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Xerosis / Dry Skin

Definition:
Ordinary dry skin (xerosis) usually isn't serious, but it can be uncomfortable and unsightly, turning plump cells into shriveled ones and creating fine lines and wrinkles. More serious dry skin conditions, such as the inherited group of disorders called ichthyosis, can sometimes be disfiguring enough to cause psychological distress.

Fortunately, most dry skin results from environmental factors that can be wholly or partially controlled. These include exposure to hot or cold weather with low humidity levels, long-term use of air conditioning or central heating, and excessive bathing.

Chronic or severe dry skin problems may require a dermatologist's evaluation. But first you can do a lot on your own to improve your skin, including using moisturizers, bathing less and avoiding harsh, drying soaps.

Causes:
Most dry skin is caused by environmental exposures, such as:
  • Weather. In general, your skin is driest in winter, when temperatures and humidity levels plummet. Winter conditions also tend to make many existing skin conditions worse. But the reverse may be true if you live in desert regions, where summer temperatures can top 110 F and humidity levels sink to 10 percent or less.
  • Central heating and air conditioning. Central air and heating, wood-burning stoves, space heaters and fireplaces all reduce humidity and dry your skin.
  • Hot baths and showers. Frequent showering or bathing, especially if you like the water hot and your baths long, breaks down the lipid barriers in your skin. So does frequent swimming, particularly in heavily chlorinated pools.
  • Harsh soaps and detergents. Many popular soaps and detergents strip lipids and water from your skin. Deodorant and antibacterial soaps are usually the most damaging, as are many shampoos, which dry out your scalp.

Other factors
Other factors, including certain diseases, can significantly alter the function and appearance of your skin. These include:

  • Psoriasis. This skin condition is marked by a rapid buildup of rough, dry, dead skin cells that form thick scales.
  • Thyroid disorders. Hypothyroidism, a condition that occurs when your thyroid produces too little thyroid hormones, reduces the activity of your sweat and oil glands, leading to rough, dry skin.
  • Alcohol and drugs. Alcohol and caffeine can visibly dry your skin. Prescription drugs such as diuretics, antihistamines and isotretinoin (Accutane) also have a drying effect.
  • Dehydration. Severe diarrhea and vomiting, a high fever, profuse sweating during exercise or simply not drinking enough liquids can cause your body to lose more fluid than you take in. One of the first signs of dehydration is skin that has lost its elasticity.
Risk Factor:
Dry skin is a nearly universal problem, but certain factors make you more likely to develop tightness, flakiness and fine lines. These factors include:
  • Your age. As you age, your skin tends to become drier because your oil-producing glands become less active. Your complexion can appear rough and dull. The lack of oil also causes cells to clump together in flakes or scales.
  • Your sex. Although everyone's skin changes with age, a man's skin tends to stay moist longer than a woman's does. Men experience a relatively small decrease in oil production until well into their 80s, whereas women's skin tends to become much drier after menopause.
  • Sun exposure. Like all types of heat, the sun dries your skin. Yet damage from ultraviolet (UV) radiation penetrates far beyond the top layer of skin (epidermis). The most significant damage occurs deep in the dermis, where collagen and elastin fibers break down much more quickly than they should, leading to deep wrinkles and loose, sagging skin (solar elastosis). Sun-damaged skin may have the appearance of dry skin.
When to seek medical advice:
Most cases of dry skin respond well to self-care measures. See your doctor if:
  • Your skin doesn't improve in spite of your best efforts
  • Dryness and itching interfere with sleeping
  • You have open sores or infections from scratching
  • You have large areas of scaling or peeling skin
Symptoms:
Dry skin is often just a temporary problem — one you experience only in winter, for example — but it may be a lifelong concern. And although skin is often driest on your arms, lower legs and the sides of your abdomen, this pattern can vary considerably from person to person. What's more, signs and symptoms of dry skin depend on your age, your health status, your locale, the amount of time you spend outdoors, and the cause of the problem.

If you have dry skin due to normal aging, you're likely to experience one or more of the following:

  • A feeling of skin tightness, especially after showering, bathing or swimming
  • Skin that appears shrunken or dehydrated
  • Skin that feels and looks rough rather than smooth
  • Itching (pruritus) that sometimes may be intense
  • Slight to severe flaking, scaling or peeling
  • Fine lines or cracks
  • Redness
  • Deep fissures that may bleed

Diagnosis:
Your doctor is likely to conduct a thorough physical exam and to ask questions about your medical history, including when your dry skin started, what factors make it better or worse, your bathing habits, your diet, and how you care for your skin.

You may have certain diagnostic tests if your doctor suspects that your dry skin is the result of an underlying medical condition, such as hypothyroidism.

Through examination and tests, your doctor may determine that your dry skin is, in fact, a sign of another skin condition. Related dry-skin conditions include:

  • Keratosis pilaris. Keratosis pilaris causes small, acne-like bumps, which usually appear on the upper arms, legs or buttocks; they usually don't hurt or itch. The bumps create rough patches and give skin a goose flesh or sandpaper appearance. Typically, patches are skin colored, but they can, at times, be red and inflamed.
  • Ichthyosis vulgaris. Sometimes called fish scale disease or fish skin disease, ichthyosis vulgaris develops when skin cells fail to shed normally and instead accumulate in thick, dry scales. The scales are small, polygonal in shape and range in color from white to brown. Ichthyosis vulgaris may also cause scalp flaking and deep, painful fissures on your palms and soles.
  • Asteatotic eczema (eczema craquele). This condition causes dry, scaly, deeply fissured skin that some doctors have described as resembling cracked porcelain or a dry riverbed. The affected skin may become inflamed, itchy and may bleed.
  • Psoriasis. A frustrating and sometimes disfiguring skin condition, psoriasis is marked by reddened skin with dry, silvery scales that sometimes resemble dandruff. In severe cases, your skin may crack, bleed and form pus-filled blisters. Psoriasis is a persistent, chronic disease that tends to flare periodically, and although it may go into remission, it usually remains active for years.
Complications:
Dry skin that's not cared for can lead to:
  • Dermatitis (eczema). This condition causes redness, cracking and inflammation.
  • Folliculitis. This is an inflammation of your hair follicles.
  • Cellulitis. This is a potentially serious bacterial infection of the skin's underlying tissues that may enter the lymphatic system and blood vessels.

These complications are most likely to occur when your skin's normal protective mechanisms are severely compromised. For example, severely dry skin can cause deep cracks or fissures, which can open up and bleed, opening the way for invading bacteria.

Treatment:
In most cases, dry skin problems respond well to self-care measures, such as using moisturizers and avoiding long, hot showers and baths. If you have very dry and scaly skin, your doctor may recommend you use an over-the-counter (nonprescription) cream that contains lactic acid or lactic acid and urea.

If you have more serious skin diseases, such as ichthyosis or psoriasis, your doctor may prescribe prescription creams and ointments or other treatments in addition to home care.

Sometimes dry skin leads to dermatitis, which causes red, itchy skin. In these cases, treatment may include hydrocortisone-containing lotions. If your skin cracks open, your doctor may prescribe wet dressings with mildly astringent properties to contract your skin and reduce secretions and prevent infection.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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