Friday, September 04, 2009
Xerosis can reflect an inherited tendency toward dry skin as it
is seen as a part of the atopic diathesis, or it can occur in
normal individuals as a consequence of frequent bathing with
excessively hot water and harsh soaps and/or after prolonged
exposure to unusually low environmental humidity (as occurs with
forced-air heating during winter months in cold climates). Finally,
xerosis can occur as a consequence of asteatosis, which may result
from suppression of sebaceous gland function during isotretinoin
therapy of acne. Whether xerosis occurs solely as a natural
consequence of aging is not known, but it seems clear that normal
aging is at least a predisposing factor.
- A daily bath is an excellent way to hydrate the stratum
corneum. Overly compulsive bathers should be encouraged to bath
less frequently, no more than daily. The frequency of bathing is
not as critical as reduction of the water temperature from hot to a
comfortable warm temperature. Hydration immediately after bathing
is critical in maintaining the hydrating benefit of the bath.
- Use of mild soaps.
- For patients who take tub baths, an oilated solution or
colloidal oatmeal can be added.
- Immediately after bathing, pat skin dry, and apply an emollient
cream or ointment. Petrolatum is an excellent option. They should
be applied to xerotic skin surfaces and rubbed in well while skin
is still damp.
- If several members of a household all have xerosis or other dry
skin-related problems, a cool-air vaporizer in the bedroom or other
living areas can be useful during winter months to counteract the
low humidity of closed-air heating systems.
- Emollients containing 10-20% urea or up to 12% lactic
acid are very effective for the scale accompanying xerosis.
The can be added to the hydrating approaches above, if visible
xerotic scale is still present.
Severe xerosis responds dramatically to occlusion therapy.
Immediately after bathing, the patient applies a moisturizer as
above. A vinyl suit, or for selected areas, plastic wrap, is used
to cover the affected area for at least 4 hours, retaining the
humidity and hydrating the skin.
- If left untreated, xerotic skin may become eczematous,
resulting in erythema, increased pruritus, and occasionally,
- The recent onset of generalized xerosis, with or without
pruritus, can reflect underlying metabolic or neoplastic
- Recalcitrant xerosis with secondary pruritus can be the
harbinger of systemic disease. If the above intensive protocol does
not bring relief in 2-3 weeks, a search for an underlying metabolic
or neoplastic cause should be instituted.
- Antihistamines may be helpful adjuncts to the management of
itch, but should be used with caution in the elderly due to
additive sedative effects of multiple medications, and/or
anticholinergic side effects, including urinary retention,
precipitation of closed-angle glaucoma, and supraventricular
tachycardias (all rare). Nevertheless, antihistamines should be
given before bedtime only, or in very low doses initially.
- Older persons are particularly at risk of slipping in the tub,
so patients should be warned and appropriate precautions should be
taken, such as use of a rubber bath mat.
- Lactic-acid-containing products of higher concentration than 5%
can induce significant pruritus and dermatitis, especially in the
atopic patient with xerosis.