An Overview of Xerosis

Xerosis is the medical term used to describe excessively dry skin. Symptoms include itching, flaking, a feeling of tightness, and possibly cracking. Xerosis can typically be managed with over-the-counter moisturizing creams and good home care; more severe or chronic cases may need to be treated with prescription medications.

Xerosis is also called xeroderma when talking about the skin specifically.

Most people will experience xerosis, or dry, itching skin, at some point. It's an incredibly common, and not generally serious, skin problem.

Symptoms include:

• Itching
• Scaly or flaking skin
• A feeling of tightness
• Roughness of the skin
• Cracking or peeling, in more severe case

You may see ultra-fine lines across the surface. The skin may take on a white, grey, or ashy appearance, and it may look like you can see a "layer" of dry skin on the surface atop your normal skin.

If xerosis gets worse it can cause redness and irritation. Cracks in the skin can become deep, and may bleed.

Xerosis can happen over the entire body, but it is most common on the arms, legs, hands, and feet. The face is also a typical place to develop extra-dry skin. It's less common on the trunk.

You may not have xerosis all the time; it may come and go, especially as the seasons change. Xerosis is more common during the extremes of winter and summer.

Xerosis happens when the skin loses more moisture than it retains, leaving your skin dried out.

The skin contains sebaceous glands, small glands that create your skin's natural oil. This oil, called sebum, helps to keep your skin lubricated and moisturized. Sebum helps to seal moisture into your skin and hair. It also plays a role in waterproofing your skin and, along with your sweat, regulating body temperature.

But sebum isn't the only thing that keeps your skin hydrated. Your skin also produces, within the stratum corneum layer, many different substances that keep the skin moisturized. These substances include ceramides, hyaluronic acid, lactic acid, urea, and amino acids. Altogether, these substances are often referred to as the natural moisture factor (NMF).

Dry skin can happen to anyone, at any time. But, there are certain factors that make your more susceptible to developing xerosis.

Age: As you age, sebum production slows down. Your skin doesn't produce enough of the substances that make up the skin's natural moisture factor, either. This accounts for why so many people develop xerosis as they age.

Weather: Extremely hot and extremely cold weather contribute to dry skin. Living in a low humidity area also is a contributing factor because the dry air can suck moisture from the skin. So too does dry indoor air.

Your bathing habits: Although it seems strange, bathing too often, using water that is too hot, and using soaps that are too stripping are all factors that can create dry skin.

Certain medications: Some medications can cause dryness of the skin. These include diuretics, certain cholesterol medications, and most acne medications (like isotretinoin, Retin-A, and benzoyl peroxide).

Underlying health problems: In certain cases, dry skin may be caused by an underlying health problem. You're more likely to develop dry skin if you have atopic dermatitis (AKA eczema), hypothyroidism, or diabetes. Diabetes especially can cause xerosis of the feet. This can quickly become a more serious problem in people with diabetes because of slow wound healing.

Certain jobs: Your field of employment can make you more likely to develop xerosis; for example, if you work with harsh chemicals or materials (like pool chemicals, cement, or mortar). Also if you have to wash your hands often, like those in the medical field, you may develop xerosis of the hands.

Minor cases of xerosis can often be self-diagnosed. If you do see a physician, a physical exam by your doctor, coupled with your medical history, is all that's typically used to diagnose xerosis.

Be prepared to answer these questions at your appointment, as they can help your doctor pinpoint the cause of your dry skin and create a treatment plan:

• How long have you had the problem?
• Does anything make it better or worse?
• Do you have any other symptoms (even seemingly unrelated ones)?

Your doctor will likely ask you about your current skin care routine, including the products you're using on your skin.

In some cases, your doctor might do testing to check for underlying conditions that may be contributing to your dry skin, like hypothyroidism. There are also skin problems that create xerosis, including psoriasis, ichthyosis, and eczema.

In many cases, you can treat xerosis at home with over-the-counter products and good home care.

First and foremost, you must help your skin replenish and retain moisture. Moisturizing creams, lotions, and, in some cases, ointments, are the number one way to do this.

If you're prone to dry skin, though, you've probably already used moisturizers to help treat your dry skin, and maybe to no avail. There are specific humectant and emollient ingredients that you should look for in your over-the-counter moisturizer, because they are more effective at protecting your skin:

• Lactic acid
• Urea
• Ceramides
• Hyaluronic acid

Petroleum jelly (like Vaseline or Aquaphor) also creates a very good barrier across the surface of the skin. These can be incredibly helpful if moisturizing creams just aren't cutting it. They're greasy, though, so you may opt to use them at night only and continue using creams during the day.

For itch relief, an over-the-counter 1% hydrocortisone cream can be used. If you're relying on OTC hydrocortisone for long-term itch relief, you should bring this up with your doctor as there may be better ways to get your dry skin under control.

Although these ingredients are most commonly recommended by dermatologists, some studies have shown that consistent use of moisturizing products is more important than any particular ingredient when treating xerosis. The take-home message is this—moisturize regularly to get the best possible results, regardless of the product you're using.

Besides moisturizing regularly, there are some lifestyle steps you can take to help manage xerosis, and in some cases prevent it from happening in the future.

• Use a humidifier in your home to add much-needed moisture into the air.
• Cut back on the frequency of your baths or showers, and cut down the time you spend in the shower.
• Take lukewarm, rather than hot, showers. Hot water can strip the skin of natural oils.
• Choose mild cleansers. You may want to go with a soap-free cleanser or non-foaming wash, as these aren't as drying as other options. Fragrance-free products are less likely to irritate your already sensitive skin, as well.
• Use fragrance-free lotions, cleansers, and laundry detergent. Highly-scented products may irritate your skin.
• Treat your skin gently. Don't use harsh scrubs or rub at your skin too hard with a towel, rough washcloth, or loofah.
• Shower immediately after spending time in a pool or hot tub. Chlorine can be rough on the skin. Don't forget to also slather on your moisturizer.

For most people, dry skin can be effectively managed with over-the-counter moisturizers and good home care. If your dry skin is severe or chronic, and you're just not getting good results treating it on your own, a prescription medication may be needed.

Some of the medications your doctor may consider include topical corticosteroids (such as fluocinonide) or an immune modulator (tacrolimus, pimecrolimus), depending on your situation.

Dry skin isn't just a cosmetic condition, so don't feel shy about seeing your doctor about it if needed. Some clues that you may need to make an appointment:

• Your skin is oozing, deeply cracked, or you have a rash or blisters.
• Itching is so severe it's interfering with your daily life or preventing you from sleeping.
• You have large areas of broken skin or sores, either from cracked, dry skin or from scratching.
• You have widespread peeling.
• Your skin is painful, red, or swollen.

Also, let your doctor know if you're not seeing your dry skin improve even with good home care and over-the-counter products.

Xerosis is a common condition. In many cases, it can be treated at home. But if you're having trouble managing dry skin, even after consistently using moisturizers and home remedies, it's time to make an appointment with a doctor.