US Pharm. 2012;37(4):9-15.
Dry pores and skin (xerosis) is a minor well being situation that seldom has severe underlying causes. Additional, lack of therapy just isn’t prone to end in severe hurt to the affected person. Nonetheless, dry pores and skin is a hard downside that’s skilled by hundreds of thousands of U.S. residents, so it’s possible that the pharmacist could have many alternatives to supply recommendation on its causes and coverings.
Table of Contents
The Prevalence of Xerosis
Just about everybody will expertise xerosis at a while or different, and most both ignore it or self-treat.1 Surveys performed in nursing houses and long-term care residences point out a prevalence of 30% to 75%.2,3
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Regular Epidermal Turnover
The human dermis is a multi-layered organ, performing many features, similar to safety from an infection and regulation of temperature. Its outer layer (stratum corneum) consists of useless pores and skin cells that act as a barrier in opposition to dehydration of the dwelling layers that lie beneath.4 Whereas the stratum corneum helps cease lack of water that’s already current, it is also crucial in retaining water that contacts it throughout regular every day actions (e.g., bathing).3
Stratum corneum cells are initially keratinocytes which are generated within the lowest epidermal layer, generally known as the stratum basale. They bear serial change as they migrate upward, flattening to grow to be the corneocytes of the stratum corneum. Corneocytes are surrounded by an intercellular substance or “cornified envelope,” composed of a set of cross-linked proteins (e.g., filaggrin, loricrin) and lipids.3 Finally, the supplies on the junctions of the corneocytes break down fully and the useless corneocytes are shed insensibly into the atmosphere.1 When this regular upward migration is altered, it may disrupt the pores and skin’s barrier perform and enhance water loss, resulting in dry and flaking pores and skin.
Epidemiology of Xerosis
Dermatologists have recognized quite a few threat elements for xerosis. Some can’t be altered (e.g., age, racial background), however others (e.g., moisture within the ambient air) might be optimized to cut back the incidence of dry pores and skin.2
Age: The affiliation between growing old and xerosis is compelling. Specialists imagine that a number of aging-related adjustments coalesce to worsen pores and skin dryness. For example, sebaceous glands lower in dimension with growing old, producing fewer lipids to lubricate the pores and skin. Sweat glands additionally bear age-related dimension discount, in order that much less moisture reaches the epidermal floor. Corneocytes enhance in quantity and dimension, forming the well-known dry flakes which are seen on dry pores and skin. The incidence of age-associated dry pores and skin will undoubtedly rise in coming a long time as the typical age of the inhabitants continues to extend.5
Ambient Air: Sufferers of virtually any age can develop irregular pores and skin dryness in opposed weather conditions. These situations are commonest through the chilly, dry winter months. The power of air to carry moisture is straight associated to the surface temperature. Chilly winter air is solely incapable of retaining moisture, whereas sizzling summer season air is saturated with moisture. Being uncovered to dry outdoors winter air for a enough time is a assure that the outer pores and skin layer will dehydrate, however staying inside is even worse. Pressured-air heating programs inside homes and workplaces artificially warmth the air contained in the buildings. Because the air recirculates, it turns into drier and drier with every passing day. Indoor relative humidity could also be as little as 10% or much less within the winter. Through the summer season, air conditioners additionally dry the air, resulting in complaints of xerosis.1
Bathing Habits: A number of bathing habits can contribute to dry pores and skin. Sufferers could use harsh soaps or cleansers or bathe in excessively sizzling water, each of that are damaging to the stratum corneum.2
Medical Circumstances: Sufferers with diabetes, Sjögren’s syndrome, zinc deficiency, hypothyroidism, HIV, lymphoma, and end-stage renal illness additionally expertise dry pores and skin.2,5
Medical Remedy: Drugs similar to diuretics, cholesterol-lowering dietary supplements, antiandrogens, and cimetidine can induce xerosis.2 Chemotherapy could make pores and skin dry and extra delicate.5
Sequelae of Dry Pores and skin
Most sufferers don’t expertise dry pores and skin to the identical diploma over the full physique floor. Moist areas such because the groin and axillae are often spared, however the remainder of the physique floor could also be dry.2 Dry pores and skin feels tight or stiff with a sensation of burning, stinging, and/or itching, and seems erythematous, flaky, tough, and/or scaly.1,6 When pores and skin is crimson and cracked, the situation generally known as erythema craquelé is claimed to be current.2 Dry pores and skin is the only commonest reason for pruritus in older sufferers.2
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If sufferers scratch the pores and skin obsessively to alleviate pruritus, they will excoriate areas which are simply accessible, such because the torso, decrease again, arms, and legs.2 Excoriated pores and skin is open to an infection, and wounds can grow to be power. In sufferers with diabetes, dry pores and skin on the soles of the toes tends to grow to be extra hyperkeratotic, growing the chance of fissuring, ulcerations, and probably amputations.5
Nonmedical Interventions
Sufferers can undertake a number of easy measures to alleviate or stop xerosis. They need to keep away from outdoors actions that expose them to dry air and chilly wind.1 Residence thermostats needs to be set as little as attainable. Through the summer season, air conditioners might be set as excessive as is comfy. Sufferers could discover it useful to wash solely each second or third day. This recommendation is usually not properly obtained, so maybe sufferers can as an alternative be instructed to restrict tub or bathe instances to 10 minutes, avoiding sizzling water always in favor of heat water. Pharmacists ought to advise sufferers that cleaning soap worsens dry pores and skin by eradicating the physique’s pure lubricants, and advocate using delicate, nonscented moisturizing soaps.2 Sufferers mustn’t add oils on to the tub, as they enhance the chance of falling and subsequent traumatic damage. Following the tub, sufferers ought to keep away from powders on the pores and skin, as they additional dry the stratum corneum.2 Moisturizers might be utilized to the pores and skin twice every day, with one of many purposes being straight after the tub or bathe.
Clothes might be handled to cut back dry pores and skin harm. Linen and wool clothes that contact the pores and skin trigger irritation, as their tough surfaces induce friction.1 Use of material softeners on clothes that touches the pores and skin has been demonstrated to cut back friction and should stop dryness of the pores and skin.1
Substances for Dry Pores and skin
An excellent dry pores and skin therapy ought to scale back pores and skin dryness, irritation, and pruritus, in addition to improve the pores and skin’s look and protecting perform by restoring the barrier.7 Merchandise for dry pores and skin sometimes comprise a number of substances, a few of which actively reverse dry pores and skin to perform the goals cited above, along with different inactive substances which are vital to the formulation. Dry pores and skin merchandise are known as emollients or moisturizers, the latter containing humectants to hydrate the dermis.8 Emollients are oily, lipid formulation that partially occlude the pores and skin, thereby filling within the areas between unshed corneocytes.9 This smooths and softens tough pores and skin, growing its capability to retain moisture and decreasing irritation and irritation.7 Emollient software may also create a lipid barrier that forestalls irritants from damaging the pores and skin.7
The FDA has evaluated and accredited a particular class of protectants as protected and efficient for serving to defend chapped or cracked pores and skin from the drying results of wind and chilly climate. Substances accredited for this use embody allantoin, cocoa butter, cod liver oil, dimethicone, glycerin, laborious fats, lanolin, mineral oil, petrolatum, and white petrolatum.10
The assorted substances and others not listed as protectants by the FDA present barely totally different and overlapping advantages for dry pores and skin.7 Petrolatum, mineral oil, and paraffin are occlusive, putting an oily layer on the pores and skin floor to forestall evaporation of moisture. Glycerin, lactic acid, glycolic acid, and urea are humectants, a gaggle of supplies that draw water from the underlying dermis and assist it stay within the stratum corneum. Ceramides, glycerol, urea, and lactic acid additionally act as rehydrating brokers, permitting pores and skin to retain water and decreasing water loss. Lipids (fat, waxes, oil) act to revive the pores and skin barrier by forming a movie over the floor of the pores and skin.
Many merchandise for dry pores and skin can be found. Some commerce names are extra acquainted to pharmacists. They embody Vaseline Authentic, which is 100% petrolatum. One other is Aquaphor, containing petrolatum 41%, mineral oil, lanolin, and glycerin (along with inactive substances). Velvachol accommodates water, petrolatum, and mineral oil. Cetaphil Moisturizing Cream accommodates water and petrolatum.
Urea is an energetic ingredient that, in concentrations of two% to 40%, will increase hydration of the dermis.5 It’s included in Aqua Care, with urea 10%, together with water, mineral oil, and petrolatum.
The dosage kind could make a distinction within the diploma of reduction it offers. The best dosage kind is one that can give a sustained impact. Ointments meet this criterion properly due to their thick, greasy consistency. In truth, some sufferers discover the perfect treatment for dry arms is to use petrolatum at bedtime and put on tender fabric gloves all night time. Ointments have a tendency to stay on the pores and skin through the day when the affected person engages in routine hand washing. Nevertheless, many sufferers won’t use ointments through the day due to the disagreeable really feel. Additional, ointments could cause irritation when utilized to wounded pores and skin. The drawbacks of ointments make nongreasy lotions and lotions well-liked for daytime use.11 Nevertheless, washing the arms removes them simply. Lotions are extra watery than lotions and much more simply eliminated.
Pediatric Merchandise
Pharmacists ought to take care in recommending dry pores and skin merchandise for infants. Some merchandise marketed for dry pores and skin in infants comprise substances which are of unknown security and efficacy, similar to beeswax, castor seed oil, and Peruvian balsam oil. Unproven merchandise are dangerous at any time, however much more so when the affected person is an toddler. The realm beneath the diaper is moist and occluded by the diaper, creating an atmosphere wherein medicines might be absorbed to a larger diploma.
PATIENT INFORMATION
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Causes of Dry Pores and skin
Dry pores and skin is a typical situation that’s often self-treatable with nonprescription merchandise similar to emollients and moisturizers. It could be attributable to a wide range of environmental, way of life, or medical elements.
Low Humidity: Critical medical situations could cause dry pores and skin, however such causes will not be as frequent as on a regular basis elements. One of many main contributors is dryness of the air open air and within the dwelling or office. Through the summer season, sizzling air can maintain a substantial amount of water, making for top humidity. Through the winter months, nevertheless, chilly air can not maintain as a lot moisture, so the surface air turns into very dry. When dwelling furnaces warmth the air, it dries out much more, in order that inside air within the winter has a really low relative humidity. As individuals stay in dry air, the eyes, throat, respiratory tract, and pores and skin all grow to be abnormally dry.
That is simple to treatment. When the air begins to show chilly in late October or November, run a vaporizer or humidifier in every room the place the household lives and sleeps. Remember to drink quantity of water daily to assist with inner hydration.
Bathing Habits: Dry pores and skin will also be attributable to bathing habits. Listed here are some easy steps to take. Maintain baths and showers as quick as attainable, and use heat relatively than sizzling water. Physicians counsel making use of cleaning soap solely to the face, armpits, and genital space. Swap to delicate cleansers similar to Aveeno, Dove, Cetaphil, or Neutrogena. Dermatologists advise taking baths solely each different day. When drying the pores and skin after bathing, don’t rub the towel throughout the pores and skin. As an alternative, gently pat the pores and skin dry.
Really useful Merchandise
After bathing and drying, whereas the pores and skin remains to be damp, use tub oils and emollient merchandise to assist retain moisture. The perfect merchandise are thick ointments with a greasy consistency, similar to Vaseline Petroleum Jelly. Alcohol dries the pores and skin, so merchandise containing it are not so good as ointments.
Keep away from scratching itchy areas along with your fingernails. As an alternative, cowl any space that itches with a cool moist fabric. Nonprescription hydrocortisone ointments or lotions will help if there’s some delicate irritation of the pores and skin.
When to See a Doctor
Pharmacists could advise sufferers to see a health care provider if the pores and skin is itching however no rash is current, or if dryness and itching are so extreme that sleeping turns into troublesome. Pay particular consideration to pores and skin that’s open or wounded. Any break within the pores and skin might be the entry level for micro organism. The dryness itself can break the pores and skin open, or vigorous scratching could cause open cuts or sores. If the pores and skin is damaged, monitor it carefully for indicators of an infection (swelling, redness, warmth, ache) and see a doctor as quickly as attainable to get an antibiotic or antibacterial prescription.
Lastly, if the easy steps described above to forestall or deal with will not be useful, it’s best to see a doctor to make sure that there’s not a extra severe underlying medical downside.
Bear in mind, if in case you have questions, Seek the advice of Your Pharmacist.
REFERENCES
1. Fujimura T, Takagi Y, Sugano I, et al. Actual-life use of underwear handled with cloth softeners improved pores and skin dryness by reducing the friction of materials in opposition to the pores and skin. Int J Beauty Sci. 2011;33:566-571. 2. White-Chu EF, Reddy M. Dry pores and skin within the aged: complexities of a typical downside. Clin Dermatol. 2011;29:37-42. 3. Paul C, Maumus-Robert S, Mazereeuw-Hautier J, et al. Prevalence and threat elements for xerosis within the aged: a cross-sectional epidemiological examine in main care. Dermatology. 2011;223:260-265. 4. Kawamura A, Ooyama Ok, Kojima Ok. Dietary supplementation of gamma-linoleic acid improves pores and skin parameters in topics with dry pores and skin and delicate atopic dermatitis. J Oleo Sci. 2011;60:597-607. 5. Borelli C, Bielfeldt S, Borelli S, et al. Cream or foam in pedal skincare: in direction of the perfect automobile for urea used in opposition to dry pores and skin. Int J Beauty Sci. 2011;33:37-43. 6. Levi Ok, Weber RJ, Do JQ, Dauskardt RH. Drying stress and harm processes in human stratum corneum. Int J Beauty Sci. 2010;32:276-293. 7. Inexperienced L. Emollient remedy for dry and inflammatory pores and skin situations. Nurs Stand. 2011;26:39-46. 8. Loden M. Function of topical emollients and moisturizers within the therapy of dry pores and skin barrier issues. Am J Clin Dermatol. 2003;4:771-788. 9. Levi Ok, Kwan A, Rhines AS. Emollient molecule results on the drying stresses in human stratum corneum. Br J Dermatol. 2010;163:695-703. 10. Pores and skin protectant drug merchandise for over-the-counter human use; last monograph. Fed Regist. 2003;68:33362-33381. 11. Wingfield C. Skincare within the older individual: a give attention to using emollients. Br J Neighborhood Nurs. 2011;16:470-478. 12. Questions and solutions about Sjögren’s syndrome. Nationwide Institute of Arthritis and Musculoskeletal Pores and skin Ailments. www.niams.nih.gov/Health_Info/Sjogrens_Syndrome/. Accessed February 28, 2012.
To touch upon this text, contact rdavidson@uspharmacist.com.
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