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Xerosis in Old Age Is Preventable

HIGHLIGHTS:

  • Frequent bathing in warm water and regular use of soaps that have alkaline qualities can result in the fatty layer of protective skin being eroded, which is a major cause of skin dryness in the elderly.
  • Members of the elderly population who are susceptible to dry, itchy skin should choose skin cleaning products that have a low alkaline rating, with a pH rating of around 5, and which also have moisturizing qualities as well as are free from surfactant chemicals.
  • For those with dry skin, moisturizing creams, lotions or oils should be applied immediately after morning and evening showers, as well as at other times during the day for those with extreme skin dryness. Furthermore, the chosen moisturizers should not contain perfumes in order to reduce the likelihood of an allergic reaction.
  • Patients should not ignore symptoms, such as skin inflammation, pus-filled wounds or bacterial infections resulting from scratching that cause itchy, because they may require medical attention.

 

Dry skin or xerosis occurs due to a reduction in the skin’s natural protective oils, resulting in moisture escaping from the skin more easily, thus leaving it dry. This lack of moisture combined with a decrease in oil production from the sebaceous glands leaves skin dry, flaky and itchy. Normally, the body has a skin barrier that holds in moisture, but its effectiveness is dependent on the following layers functioning properly:

  1. The stratum corneum layer consists of skin cells, pigment cells, amino acid proteins, water and fat, and these fats play a crucial role in locking in the skin’s moisture and preventing liquid from evaporating from the skin’s surface. Ceramide, which is mainly made up of fatty acids and cholesterol, also plays a vital role in this process.
  2. The dermis layer consists of collagen, elastin and hyaluronic acid, which absorb moisture into the dermis layer, making the skin both tight and flexible. Aside from this, the dermis layer also contains sweat glands that produce and excrete liquid in order to manage the body’s core temperature, while these sweat glands also excrete fats that prevent the skin from drying out.

Where external or internal risk factors affect the skin barrier’s natural balance, it could lead to xerosis and the skin peeling away. These factors can be categorized as follows:

  • Intrinsic factors, including old age, being a postmenopausal woman, kidney disease, thyroid deficiency, nutrient deficiencies, dehydration or certain forms of medication, such as diuretics and retinoic acids.
  • Extrinsic factors, such as a lack of moisture in the air, cold weather, air conditioning, bathing too frequently or exposure to products that are highly alkaline, such as soaps with high alkaline levels or cleaning products containing alcohol, as well as wearing clothes that irritate the skin.

Every layer of the skin undergoes natural changes as we enter old age, and this means a reduction in new cell production capabilities for the stratum corneum layer. The skin replacement cycle usually takes around four weeks, but this time length may be doubled for members of the elderly population. Furthermore, this layer’s ability to hold onto skin moisture is also reduced, as this layer decreases in thickness by up to 50%, particularly in areas of the skin which have been regularly exposed to sunlight, such as the face, neck, back of the hands and outer arms. As for the dermis layer of skin, elastin and collagen fibers become thinner, meaning these fibers lose their elasticity, resulting in a slackening of the skin. In addition, sweat gland and sebaceous gland function is negatively affected by the ageing process, leading to some members of the elderly population suffering from extremely dry skin that is more prone to flaking and irritation.

Xerosis in the elderly is therefore quite common and often presents itself in the form of dry, flaky skin, or whole sections of skin peeling away or appear as scaly skin – similar to fish scale. This can affect the skin anywhere on the body, but is most pronounced on the arms and legs. The condition can occur in both women and men equally, showing that hormones are not the most important factor behind xerosis. Old age is the most likely cause for the reduction in subcutaneous fat production, meaning post-menopausal women are particularly at risk. That being said, frequent bathing in warm water and the use of high alkaline soap products can also damage the fat that provides protection for the skin barrier, making this another major cause of elderly xerosis. This is particularly the case during the cool season due to the lack of moisture in the air, causing the skin to lose its moisture, thereby leading to increased dryness and itchiness.

Treating xerosis requires the application of lotions that trap in moisture, reduce itchiness, improve the effectiveness of the skin barrier and decrease the amount of moisture lost through the skin. However, in cases of skin inflammation or bacterial infections as a result of scratching (causing pus-filled wounds), it is recommended that a doctor be consulted to provide advice on potential courses of treatment.

Care for your skin to prevent xerosis and avoid the following risk factors which increase the risk of xerosis:

  1. Use suitable skin care products, meaning they should have a low alkaline rating, preferably around the pH 5 level. Skin care products should also offer moisturizing qualities and be free from surfactants.
  2. Regularly apply lotions, creams or oils designed to moisturize the skin after bathing in the mornings and evenings, or as frequently as necessary in cases of extreme dryness. Moreover, be sure to select moisturizers that do not contain perfumes to reduce the likelihood of an allergic reaction.
  3. Try to avoid bathing in water that is too hot or showering for an extended period of time.
  4. Avoid the use of products containing alcohol or perfumes.
  5. Do your best not to scratch or rub areas that are itchy because this will increase the risk of inflammation and infection.
  6. Select comfortable clothing that does not cause irritation.
  7. Drink plenty of water to ensure your skin has enough moisture at all times.
  8. Avoid prolonged exposure to direct sunlight and, when out in the sun, protect yourself by using sun cream, carry a shade umbrella, wear a hat and a long-sleeved top.

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Laor Aroonpoonsub, M.D. Summary: Internal Medicine Dermatology