Dry Skin (Xeroderma)

Xeroderma, also known as Dry skin, xerosis cutis, or asteatosis, is a prevalent condition resulting from inadequate hydrolipids in the skin.

It manifests as roughness, tightness, scaling, and flaking, often leading to pruritus, excoriations, and an increased risk of infections. The condition may lead to pruritus, resulting in excoriations and an elevated susceptibility to skin infections.

Factors contributing to xeroderma include environmental changes (e.g., cold weather, low humidity), frequent use of harsh soaps, and systemic conditions such as diabetes or hypothyroidism. Areas with fewer sebaceous glands, such as the lower legs, forearms, and feet, are most commonly affected.

CLINICAL FEATURES

Dry skin has a dull surface with a rough, scaly quality. The skin is less pliable and cracked. When dryness is severe, the skin may become inflamed and fissured.

Individuals with xeroderma may encounter subjective symptoms, including pain, a burning sensation, tightness, and pruritus. When xeroderma is associated with pruritus, it can significantly diminish the patient's quality of life.

The most frequently affected body areas include the lower legs, forearms, hands, and feet.

A physical examination typically reveals dry, rough, and scaly skin with a somewhat grayish hue. Moreover, reduced skin elasticity, wrinkling, erythema, and fissures may also be observed.

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INVESTIGATIONS

The diagnosis of xeroderma primarily relies on clinical assessment, with a comprehensive history and physical examination adequate to identify this prevalent condition.

The type of dry skin is diagnosed by careful history and examination.

In children:

Family history

Age of onset

Appearance at birth, if known

Distribution of dry skin

Other features, eg eczema, abnormal nails, hair, dentition, sight, hearing.

In adults:

Medical history

Medications and topical preparations

Bathing frequency and use of soap

Evaluation of environmental factors that may contribute to dry skin.

Healthcare providers may conduct laboratory testing to evaluate the potential underlying causes of the condition, including assessments of thyroid hormone and vitamin levels.

In rare instances, a skin biopsy may be warranted to differentiate xeroderma from conditions that mimic its presentation.

DIFFERENTIAL DIAGNOSIS

A differential diagnosis for xerosis may encompass the following conditions:

· Ichthyosis Vulgaris

· Atopic dermatitis

· Stasis dermatitis

· Irritant contact dermatitis

· Allergic contact dermatitis

· Nummular dermatitis

· Scabies

· Tinea corporis

· Psoriasis

· Cutaneous T-cell lymphoma

TREATMENTS

The mainstay of treatment of dry skin and ichthyosis is moisturizers/emollients. They should be applied liberally and often enough to:

Reduce itch
Improve the barrier function
Prevent entry of irritants, bacteria
Reduce transepidermal water loss.

Emollients generally work best if applied to damp skin, if pH is below 7 (acidic), and if containing humectants such as urea or propylene glycol.

Additional treatments include:

Topical steroid if itchy or there is dermatitis — choose an emollient base

Topical calcineurin inhibitors if topical steroids are unsuitable.

PREVENTION

Eliminate aggravating factors.
Reduce the frequency of bathing.
A humidifier in winter and air conditioner in summer.
Compare having a short shower with a prolonged soak in a hot bath.
Ensure good hydration by drinking plenty of water.
Use lukewarm water, not hot water.

Replace standard soap with a substitute such as a synthetic detergent cleanser, water-miscible emollient, bath oil, anti-pruritic tar oil, colloidal oatmeal etc.

Apply an emollient liberally and often, particularly shortly after bathing, and when itchy. The drier the skin, the thicker this should be, especially on the hands.