & lactic acid 5) net loss of moisture from epidermis in xerosis 6) stratum corneum becomes less pliable & prone to cracking & cracking 7) elderly at risk for dry skin because of reduction in the number & activity of sebaceous glands & decreased perspiration Clinical manifestation 1) rough, flaky or scaly skin 2) dry skin commonly occurs on extremities, but may affect trunk & face 3) dry skin is exacerbated by cold, dry weather & low humidity associated with central heating & air conditioning 4) associated hyperpigmentation of skin may occur 5) pruritus 6) inflammation, erythema & fissures associated with xerotic eczema Laboratory: No specific testing Management: 1) pharmacologic agents (moisturizing agents) a) 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 b) ointments: mixtures of water in oil (lanolin or petrolatum) - Vaseline - Aquaphor - hydrocortisone 1% [4] c) creams: mixtures of oil in water, more effective than lotion [5] - Eucerin - Moisturel - Pen-Kera - apply after shower [5] d) Lotions (suspensions) - Lubriderm - Keri-lotion - Vaseline intensive care e) foams (leave oily residue) f) oils - bath oil (caution, may result in slippery surfaces) [4] - mineral oil - baby oil g) oatmeal baths [4] 2) glucocorticoids (topical triamcinolone 0.1%) useful for atopic eczema, asteatotic dermatitis & nummular eczema (see Etiology:) 3) 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 [4]

Related

pruritus (itching)

General

sign/symptom

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 912-13
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Prescriber's Letter 15(3): 2008 Dry Skin Management Detail-Document#: 240316 (subscription needed) http://www.prescribersletter.com
  4. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  5. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019