Dry Skin (Xerosis) - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Does your skin feel rough and flaky? Does it crack easily? You may have dry skin. In fact, this is a common affliction, especially with aging, as 55% of people over the age of 65 have dry skin.[1] However, even if you are younger, you may suffer from dry skin.

Dry skin is a problem with the skin’s barrier, leading to an increase in water loss through the skin. Additionally, drying agents can increase this process, while a lack of proper hydration or nutrition can further diminish the amount of water available to the skin. The imbalance produced by the three major components will lead to dry skin: a defective skin barrier, exposure to drying agents, and poor hydration and nutrition.

Treatment Philosophy

The treatment of dry skin focuses on hydration of the skin and avoidance of drying factors. Prevention is key and attainable with the use of the right products, foods and liquids and the avoidance of certain products and climates. Regular use of moisturizers throughout the day will prevent the skin from losing too much water by creating a barrier while providing additional hydration to the skin. Avoiding drying agents like harsh soaps and drier climates is important as is ensuring you are eating a balanced diet with ample fluid intake to support the body’s internal water supply.

Symptoms

Dry skin often begins with a feeling of tightness and/or itchiness. Often, the skin will feel rough and may flake. Flaking can look like fine dust or it can be much more obvious with large pieces of skin peeling and falling off the skin. If left to dry out even further, the skin may become red due to irritation of the underlying healthy skin and may begin to crack very easily resulting in cuts and more discomfort.

Causes

Skin typically acts as an important barrier to keep harmful chemicals out, but also prevents our skin from losing too much water. When this barrier is not working correctly, water is lost more easily through the skin, leading to dryness. The skin barrier is made up of a portion of the skin that is known as the epidermis and made of several layersIt is an extremely important barrier because it traps water within the skin to keep it hydrated. The top layer is known as the stratum corneum and is made up of lipids (molecules of fat) that block water. When the lipid (fat) content of the stratum corneum decreases, this leads to excessive water loss through the skin and dryness.

Water loss is measured as ‘transepidermal water loss’ (known by the abbreviation TEWL). When the TEWL is low, water is not lost through the barrier as easily. In contrast, when the TEWL is high, as in the case of dry skin, water travels more easily through the skin barrier.

Risk Factors

Your body 

  • Age: The older we get, the more likely we are to experience dry skin. But all ages can be affected and should be aware of the risk factors. As the skin ages, it loses integrity and begins to decline in function. The skin’s ability to be a barrier worsens with age.[2]This includes the water-holding capabilities of the barrier. For example, one study showed that skin hydration levels in men decreased with age.[3]
  • Genetics: You may be naturally predisposed to having a poorly working barrier. If your parents or siblings have had trouble with dry skin, you might too.
  • Hormonal Changes: The lack of several hormones can lead to dry skin. For example, a thyroid gland that does not produce enough thyroid hormone can lead to dry skin.[4] Another example are estrogen hormones since many women develop dry skin during menopause, a period when estrogen levels can change drastically.[5] A third example is that deficiencies in growth hormone can lead to decreased skin hydration.[6]
  • Sleep: The amount of sleep you get matters , as it is vital to maintaining the body’s normal functions. Women that are chronically sleep deprived had higher TEWL measurements and poor recovery of their skin barrier.[7]

Products

  • Medication: Diuretics are often used to treat high blood pressure and designed to cause water loss, which can lead skin dehydration and dryness. Diuretics should not be stopped due to dry skin as they are likely prescribed for other health benefits.
  • Soap: Soaps increase the chance to develop dry skin. Products like bar soap, liquid soap, dishwashing detergent, and body wash all contain ingredients that clean your skin, removing dirt by dissolving the natural skin oils. Unfortunately, soaps can dissolve the protective oils of your skin, weakening its effectiveness as a barrier.[8] Using soap can also affect the proteins within the skin, decreasing its water retention.[8]

Environment 

Cool and dry air has been associated with increased dryness in the skin.[9] Dry air can promote quicker loss of water through the skin, leading to more skin dryness. This is the reason many people experience worsening of their dry skin in the winter months or when they visit areas with cooler, drier climates. Learn more about skin types and the climates that can aggravate dry skin.

Treatments

By keeping your skin as healthy as possible at all times, your skin will have much better defenses to prevent dryness. Improving the barrier function may also prevent allergen sensitization.[10]

Nutrition and diet

  • Fluid Intake: Although it used to be thought that water intake does not make a difference to dry skin, newer research is showing otherwise. Several studies show that for those that do not drink much water, drinking an extra two to four bottles of water (there’s about 500 mL of water in a bottle) of water helps increase your skin’s hydration.[11-13] On the other hand, if a person is already drinking about six 500 mL water bottles daily then it is not helpful to add any more water. For people with heart disease, kidney disease, or another condition where excess water intake can be dangerous, water intake should be carefully discussed with a health care provider.
  • Diet: A balanced diet will aid in the skin’s ability to retain moisture and function optimally. Eating foods with higher water content like fruits will aid in proper hydration. Ensuring your diet consists of enough vitamin A is also important for proper skin function.

Lifestyle changes

  • Limit the Use of Soaps: Not all body parts are made equal. Areas such as the armpits, under the breasts, in the groin, and toe webs require regular soaping since they can build up bacteria and odors more quickly. For the rest of the body soap can be used once or twice a week as needed and rinsing with water will get you clean enough.
  • Moisturizers & Oils: The daily use of a moisturizer helps to keep the skin hydrated and prevents the skin from losing its own natural water from within.
  • Sleep: Sleep is vital to your body’s recovery.
  1. Paul C, Maumus-Robert S, Mazereeuw-Hautier J, et al. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology. 2011; 223(3):260-265; PMID: 22104182 Link to research.
  2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011; 29(1):37-42; PMID: 21146730 Link to research.
  3. Luebberding S, Krueger N, Kerscher M. Skin physiology in men and women: in vivo evaluation of 300 people including TEWL, SC hydration, sebum content and skin surface pH. Int J Cosmet Sci. 2013; 35(5):477-483; PMID: 23713991 Link to research.
  4. Keen MA, Hassan I, Bhat MH. A clinical study of the cutaneous manifestations of hypothyroidism in kashmir valley. Indian J Dermatol. 2013; 58(4):326; PMID: 23919021 Link to research.
  5. Calleja-Agius J, Brincat M. The effect of menopause on the skin and other connective tissues. Gynecol Endocrinol. 2012; 28(4):273-277; PMID: 21970508 Link to research.
  6. Borlu M, Tanriverdi F, Koc CA, et al. The effects of severe growth hormone deficiency on the skin of patients with Sheehan's syndrome. J Eur Acad Dermatol Venereol. 2007; 21(2):199-204; PMID: 17243955 Link to research.
  7. Oyetakin-White P, Suggs A, Koo B, et al. Does poor sleep quality affect skin ageing? Clin Exp Dermatol. 2015; 40(1):17-22; PMID: 25266053 Link to research.
  8. Wolf R, Parish LC. Effect of soaps and detergents on epidermal barrier function. Clin Dermatol. 2012; 30(3):297-300; PMID: 22507044 Link to research.
  9. Egawa M, Oguri M, Kuwahara T, et al. Effect of exposure of human skin to a dry environment. Skin Res Technol. 2002; 8(4):212-218; PMID: 12423539 Link to research.
  10. De Marchi F, Piacentini GL, Piazza M, et al. Correlation of skin barrier impairment in atopic dermatitis with aeroallergen sensitization. Allergy Asthma Proc. 2015; 36(6):127-133; PMID: 26534744 Link to research.
  11. Palma L, Marques LT, Bujan J, et al. Dietary water affects human skin hydration and biomechanics. Clin Cosmet Investig Dermatol. 2015; 8:413-421; PMID: 26345226 Link to research.
  12. Palma ML, Tavares L, Fluhr JW, et al. Positive impact of dietary water on in vivo epidermal water physiology. Skin Res Technol. 2015; 21(4):413-418; PMID: 26058417 Link to research.
  13. Mac-Mary S, Creidi P, Marsaut D, et al. Assessment of effects of an additional dietary natural mineral water uptake on skin hydration in healthy subjects by dynamic barrier function measurements and clinic scoring. Skin Res Technol. 2006; 12(3):199-205; PMID: 16827695 Link to research.