Xerosis (Dry Skin) in Older Adults

Xerosis is a common condition that generally isn’t serious (Cafasso & Sullivan 2023). However, it can significantly affect quality of life, especially if accompanied by itching (Yao et al. 2023).

What is Xerosis?

Xerosis (also known as xeroderma or asteatosis) is the medical term used to describe abnormally dry skin, which is caused by dehydration of the stratum corneum (the horny cell layer of the epidermis) (Oakley 2022).

A lack of moisture in the stratum corneum causes the skin surface to lose its flexibility, resulting in splits and cracks. Flaking, scaling, redness or itchiness may also occur (Ciconte 2017).

Skin surfaces affected by xerosis may appear dull, rough or scaly (Oakley 2022). While xerosis can appear anywhere on the body, the most commonly affected areas are the lower legs, arms, scalp and hands (Ciconte 2017).

While the condition is equally common in males and females and affects people of all ages, it is most prevalent in older adults, affecting almost every person over the age of 60 (Oakley 2022).

Why is Xerosis More Common in Older Adults?

Skin is the first part of the body to show age, and changes such as drying, thinning, sagging and wrinkling are inevitable parts of the ageing process (Better Health Channel 2023).

Specific age-related changes in the skin that may contribute to xerosis include:

Thinning of the epidermis and dermis
Reduction in strength
Reduction in the number of cutaneous blood vessels and nerve endings
Reduction in connective tissue (which includes collagen and elastin)
Reduction in sweat glands and oil glands
Reduction in subcutaneous fat
Decreased moisture-retaining ability
Decreased thermoregulation
Reduced ability of the skin to sense the external environment
Decreased cell turnover
Decreased skin barrier function
Decreased immune system response
Decreased vascularity.

(MedlinePlus 2022; Better Health Channel 2023; Benedetti 2024)

Risk Factors for Xerosis

In addition to older age, risk factors for xerosis include:

Health-related factors

Genetic factors (e.g. acquired ichthyosis)
Inflammatory skin conditions (e.g. eczema, psoriasis)
Certain comorbidities (e.g. thyroid disease, renal disease, diabetes)
Systemic disease that results in ichthyosis (e.g. lymphoma, malnutrition)
Certain medicines (e.g. diuretics, cholesterol-lowering drugs, retinoids)
Infection (e.g. hepatitis B, hepatitis C, HIV)
Hormonal changes (e.g. menopause, pregnancy)
Certain psychological conditions (e.g. obsessive-compulsive disorder, anorexia, substance abuse)
Excessive sweating
Dehydration
Weight loss

Environmental factors

Low-humidity climate
Cold, dry air
Direct heat (e.g. central heating, fireplaces)
Air conditioning
Chronic sun exposure and damage
Soaps or detergents with harsh ingredients
Irritation from rough clothing

Lifestyle factors

Frequent immersion in water
Swimming in chlorinated pools
Long, hot showers or baths
Excessive handwashing
Over-cleaning or scrubbing the skin
Drying skin too vigorously with a towel

(Ciconte 2017; Mayo Clinic 2023; BPAC NZ 2014; Augustin et al. 2019; Cafasso & Sullivan 2023; Oakley 2022)

Symptoms of Xerosis

People with xerosis may experience:

Skin tightness, particularly after being immersed in water
Roughness
Itching
Flaking, scaling or peeling (can range from mild to severe)
Fine lines or cracks
Grey, ashy-looking skin
Redness
Bleeding from deep cracks.

(Mayo Clinic 2023)

Potential Complications of Xerosis

Eczema
Skin infection (if pathogens enter a break in the skin)
Overheating
Food allergies
Contact allergies.

(Oakley 2022)

How is Xerosis Treated?

Depending on the severity of the dryness, treatment may involve using moisturisers (to add moisture to the skin) and emollients (to soften the skin). Ideally, these should be liberally applied to the affected skin area after washing or when itchy (Oakley 2022).

Generally, the drier the skin, the more thickly an emollient should be applied (especially on the hands) (Oakley 2022).

Moisturisers and emollients help to:

Decrease itching
Improve the functioning of the skin barrier
Prevent irritants and pathogens from entering the affected skin area
Decrease transepidermal moisture loss
Attract water to the epidermis from the dermis
Prevent the escape of moisture from the skin by creating an oily layer (if using in an ointment form)
Reduce inflammation.

(Oakley 2022; BPAC NZ 2014)

Additionally, patients may require topical steroids or topical calcineurin inhibitors (seek medical direction) (Oakley 2022).