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Xerodermia; Causes, Symptoms, Diagnosis, Treatment

Xerodermia is a condition involving the integumentary system, which in most cases can safely be treated with emollients or moisturizers. Xeroderma occurs most commonly on the scalp, lower legs, arms, hands, the knuckles, the sides of the abdomen, and thighs. Symptoms most associated with xeroderma are scaling (the visible peeling of the outer skin layer), itching, and skin cracking.

Dry skin, which refers to roughened, flaky, or scaly skin that is less flexible than normal and dry to feel, is a relatively common problem in all age groups but is more common in elderly individuals. The water content of the stratum corneum is of paramount importance in maintaining the normal appearance and texture of human skin. The relative hydration of the stratum corneum is a composite of 3 factors viz. the rate of water transport from the dermis to stratum corneum, the rate of surface loss of water and the rate of water binding ability of stratum corneum. Loss of integrity of the barrier function is a central factor in the development of dry skin conditions and eczema. The various factors involved in producing dry skin, various causes of dry skin and the role of emollients in the management of these conditions are discussed.[Rx]

Normal, healthy skin is coated in a thin layer of natural lipids or fatty substances. They keep in moisture, leaving the skin soft and supple.

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While patches of dry, itchy skin can appear anywhere, it’s most common on the arms, hands, lower legs and abdomen. Dry skin is often felt more than it’s seen, but on some people, it can be noticeable and embarrassing. For many black people, dry skin is a special concern, since the flakes of skin can look grey.

Causes of Xerodermia

Who gets dry skin and why?

Anyone can get dry skin. Skin becomes dry when it loses too much water or oil. Some people are more likely to have dry skin. Some causes of dry skin are:

Age: As we age, our skin becomes thinner and drier. By our 40s, many people need to use a good moisturizer every day.
Climate: Living in a dry climate such as a desert.
Skin disease: People who had atopic dermatitis (also called eczema) as a child tend to have dry skin as adults. Psoriasis also causes very dry skin.
Job: Nurses, hair stylists, and people in other occupations often immerse their skin in water throughout the day. This can cause the skin to become dry, raw, and cracked.
Swimming: Some pools have high levels of chlorine, which can dry the skin.
Weather. Skin tends to be driest in winter when temperatures and humidity levels plummet. But the season may not matter as much if you live in desert regions.
Heat. Central heating, wood-burning stoves, space heaters and fireplaces all reduce humidity and dry your skin.
Hot baths and showers. Taking long, hot showers or baths can dry your skin. So can frequent swimming, particularly in heavily chlorinated pools.
Harsh soaps and detergents. Many popular soaps, detergents, and shampoos strip moisture from your skin as they are formulated to remove oil.
Other skin conditions. People with skin conditions such as atopic dermatitis (eczema) or psoriasis are prone to dry skin.
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The signs (what you see) and symptoms (what you feel) of dry skin are

Rough, scaly, or flaking skin.
A feeling of skin tightness, especially after showering, bathing or swimming
Skin that feels and looks rough
Itching (pruritus)
Slight to severe flaking, scaling or peeling
Fine lines or cracks
Gray, ashy skin
Redness
Deep cracks that may bleed
Itching.
Gray, ashy skin in people with dark skin.
Cracks in the skin, which may bleed if severe.
Chapped or cracked lips.

When dry skin cracks, germs can get in through the skin. Once inside, germs can cause an infection. Red, sore spots on the skin may be an early sign of an infection.

Treatment and Prevention

These are easy suggestions that are important to keep in mind:

Choose short showers over baths. Long baths or showers, especially in hot water, increase the loss of natural oils from the skin and worsen skin dryness. The shower should be in warm rather than hot water. Apply a moisturizer after shower or hands washing.
Apply moisturizing creams, emollients or ointments moisturizers several times a day: they are fundamental in dry skin treatment because they reconstitute cutaneous hydro-lipidic film holding water in the skin. Cream moisturizers, when applied they disappear when rubbed into the skin because of they are more popular than other treatments. They protect damaged and sensitive skin and make skin softer and smoother. They preserve natural skin lipids and limit dehydration trapping and sealing water in the stratum corneum.
Choose a non-alcohol-based moisturizer.
Use a mild non-soap skin cleanser. Harsh soaps remove the oils from the surface of the skin and dry it out.
Avoid antibacterial soaps.
Place a humidifier in your home or add it to the central heating system to maintain the air moisturized during the winter and in dry weather.
Avoid rubbing or scratching the skin.
Wear gloves, hats, and scarves in the winter.
Avoid dehydration caused by drinking alcohol and by neglecting to replace fluids lost through sweating.
Avoid itchy clothing because it might get more itchy. Dry skin is especially sensitive to contact irritants and it may worsen itching and redness.

Special Additives in Moisturizers

Botanical substances – In this era of going natural, the use of herbal products and extracts has caught everyone’s attention. These herbal products are being used in topical preparations since time immemorial. However, the rationale to include herbal extracts in moisturizers has not always been based on controlled studies or evidence-based meta-analysis of clinical trials.[] Instead, they may be added for marketing reasons to nurture consumer interest in the perceived benefits of natural ingredients on the skin

The most famous of all is Aloe (Aloe barbadensis Miller leaf extract) – of which more than 300 species are available. Evidence to support its role as a moisturizer is lacking although its role in the healing of skin ulcers and burns due to its anti-inflammatory, antibacterial, and vasodilator action has been propounded from time to time[Rx]
Allantoin (comfrey root) – is a synthetic derivative known as aluminum dihydroxy allantoinate. It has been marketed for its role as a moisturizer as well as keratolytic. However, supportive studies are lacking[Rx]
Oatmeal (Avena sativa) – baths for soothing rashes have been part of nursing practice since decades and are considered to be highly reliving to the patient[Rx]
Bioflavonoids – plant-derived polyphenols are being promoted as topical antioxidants. As a result, they have found a suitable place as an additive to the moisturizers. However, how far they are useful in relieving the oxidant stress of the skin is yet to be proved.[Rx]
Antioxidants[Rx]: Are the agents which inhibit oxidation of ingredients by reacting with free radicals and blocking the chain reaction. Typical antioxidants are tocopherols (Vitamin E), butylated hydroxytoluene, and alkyl gallates.[Rx] Reducing agents, such as ascorbic acid, may also act by reacting with free radicals, as well as oxidize more readily than the ingredients they are intended to protect[Rx]
Chelating agents[Rx] – Citric acid, tartaric acid ethylenediaminetetraacetic acid, and its salts have limited antioxidant activity themselves, but enhance the efficacy of antioxidants by reacting with heavy metal ions. Such substance is called chelating agents.

Vitamins

Vitamins[Rx] – There have been poorly substantiated claims of skin rejuvenation by the addition of Vitamins such as A, C, and E. However, their penetration through the skin is doubtful. They should be in water-soluble form to be absorbed percutaneously hence oral/parenteral supplementation is preferred over topical application of the same.
Fragrances and coloring agents[Rx] – Added more for their cosmetic enhancement rather than any actual role as moisturizers. They may vary from cinnamic acid, cinnamates, menthol, benzoin resin, etc. Coloring agents impart subtle hues and other optical effects leading to more acceptance although at times can lead to irritant dermatitis.
Preservatives[Rx] – They are meant to kill or inhibit the growth of microorganisms inadvertently introduced during use or manufacturing. Contaminating organisms may be either pathogens or nonpathogens. The ideal preservative must have a broad spectrum of activity; it must be safe to use; it should be stable in the product, and it should not affect the physical properties of the product. No single preservative meets all these requirements, and usually, a combination of substances is used. Phenoxyethanol and parabens (methyl-, propyl-, ethyl- and butyl-paraben) are the most frequently used in moisturizers.

Emulsifying agents[Rx] – The natural tendency of any oil and water to separate in different phases is undone by the addition of emulsifying agents mostly detergents. The most commonly used ones are Laureth 4 and 9, ethylene glycol monostearate, octoxinols, and nonoxinols. Liposomes dispersion is the newer technique which delivers the active ingredients into the epidermis for enhanced action.
Sunscreens[Rx] – Last but not the least, they have found a comfortable berth as an important ingredient in many moisturizers serving a dual function, for example, replenishing creams. Cinnamates, titanium dioxide, and zinc oxide have replaced the much toxic para-aminobenzoic acid agents.

Depending on the site of application, the moisturizers are generally marketed in various categories. Within each category, there are specialized products geared for certain areas such as lips, under eyes, feet. Commercially, they are classified as:

Facial moisturizers[Rx] – Face in particular is prone to effects of the environment such as cold and hot weather, arid conditions, humidity, dust, pollution, and UV rays. Hence, facial moisturizers have a unique place in daily skin care. They are designed to be nongreasy, noncomedogenic with an emphasis on esthetics and maximal skin benefits. Silicone-based derivatives are suitable for oily skin. Other ingredients are added to reduce the appearance of excess shine such as oil absorbent compounds, for example, kaolin, talc.[Rx] Under eye, creams are lightweight cream formulas meant to restore firmness, diminish dry lines, reduce puffiness, and pigmentation. Essentially, they are moisturizers, and their effects are limited to those of other routine moisturizers.
Body and hand feet moisturizers – They are mostly aimed at prevention as well as treatment of dry skin, eczema, and xerosis. They are dispensed in the form of lotions, creams, and mousse. Some specialized products aims include cellulite firming, bronzing, and minimizing the signs of aging.[Rx]
Anti-aging products – The quest for a younger looking skin has led to a boost in the anti-aging technology. Special agents are especially useful for photoaged skin and include sun protectants, alpha hydroxyl acids (e.g., glycolic acid), retinol, and its derivatives. These moisturizers play a role in treating and augmenting therapy for the aging face.[Rx]

Facing the enemy

As temperatures drop, heaters clank on, and the wind whips up, the battle for healthy skin begins. Dry air takes away the thin layer of oil that traps moisture in the skin, flaring itchy and painful conditions such as eczema, psoriasis, and severely dry skin.
If we stop producing moisture or if heating sucks it out of the skin, and it’s not being replaced, that will tend to cause little cracks that affect the barrier of the skin,” says Alan Menter, MD, chair of psoriasis research and the division of dermatology at Baylor University Medical Center in Dallas. Any trauma to the skin, such as cracking, causes an inflammatory response, which can make skin more susceptible to flare-ups of psoriasis and eczema.

Bathe Frequently

When it’s cold outside, some of us prolong our hot showers and baths, which is a recipe for dry, irritated skin, says Dr. Menter. Instead, he recommends you

Keep the shower as brief as possible and use lukewarm, not hot, water.
Switch to less aggressive, moisture-rich soaps made for sensitive skin, such as those made by Dove and Aveeno.
Gently pat yourself dry to avoid traumatizing or overdrying the skin.
Apply moisturizer while your skin is still slightly damp.

Therapeutic baths, such as oatmeal baths or sea salt baths, may help some patients, but they tend to take time, and some salt treatments can be drying, so it’s important to moisturize afterward.

Moisturize, moisturize

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Whether you have eczema, psoriasis, or severely dry skin (known as xerosis), you need to replace any moisture the dry air steals away. “As soon as the weather gets dry, I tell my patients to start a regular regime of moisturizing. The best time to do it is right after they bathe,” says Dr. Menter.
I tell patients that I don’t care how they moisturize, just do it regularly in a way that you like.” He recommends targeting problem areas first.

Get comfortable

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Dress for less irritation – If your skin does flare up, choose soft, breathable fabrics, like cotton, instead of itchy woolens or polyester. Loose-fitting clothing will also help to keep your skin from chafing and becoming irritated by perspiration.
Change the air around you – Dr. Strober suggests that his patients use a humidifier to increase moisture levels in the home. Experts recommend keeping the humidity level between 30% and 50% (which you can measure with a hygrometer).

Stay healthy

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Because psoriasis and eczema involve immune system responses, experts believe that many bacterial, viral, or fungal infections can make them worse.

Dry Skin Allergy Treatments:

There are different treatments for dry skin depending on the condition and severity of the problem. Treatments can be both external and internal. Few treatments are:

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Moisturizing

Moisturizing is an external treatment. It involves frequent application of moisturizers on the problem skin area. Applying moisturizer on damp skin is more effective. In case of extreme dry skin, moisturizers containing urea or lactic acid are useful.
These ingredients help the skin in holding and retaining the water and keeping the skin well hydrated. It is effective in not so very severe cases. Some of the moisturizers are – Vaseline, Aquaphor, Cetaphil lotion, Lubriderm Lotion, Crisco Vegetable Shortening etc. Topical steroid creams like hydrocortisone 1% cream, Pramosone 2.5% cream, Triamcinolone 0.1% cream, Clobetasol 0.05% cream may also be prescribed.

Medicines

If the condition of the skin gets worse, consulting a dermatologist is the best way forward. The dosage of the medicines depends on the severity of the case. If the condition is getting very severe, steroids may also be prescribed. Some of the oral medications are: Hydroxyzine (Atarax), Diphenhydramine (Benadryl), Cetirizine (Zyrtec), Loratidine (Claritin).

Change In Lifestyle

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This the most important factor in case of skin ailments. Most of the severe dry skin problems like eczema, psoriasis, dermatitis, etc., can be directly linked to unbalanced, unhealthy or stressful lifestyle. A person has to maintain healthy habits to avoid such kinds of ailments. One should avoid doing all such things which can trigger the problem or increase it. Like, if a person is allergic to some kind of environment or food which causes dry skin, he/she should avoid it. If pollution or cold is the reason, then one should keep the skin covered when going out.

Humidify During Winter

Dry skin, as mentioned before, occurs due to lack of moisture. Humidifying the air to keep it moist is a good way to protect the skin during winter. One can use humidifiers at home and in office as well. They make the dry air moist and lessen the dry skin problems.

Applying Cool Cloths And Avoiding Heat

Heat is an enemy of dry skin as it bereft the skin of its moisture content. Using hot water strips the skin of its natural oils, making it dry.
You should replace hot water with warm water to give your skin some respite. One should also avoid frequent and long baths. Five-10 minutes in the bath hydrates the skin, but longer than that is bad for your skin. Harsh soaps and cleansers should also be avoided.

Dry Skin – Tips for Managing

Here are tips that can prevent dry skin or keep it from getting worse.

Do not use hot water. Hot water removes your natural skin oils more quickly. Warm water is best for bathing.
Use a gentle cleanser. Soaps can strip oils from the skin. Stop using deodorant bars, antibacterial soaps, perfumed soaps, and skin care products containing alcohol, like hand sanitizers. Look for either mild, fragrance-free soap or a soap substitute that moisturizes.
Limit time in the bathtub or shower. A 5- to 10-minute bath or shower adds moisture to the skin. Spending more time in the water often leaves your skin less hydrated than before you started. Do not bathe more often than once a day.
Moisturize right after baths and showers. To lock in moisture from a bath or shower, apply a moisturizer while the skin is still damp.
Before you shave, soften skin. It is best to shave right after bathing when hairs are soft. To lessen the irritating effects of shaving your face or legs, use a shaving cream or gel. Leave the product on your skin about 3 minutes before starting to shave. Shave in the direction that the hair grows.
Change razor blades after 5 to 7 shaves. A dull blade bothers dry skin.
Use a humidifier. Keep the air in your home moist with a humidifier.
Apply cool cloths to itchy dry skin.
Soothe chapped lips. At bedtime, apply a lip balm that contains petrolatum. Other names for this ingredient are petroleum jelly and mineral oil.
Cover up outdoors in winter. In the cold, wear a scarf and gloves to help prevent chapped lips and hands.
Be good to your face. If you have very dry skin, cleanse your face just once a day, at night. In the morning, rinse your face with cool water.

Dry skin facts

Dry skin is a very common condition that causes small fine flakes and dry patches.
Itching is one of the most common symptoms of dry skin.
Scratching may be hard to resist.
Dry skin is more common in colder winter months and drier climates.
The elderly are more prone to dry skin than younger people.
Dry skin is more common in individuals with a history of eczema.
Dry skin may rarely be a side effect of certain medications.
Dry skin is more common in those with hypothyroidism.
Repeat itch-scratch cycles may lead to skin thickening and darkening.
Possible complications include rashes, eczema, and bacterial infections.
Extremely dry skin can cause cracks and breaks in the skin.
Medications including topical corticosteroids and lubricating lotions and creams can help ease itching.
Secondary infections may result from scratches and skin breakdown.
Topical or oral antibiotics may be necessary for secondarily infected dry skin.
Several home remedies, such as decreasing the bathing frequency and lubricating the skin with moisturizers after showers, can help control and prevent dry skin.