Xerosis is a common condition that generally isn’t serious (Cafasso & Sullivan 2018). However, it can significantly affect quality of life, especially if accompanied by itching (Augustin et al. 2019).
What is Xerosis?
Xerosis (also known as 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 2015).
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 2015). 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 2015).
Why is Xerosis More Common in Older Adults?
Skin is the first part of the body to show age, with changes such as drying, thinning, sagging and wrinkling being an inevitable part of the ageing process (Better Health Channel 2018).
Specific age-related changes in the skin that may contribute to xerosis include:
Thinning of the epidermis and dermis
Reduction in mechanical 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
Reduced ability of the skin to sense the external environment
Skin infection (if pathogens enter a break in the skin)
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 2015).
Generally, the drier the skin, the more thickly an emollient should be applied (especially on the hands) (Oakley 2015).
Moisturisers and emollients help to:
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)
(Oakley 2015; BPAC NZ 2014)
Additionally, patients may require topical steroids or topical calcineurin inhibitors (seek medical direction) (Oakley 2015).
Preventing Xerosis in Older Adults
The following practical strategies may help to prevent xerosis in your patients:
Identifying and avoiding triggers such as harsh soaps, hot water and clothes that cause irritation
Reducing the frequency and length of bathing
Using a humidifier in winter
Using lukewarm water instead of hot water when washing or bathing
Replacing soaps with gentle substitutes (soap-free, fragrance-free cleansers or bath oil)
Drying the skin by patting it gently and thoroughly rather than rubbing vigorously
Ensuring patients are getting adequate nutrition and hydration
Ensuring fingernails and toenails are trimmed to a suitable length
Using dressings that are non-adherent and non-adhesive
Managing incontinence (as exposure to urine and faeces are associated with skin breakdown)
Reviewing medicines (if appropriately qualified to do so)