Clinical Description

S ynonyms for xerosis include asteatosis, dry skin, winter itch, and eczema craquelé.
Manifestations of dry skin can progress from reddening and cracking to severe persistent pruritus
and lichenifi cation. The loss of hydration in the epidermis causes fi ssuring and cracking of the
stratum corneum, making the skin look like antique porcelain (eczema craquelé). As the
condition worsens, the skin scales and begin to fl ake, cracks may extend and deepen, and the
skin feels uneven. Local or generalized pruritus may also be present. Chronic scratching and
rubbing result in painful excoriations and infected with lesions that become thick and lichenifi
ed. Dry skin is the most common skin complaint in the elderly, affecting nearly 75 % of those 64
and older. In a recent study, the most common problem affecting nursing home patients was dry
and pruritic skin. Dry skin is worse in the winter due to low humidity [ 1 , 2 ].
Etiology and Pathophysiology
X erosis is caused by dehydration through the hyperpermeable epidermis and stratum corneum.
Increased age includes reduced sebaceous and sweat gland activity causing dryness. Xerosis has
also been associated with zinc or essential fatty acid defi ciency, renal disorders, hypothyroidism,
neurologic disorders that decrease sweating, HIV, malignancies, obstructive biliary disease, and
in those with radiation therapy [ 3 , 4 ].
Histopathology
B iopsies are rarely performed since dry skin can easily be detected clinically.
Differential Diagnosis
Ichthyosis vulgaris – an autosomal dominant disorder associated with atopic dermatitis,
hyperlinear palms, and keratosis pilaris. 2. Nummular dermatitis – red, annular, scaly, dry
patches on arms and legs. 3. Pityriasis alba – presents as white, fi ne scaling or non- scaling
patches on the face and trunk of younger patients.
Treatment
1. Artifi cial humidifi cation in homes through vaporizers and humidifi ers. 2. Changing
bathing habits: Bathing less frequently, using warm instead of hot water, and showering instead
of soaking in a tub can help reduce natural oil loss. 3. Patients should drink plenty of water
daily and wear protective clothing in cold, dry weather. 4. Milder superfatted soaps and
cleansing creams and help reduce excessive skin oil loss. Products with alcohol and fragrance
should be avoided, as they also lead to dryness. 5. Moisturizers such as ceramide-based
creams and lotions can be very helpful for protecting and restoring the epidermal water barrier.
Petrolatum, lanolin, cocoa butter, olive oil, and heavy mineral oils can be greasy and sticky, but
work well when combined with humectants such as glycerin, propylene glycol, pyrrolidone,
carboxylic acid, sodium lactate, and urea [ 1 , 5 ].
 Prognosis
Prognosis for patients with xerosis is generally good. However, underlying conditions such as
systemic and genetic