By Gary M. White, MD
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.
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.
Give the 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, a topical steroid ointment should be given, e.g., triamcinolone 0.1% ointment.
A DBPCT of 50 women with very dry skin showed an approximate 15% increase in skin hydration in the active group vs. placebo [Int J Cosmet Sci. 2011 Apr;33(2):138-43]. The patients took two capsules BID of an oral formulation of 350 mg of wheat extract oil (WEO--high in ceramides). Side effects were minimal. The overall acceptability was slightly higher in the WEO group than placebo. The actual product contains 350 mg of Lipowheat (Skin restoring phytoceramides with Lipowheat).
See also atopic dermatitis and eczema.
Xerosis of the shins.
The elbows are commonly dry.
Dry skin is more easily injured, shown here with a crust.
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