Xerosis of the skin

In medicine, xerosis means excessive dryness of the skin (from Greek xeros - dry), i.e. Insufficient hydration. According to ICD-10, this condition is classified as a disease of the skin and subcutaneous tissue, under the heading "Other epidermal thickening" with the code L85.3 and the specification - dry dermatitis.

Epidemiology

There is no exact data on the prevalence of xerosis, but researchers say that in the elderly (60+), this skin condition occurs in 55-65% of people: men and women equally. In 25-40% of cases, increased dryness of the skin is accompanied by itching.

About 10% of the population have drier skin and often suffer from atopic dermatitis (eczema). Xerosis affects 20-30% of HIV-infected patients.

Causes of the skin xerosis

The main causes of xerosis or dry skin, are related to a decrease in the amount of moisture in the epidermal layer of the skin and insufficient production of sebum (Latin: sebum), which is caused by a deterioration in the function of sebaceous glands (sebaceous glands).

Often the causes of dry dermatitis or dry eczema are unknown, but the triggers for this condition can be dry air, cold weather, frequent hot baths, aggressive detergents, etc. Dry dermatitis can appear on any part of the body, but its most common localization is on the extremities and trunk.

In a significant proportion of cases, there is chronic or prolonged dry skin, which may be one of the symptoms of the underlying disease: insufficient levels of thyroid thyroid hormone - hypothyroidism, non-sugar diabetes, hyperglycemia in the presence of diabetes mellitus, chronic kidney failure, diathesis in adults, which has an autoimmune nature Sjögren's syndrome.

Skin can become very dry due to the side effects of systemic and topical retinoids (trans-retinoic acid derivatives), blood cholesterol-lowering statins, certain antihistamines and diuretics, and oral contraceptives.

Xerosis of the skin in the elderly or senile xerosis is the result of biological aging of the skin, part of which is involution of the sebaceous glands with a decrease in their metabolic and functional activity.

Decreased production of sex hormones in women leads to dry skin at menopause.

And xerosis of the skin in a child appears both with loss of moisture (excitosis), atopic dermatitis, diabetes or ichthyosis, and with the use of certain drugs, for example, prescribed for the treatment of nocturnal enuresis and non-sugar diabetes Desmopressin or antiepileptic drug Zonisamide (Zoresan).

Read also - Dry skin in a newborn baby

Risk factors

Factors that increase the risk of skin xerosis include:

• Improper skin cleansing (washing hands too often with products that deprive the skin of its hydrolipid mantle - a thin water-fat emulsion film, which causes transepidermal water loss;
• Frequent use of scrubs and chemical peels;
• Using too hot or hard water (high mineral content) to wash your body;
• Exposure of the skin to low winter temperatures, wind and dry air, irritants and toxic substances;
• prolonged and frequent sun exposure and exposure of the skin to UV radiation;
• dehydration from inadequate water intake;
• deficiency of vitamins A, D, C and E, as well as deficiency of essential fatty acids, zinc and selenium - in case of unbalanced diet, starvation, malabsorption or eating behavior disorder - anorexia;
• Excessive use of alcohol, caffeinated beverages, and foods high in sodium;
• Allergies, diabetes, thyroid or kidney disease, pituitary disorders, adrenal, ovarian or testicular problems;
• Old age and aging.

Pathogenesis

Most often, the pathogenesis of skin xerosis is due to dysfunction of the epidermal barrier due to reduced secretion of sebum (sebum) produced by sebocytes, the cells of the sebaceous glands, through holocrine secretion. The contents of these cells - after their apoptosis - are converted into sebum, and its components (glycerides, free fatty acids, wax esters, squalene, cholesterol and its esters) help to retain moisture inside the skin, which contributes to its moisturization and elasticity.

If sebum production is reduced, the skin's hydrolipidic mantle loses some or all of its protective properties and retains moisture poorly.

Stimulate the proliferation of sebocytes and regulate sebum production androgens - sex hormones testosterone and dihydrotestosterone (DHT), produced by male testicles, female ovaries and adrenal cortex (the work of which is provided by the pituitary gland of the brain).

Meanwhile, the conversion of testosterone to the more potent DHT, which initiates sebum secretion, requires the presence of the macrosomal enzyme 5α-reductase type 1 (5-alpha-R-1), which is synthesized in the skin and liver.

So both androgen imbalance, enzyme deficiencies, and pituitary dysfunction can affect the skin in the direction of increased dryness.

In normal skin, molecules of free amino acids, derivatives of these amino acids, inorganic salts, as well as lactic acid and urea, collectively called natural moisturizing factors (NFs), attract and bind water to the stratum corneum. It turns out that they are the ones that maintain physiologically normal skin hydration. All components of NFM are "packed" in corneocytes - the main cells of the outer stratum corneum of the skin, which have lost the nucleus and their subcellular organelles and are surrounded by lamellar lipid matrix and bound by corneodesmosomes. And the mechanism of skin xerosis is related to the deficiency of moisture retaining factors in the skin, which causes a violation of the skin barrier and leads to dry skin.

See also - Features of skin barrier properties

Symptoms of the skin xerosis

The first signs of skin xerosis can be manifested by a feeling of tightness, which indicates dehydration of the epidermal layer of the skin, which leads to thickening of its cells.

Symptoms also manifest themselves in the form of:

• roughness of the skin due to some of the cells peeling off in some areas or accumulating into thicker layers, making the skin rough to the touch.
• desquamation or skin flaking;
• skin itching.

Xerosis of the skin of the hands see:

• Dry hands
• cracked hands

For xerosis of the facial skin, see Xerosis of the facial skin. - Facial dryness

For xerosis of the skin of the feet see. - Dry skin of the feet

For xerosis of the skin of the back see. - Dry body skin

Complications and consequences

Cutaneous xerosis can turn into asteatosis eczema (with deep cracking of the skin) or keratoderma.

In dry skin cracks, infection and inflammation at the level of the dermis can penetrate and develop, and the inflammatory process can worsen the condition of the skin, increase its flaking and itching. And scratching the skin leads to its irritation, hyperemia and focal structural abnormalities in the form of atrophy.

Diagnostics of the skin xerosis

To diagnose skin xerosis, patients' medical history and physical examination with assessment of the skin. It is also necessary to identify environmental and endogenous factors that may have triggered the development of xerosis.

Blood tests (general, serum levels of sex and thyroid hormones, urea, glucose, CD4 lymphocytes, IgE immunoglobulin, IgG antibodies, etc.). In the presence of rashes, a skin biopsy may be required to diagnose and confirm various dermatologic diseases with increased skin dryness and itching.

Differential diagnosis

It is such skin diseases (in particular, simple ichthyosis, dyshidrotic, discoid and varicose eczema, follicular keratosis, psoriasis) should exclude differential diagnosis.

Treatment of the skin xerosis

To treat xerosis of the skin, ointments and creams are primarily used to help increase skin moisture.

Read more in the publications:

• Dry skin: moisturizing
• Moisturizing creams for dry and flaky skin
• Ointment for flaky skin
• Hyaluronic acid creams for face
• Facial emulsions
• Masks for dry skin
• Therapeutic hand creams
• Moisturizing foot creams

In the presence of an underlying disease (some of which were named above), appropriate medications are prescribed. And in case of severe itching antihistamines are used, more information in the material - Treatment of itchy skin

It is recommended to take vitamins, particularly vitamins A and C, vitamin D (which plays an important role in skin barrier function), tocopherol acetate (vitamin E), cyanocobalamin (vitamin B12), pyridoxine hydrochloride (vitamin B6) and calcium pangamate (vitamin B15), as well as vitamin complexes with zinc, polyunsaturated fatty acids (omega-3 and omega-6) or fish oil.

Treatment with herbs can also bring tangible benefits in reducing dry skin. Thus, for decoctions (which are added to bath water, make compresses or wipe the skin) are used rhizomes of burdock and elecampane high, herbs medunica medicinal, violet tricolor and medicinal melon, leaves and roots of medicinal lovage, leaves of black currants and seeds of sown oats. It is useful to make herbal face masks.

Essential oils: jojoba, karite (shea), evening primrose, rosehip, borage (cucumber), as well as olive oil for face, coconut and almond oils, argan oil for face contribute to skin moisturizing.

Physiotherapeutic treatment of facial xerosis in the form of hyaluronic acid facial mesotherapy.

If the skin becomes inflamed or cracked, dermatologists prescribe ointments with corticosteroids of medium and high activity.

Prevention

To prevent xerosis of the skin is necessary:

• refuse hot water in the bath or shower and shorten the duration of these hygienic procedures (and do not rub yourself with a towel after them);
• use mild cleansers without dyes, fragrances or alcohol.
• drink plenty of water;
• use sunscreen before going outdoors;
• humidify the indoor air in dry weather and when the heating is on in winter;
• protect hands from contact with hot water and strong detergents - wear gloves.

Forecast

If xerosis of the skin is associated with the action of external factors, then its prognosis - with proper skin care - is certainly favorable.

In other cases, excessive dry skin can be a chronic and difficult problem to address.

List of authoritative books and studies related to the study of skin xerosis

1. "Dermatology" - by Jean L. Bolognia, Joseph L. Jorizzo, Julie V. Schaffer (Year: 2017)
2. "Clinical Dermatology: A Color Guide to Diagnosis and Therapy" - by Thomas P. Habif (Year: 2020)
3. "Fitzpatrick's Dermatology in General Medicine" - by Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest (Year: 2020)
4. "Textbook of Cosmetic Dermatology" - by Robert Baran (Year: 2019)
5. "Cosmeceuticals and Active Cosmetics" - by Raja K. Sivamani (Year: 2016)
6. "Dry Skin and Moisturizers: Chemistry and Function" - by Marie Loden (Year: 2000)
7. "Xerosis and Pruritus in the Elderly: Recognition and Management" - by Robert A. Norman (Year: 2018)
8. "Skin Barrier Function" - by Kenneth R. Feingold, Peter M. Elias (Year: 2006)
9. "Topical Application of Antioxidants" - by Lester Packer (Year: 1999)
10. "Moisturizers and Skin Care" by Zoe Diana Draelos (Year: 2005).

Literature

Butov, Y. S. Dermatovenerology. National guide. Brief edition / edited by Y. S. Butov, Y. K. Skripkin, O. L. Ivanov. - Moscow : GEOTAR-Media, 2020.