Dry Skin (Xerosis)

Xerosis, or dry skin, is extraordinarily common. Simple measures, such as daily emollient use, can make a big difference in patients’ lives. More than 99% of cases are benign.

Differential Diagnosis

• Dry skin is a very common problem
  –Low humidity and cold temperatures make winter xerosis and “winter itch” common complaints
  –Mild xerosis can cause impaired skin barrier function and allow irritants and allergens to more easily affect the skin
  –Most common on the legs, but often affecting the entire skin surface
  –Can present with severe pruritus without much evidence of a rash
• Severe xerosis is common in the elderly, and can cause eczema craquelé
  –Patient's legs often have scale that resembles cracked porcelain
  –Secondary erythema and excoriations occur because of the persistent itch
• Ichthyoses vulgaris
  –Very common cause of dry skin
  –A genetic defect in skin barrier function, leading to a higher risk of atopic dermatitis
  –Patients often have hyperlinearity of their palmar skin and xerotic fish scale on their legs
• Many genetic conditions, such as the large family of ichthyoses (including X-linked ichthyoses, Netherton's disease), lead to severely dry skin in association with other systemic manifestations
• Hypothyroidism and hyperthyroidism can also cause marked xerosis and/or itch
• Anemia
• There is an uncommon association between lymphoma and marked xerosis
• HIV
• Sarcoidosis
• Liver and biliary disease, and renal insufficiency, are commonly associated with xerosis and marked pruritus
• Diabetes mellitus
• Medications (e.g., niacinamide)
• Atopic dermatitis

Workup and Diagnosis

• A complete history should be taken that includes social, family, environmental, and exposure history; past medical history; a focused physical examination should also be performed, including thyroid, entire skin surface, and other exam
• Most cases of xerosis are secondary to environmental factors; If the xerosis is very severe or of acute onset, or is associated with intractable pruritus or other systemic symptoms, consider checking a CBC, thyroid function tests, BUN/creatine, and liver function tests
• Young, at-risk patients with severe xerosis, especially of recent onset, may be considered for HIV testing
• If the patient fails to respond to conservative therapy, age-appropriate malignancy screening should be considered

Treatment

• Emollients and humectants should be incorporated into the patient's daily routine; Avoid harsh antibacterial soaps, and avoid long, hot baths or showers; Apply rich creams (e.g. Keri lotion_^R, Eucerin_^R) that are fragrance-free and hypoallergenic immediately after bathing and twice daily
• Hydroxyzine and even phototherapy can be helpful to these patients. Bile acid-sequestering medications can help liver patients with xerosis and pruritus
• Topical steroid ointments are sometimes necessary to control the pruritus until the skin barrier function is restored
• Compliance is a problem in xerosis patients who don’t want to put greasy or heavy creams on their skin
• Systemic retinoids are sometimes used as adjuvant therapy for patients with certain genetic ichthyoses
• For the rare patient that has an associated malignancy, the xerosis should improve once the malignancy is eradicated

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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