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Dry Skin | Xerosis



 

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Can you please explain what dry skin is, what causes it and how to identify it?

When you think about dry skin, also known as xerosis cutis, think of your skin as not smooth like a wall- it’s more like a cobblestone street. Cold weather, low thyroid, hot showers, and aging amongst other causes tend to break apart the mortar that holds the bricks (our skin cells) together and depletes the natural oils in our skin. This makes them more susceptible to irritation and sensitivities from the environment. The skin can start to take on a ‘cracked porcelain’ like appearance. When it lasts too long, the ‘cracks’ will start to become pink and inflamed from outside irritation or sensitivities.



What are the most common triggers for dry skin?



The most common triggers for dry skin include:
  • Cold air: colder temperatures result in less moisture in the air. The moisture in our skin evaporates faster leaving it feeling dry and scaly.

  • Age: as we get older our skin starts to thin. This makes it less able to hold onto moisture leaving it more vulnerable to dryness.

  • Medications: retinoids, blood pressure medications, and cholesterol-lowering medications are the most common. Retinoids such as isotretinoin, tretinoin, and retinol can dry the skin by causing it to exfoliate. Blood pressure medications, diuretics, in particular, work by pulling fluid out of our body to lower our blood pressure. Inevitably the skin will dry as well. Cholesterol is found in the skin and the bloodstream. Many people on cholesterol-lowering medications will note dry skin as a result of this loss.

  • Sun exposure: The sun can thin the skin further and break down collagen and elastic fibers in the skin that can hold moisture. This results in less of an ability to hold onto moisture. It can also trigger further evaporation of moisture from the skin.

  • Exposure to irritating chemicals: most common examples here are sodium laureth sulfate in soaps and cleansers or bleach solutions. These products can directly break down the skin causing it to dry excessively.

  • Hot showers and space heaters: hot showers can strip the skin of natural oils and result in excess dryness.

  • Hypothyroidism and other hormonal imbalances such as estrogen: a low-functioning thyroid is known to cause excessively dry skin

  • Genetic disorders: some people lack certain proteins in the skin that are needed to keep the skin intact. Ichthyosis is a disorder that causes the skin to have a fish-like scale from excessive dryness.


 


 

What are some issues that could be observed/experienced due to dry skin?

As our skin loses its natural oils and hydration, we need to replace these with hydrating products. If you think about the cobblestone street analogy- if the mortar between the bricks is dissolving then we need to fill in those areas with the right products! If we don’t take the steps to control dry skin, then there can be several issues that follow… Itchy skin. One of the most common issues that come up with excess dry skin is itching. It can be a little frustrating when the itch-scratch cycle starts because it can be hard to shake. The breakdown in the mortar between the cells makes our skin more sensitive to the environment. This can result in an itchy sensation that leads us to want to scratch it. Most often this itch is worse at night when trying to sleep. This is when we have fewer distractions to let us focus on our skin. I even have patients who scratch when they sleep- sometimes one foot against the other leg or using the tubing of the mattress to scratch the ankles. By taking the time to apply moisturizer before bedtime or after showers, this tendency can be reduced. Fissures or cracks in the skin. The breakdown in the skin can cause small fissures or cracks in the skin. These will burn or sting when using hand sanitizer and worsen with each hand washing. When this gets severe, all the moisturizer in the world will not feel like it works! If you are lucky and Vaseline or thicker moisturizers repair the skin then take the time to apply moisturizer after each hand washing. If you feel like it persists no matter how hard you try to clear it, it may be time to see your dermatologist to consider a steroid cream to help speed the recovery. Infections/ cellulitis. One of the main reasons I take the time to counsel patients on the importance of dry skin care is the simple fact that one of the most common reasons for hospital consultations for dermatology is cellulitis. Many of these cases could have been prevented by simple skin care regimens. This commonly occurs on the ankles or lower legs of people with poor circulation and dry skin. The Itchiness, especially at night, can get out of control. Some will say they even wake up and find little blood stains on their sheets. If the skin breaks down enough, bacteria can find its way in and infect or inflame the skin. This is a big problem. When this happens in someone with poor circulation, they have little ability to clear out impurities in the skin. Taking the right measures to protect and repair the skin early can save a lot of unnecessary hospital admissions and IV antibiotics!




What are some preventative actions that those with dry skin can take to reduce the frequency with which they experience issues?


Moisturize after every shower. Get a big bottle of fragrance-free moisturizer. Stick it in your shower. When you turn the shower water off, apply the moisturizer to damp skin and then blot it dry. It will work better and last longer! Turn down the temperature of the water in your shower. The hotter the shower the drier your skin will get. I know it may feel good when you are in there but your skin will pay the price later! Don’t be afraid to seek help when it doesn’t get better within 1-2 weeks of using a moisturizer. The more aggressive you are about managing dry skin, the less likely your dry skin can get infected. Avoid fragranced leave-on products when possible. These can tend to irritate or dry the skin out further in many people. Rinse-off products such as cleansers and detergents are less likely to cause issues. Leave-on products such as moisturizers and perfumes can prolong your skin's exposure. I know Vaseline is greasy but it works! Sometimes it’s the only thing that can really hydrate, repair, and protect the skin effectively. At least try it out at night.


Do you have any body lotion recommendations?



Amlactin: This has always been an easy product to recommend. It contains lactic acid which helps achieve hydration of the skin while also smoothing the dry, flaky, bumpiness that can accompany dry skin. Vanicream: I have always been a fan of Vanicream as a general recommendation for the whole family not only for what it contains but also for what it does not contain. It tends to be fragrance-free, paraben-free, and formaldehyde-free.. When it comes to a recommendation for the entire family knowing each person may have varying sensitivities to products, this is a simple and easy recommendation to make. CeraVe Moisturizing Lotion: The ceramides that make up the core of CeraVe products are focused on restoring and protecting the skin. This is important for every age group. LubriDerm: This product contains humectants including glycerin and panthenol giving it the tools it needs to adequately hydrate the skin. It tends to hold moisture in the skin and not on top making it less greasy or messy to work with.






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