15 September 2018
Dry skin or xerosis is a very common skin condition which can involve any age group but is more common in elderly population, with 75% of those 64 and older. Excessive dryness can cause the skin to crack open and sometimes bleed.
Skin is in two layers, the upper layer or epidermis and the dermis, which is underneath. Skin is a barrier that protects the body from the influx of various chemicals and also prevents loss of fluids and electrolytes from the internal environment. It has been shown that almost 50% of all severe cases of eczema may have a defect in the Filaggrin gene, which is mainly responsible for its barrier function.
There are specific glands, namely sebaceous glands and sweat glands, within the dermis which open up to the surface of the skin. These glands’ secretions will help with the barrier functioning of the skin and its hydration. The following changes with ageing are the mechanisms responsible for having dry skin in elderly people:
- Tendency to reduce liquid intake
- Loss of skin elasticity
- Reduced activity in the sebaceous and sweat glands
Interestingly, male sebaceous activity remains highly active until the eighth decade, while in women levels start to fall much sooner. Environmental factors are also a factor in causing dry skin. During winter, low temperature and low humidity (due to very hot and drying heating systems) cause a decreased amount of water in the outer layer of the skin. In contrast, constant exposure to air conditioning during summer may produce similar effects. Furthermore, artificial air in places such as inside airplanes can make the skin dry and sunlight worsens dry skin by drying the epidermis. Tight clothing can increase the risk of dry skin and worsen existing dry skin through abrasive friction as a person moves.
Drugs such as diuretics, anti-androgens and retinoids cause dry skin and tropical medications, such as lotions which contain alcohol, can also make the skin dry. Hormone imbalances that occur in menopause, under active and overactive thyroid, neurological diseases affecting sweat glands, HIV, internal organ failure such as kidney and liver disease and malnutrition can also cause severe skin dryness.
Finally, very rarely, a sudden onset of severe dry skin later in life could be a signal to an internal malignancy such as lymphoma, which needs to be investigated further.
For many people, daily bathing is an essential activity, however the surfactants and soaps used in bathing decrease surface skin oils and adversely affect the skin's proteins. For this reason people with dry skin, such as the elderly, are advised to bathe only on alternate days. Patients are advised to pat the skin dry gently as rigorous towel drying can cause severe friction to the skin. Furthermore, a brief shower is better for the skin than a bath, since the cooler water temperature of the shower dries the skin less than sustained immersion in hot bathwater. Hard water with a high amount of minerals can also cause dry skin by irritating and damaging its surface, consequently effecting its barrier function.
Patients with xerosis should use emollients as a soap and shampoo substitute and use bath oils very cautiously as irritating chemicals in them would exacerbate the situation by damaging the epidermis even more. Use of soap may be limited to the axillae, groin and face, but appropriate moisturiser should be applied after each shower to prevent skin dryness.
If you suffer from dry skin or eczema and are looking for treatment options, book in to see Dr Ghazavi here at Spire Harpenden Hospital today by calling 01582 714 420.