Itchy, Scratchy Skin: Preventing and Managing Xerosis

Author: Yvette C. Terrie, BSPharm, RPh


A proper skin care regimen is crucial to the management and prevention of dry skin.
Establishing a routine skin care regimen is essential to maintaining healthy and hydrated skin. Unfortunately, many people underestimate the importance of keeping their skin healthy and, as a result, experience dermatologic issues such as xerosis (dry skin).

Xerosis has a variety of causes, including environmental factors, improper skin care regimens, aging, and other medical conditions.1,2 The increasing prevalence of xerosis with advanced age is believed to be the result of alterations in the keratinization process and in the lipid content of the stratum corneum (the outer layer of the skin) as well as the cumulative effect of environmental factors and physical damage to the stratum corneum.1,2 Certain medications and many medical conditions (eg, hypothyroidism, hyperthyroidism, diabetes, and Sjögren’s syndrome) can also help cause or exacerbate xerosis.2,3 In addition, many inflammatory dermatologic conditions, such as atopic dermatitis, irritant contact dermatitis, and psoriasis, can cause localized areas of xerosis.4 Hormonal imbalances that occur during perimenopause and menopause, such as declining levels of hormones that normally stimulate oil glands, can also cause dry skin.2,3 Deficiencies in essential fatty acids as well as thyroid imbalances may also contribute to dry skin.3 Other causes of dry skin include excessive ultra-violet (UV) radiation exposure, taking frequent hot baths and showers, use of harsh soaps and detergents, and dehydration.1,3 Xerosis typically gets worse during winter months when the air is generally colder and drier.1,2

Patients with xerosis may present with skin that is dull, flaky, or rough. Many xerosis patients also experience pruritus, especially if dry skin appears on the forearms, hands, elbows, or lower extremities.3,5 Pharmacists are in a pivotal position to counsel patients on the nonprescription products currently available for managing and preventing dry skin as well as to encourage those with severe cases of dry skin to seek further medical care in order to prevent complications.

Treating, Managing, and Preventing Dry Skin

If left untreated, dry skin can lead to complications. For example, if dry skin prompts itching, inflammation and breaks or cracks in the skin that can lead to a secondary bacterial infection may result.1 The general goals of treating dry skin involve identifying its underlying causes, improving the skin’ s appearance by restoring hydration, rehabilitating the skin’ s barrier function, and ensuring that the patient understands how to prevent dry skin from recurring.1

There are a range of products on the market formulated to prevent and treat dry skin by restoring and maintaining skin hydration. Examples of these products include bath products, emollients, hydrating agents, and keratin-softening agents.1 Moisturizers are available in cream, lotion, gel, and ointment form. Antipruritic products, skin protectants, and topical hydrocortisone are also available to protect areas of dry skin and to relieve inflammation, erythema, and itching.1 A new product on the market formulated specifically for diabetics with dry skin is Gold Bond Diabetics’ Dry Skin Relief Rehydrating Lotion (Chattem Inc).

Moisturizers should generally be applied 3 to 4 times per day for optimal results, although frequency of application can be adjusted depending upon the severity of the dry skin.1 Patients with dry hands should be advised to apply moisturizers after washing their hands and throughout the day when needed.1 For those who experience dry skin in the facial area only, there is a wide range of facial moisturizers formulated for various skin types.

The Importance of Moisturization
The skin’s stratum corneum has a water content of 10% to 30% under normal conditions, and the signs and symptoms of dry skin become apparent in many people when its water content falls below 10%.8,9 Moisturization is essential to maintaining healthy skin since, when skin becomes dry, it can no longer function optimally.8,9 Studies have demonstrated many benefits to moisturization, including improving the appearance of skin, repairing and/ or maintaining the skin barrier, increasing and retaining skin water content, decreasing transepidermal water loss, restoring lipid barriers, and preserving the integrity and appearance of the skin.8,9 In general, moisturizers should be hypoallergenic, fragrance-free, and non-comedogenic, especially for those with sensitive skin.9 Moisturizers typically contain a combination of emollients, occlusives, and humectants to hydrate skin.9 Some moisturizers also contain photoprotective agents to protect against UV radiation exposure. An effective moisturizer should hydrate the stratum corneum, be readily absorbed in the skin, and immediately hydrate the skin as well as aid in restoring the lipid barrier by duplicating and enhancing the skin’ s natural moisture-retention mechanisms.9

Conclusion
While most cases of dry skin respond to treatment, if skin dryness is particularly severe or appears to worsen or fails to improve after at least 7 days of self-treatment, patients should be advised to seek medical care from their primary health care provider. Patients should also be advised to seek medical care if their skin shows any signs of infection or if a large area of the skin is peeling and inflamed

It is imperative that diabetics understand the importance of daily skin care regimens and routine skin inspections and that they should immediately report any signs of inflammation or infection to their primary health care provider. Some pharmacologic agents, including diuretics, anti-androgens, chemotherapy agents, some cholesterol-lowering supplements, and topical retinoids, may contribute to dry skin, so pharmacists are in a key position to identify those patients at greater risk of developing dry skin and to counsel them accordingly.7,8,10 Pharmacists can also provide patients with key tips on how to decrease or prevent dry skin and how to maintain healthy, hydrated skin.

Table 3: American Academy of Dermatology’s Recommendations for Relieving and Preventing Dry Skin1,11
  • Take short baths or showers daily with warm (not hot) water
  • Use mild cleansers that are fragrance- and alcohol-free
  • Gently pat (rather than rub) the skin dry
  • Apply skin moisturizer within 3 minutes of getting out of bath or shower
  • Moisturize the skin daily
  • If needed, use a humidifier to add moisture in the air of the home
  • Apply sunscreen daily, especially when going outdoors
  • Wear fabrics such as cotton that allow your skin to breath
  • Stay hydrated by drinking at least 8 glasses of water daily, if not contraindicated by a medical condition (eg, congestive heart failure or renal disease)


Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References:

1. Scott S. Atopic dermatitis and dry skin. In: Krinsky D. Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.

2. Weber TM, Kausch M, Rippke F, Schoelermann AM, Filbry AW. Treatment of xerosis with a topical formulation containing glyceryl glucoside, natural moisturizing factors, and ceramide. J Clin Aesthet Dermatol. 2012;5(8):29-39.

3. Dry skin. Women to Women website. www.womentowomen.com/understandyourbody/symptoms/skin.aspx.

4. Fowler J. Understanding the role of natural moisturizing factor in skin hydration. Practical Dermatology. July 2012. http://bmctoday.net/practicaldermatology/2012/07/article.asp?f=understanding-the-role-of-natural-moisturizing-factor-in-skin-hydration.

5. Dry skin. Merck Manual of Health and Aging Online Edition. Merck website. http://eglobalmed.com/core/MerckMultimedia/www.merck.com/pubs/mmanual_ha/sec3/ch35/ch35b.html.

6. Dry skin. MedicineNet.com website. www.medicinenet.com/dry_skin/page5.htm.

7. Dry skin. American Skin Association website. www.americanskin.org/resource/dryskin.php.

8. Dry skin. PDR Health website. www.pdrhealth.com/diseases/dry-skin.

9. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Medscape website. www.medscape.com/viewarticle/505759. Skin Therapy Lett. 2005;10(5):1-8.

10. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29:37-42.

11. Dermatologists’ top 10 tips for relieving dry skin. American Academy of Dermatology Aging SkinNet website. www.skincarephysicians.com/agingskinnet/winter_skin.html.