DRY SKIN or XEROSIS

In dry skin, also known as xerosis, the outer water barrier is disrupted and the underlying epidermis dries out. Thus, the fundamental defect in dry skin is not decreased water, but impaired barrier function. In diabetics, a history of smoking correlates with dry skin. The longer the duration of smoking, the greater the risk of dry skin. If the diabetic quits smoking, the number of years since quitting correlates with a decreased risk of dry skin. Regardless of smoking status, there is a trend in diabetics toward increasing dryness with increasing hemoglobin A1c.

• Loss of the surface water barrier.
• Very itchy!!
• Worse in the winter and common on the shins.
• Skin barrier function decreases with lower humidity and lower temperature (e.g., cold winters!).
• Risk factors include increasing age, female sex, eczema, smoking, lower BMI and lower outside temperature/humidity.
• Other risk factors for generalized dry skin include older age, female sex, elevated BMI, cooler outside temperature, history of eczema, chemotherapy in the past, use of statins and diuretics.
  

Clinical

The skin surface is rough, often with fine scale. The lower legs are commonly affected, but any part of the body may develop xerosis, especially after repeated water contact or in the dry, cold winter months. Dry skin often itches tremendously. Over time, the skin may become inflamed, causing asteatotic eczema.

Treatment

• Immediately after the shower, pat dry and apply a cream or grease. No lotions or pump bottles please!
• Use a ceramide containing cream, e.g., Cerave products, CeraVe Moisturizing Cream for Itch Relief Dry Skin Itch Relief Cream with Pramoxine Hydrochloride.

There is a Dry Skin Handout. The most important intervention is to apply something greasy like a heavy cream or ointment immediately after the bath or shower while the skin is still "sticky." This locks in the moisture. Waiting even 5-10 minutes allows the skin to dry out. Eucerin cream, Cetaphil cream, Aquaphor, or Vaseline are effective. Ointments are better than creams. Lotions, or any moisturizer in a pump bottle, are generally not thick enough to help protect the water barrier and therefore are not recommended. If there is redness and inflammation, eczema has set in and a prescription topical steroid ointment will help, e.g., triamcinolone 0.1% ointment.

See also atopic dermatitis and eczema.

RegionalDerm

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