EpistemisCutaneous xerosis
Specialty: Skin.
Why it occurs
- Skin senescence (physiological decrease in the activity of sebaceous and sweat glands linked to aging)
- Atopic dermatitis (genetic alteration of filaggrin synthesis that alters barrier function and increases transepidermal water loss)
- Primary hypothyroidism (decrease in systemic metabolism and glandular lipid secretion)
- Chronic renal failure (uremia and impaired keratinocyte hydration)
- Extreme environmental factors (continuous exposure to cold, low humidity or chronic use of aggressive alkaline soaps)
Initial workup
Clinical evaluation by inspection under Wood's light, determination of the hydration status of the stratum corneum by corneometry if available. General laboratory profile including thyroid stimulating hormone (TSH), free T4, creatinine, blood urea nitrogen (BUN), complete blood count, and serum electrolyte levels.
red flags
Appearance of painful and bleeding erythematous fissures with suspicion of bacterial superinfection, generalized desquamative erythroderma that compromises thermoregulation, or intractable nocturnal pruritus that suggests an underlying lymphoproliferative process.
Standard management
- Emollients enriched with 10% urea — wetting agent that captures water from the stratum corneum and exerts a mild keratolytic effect
- Lipid creams with ceramides and free fatty acids — structural restorers of the intercellular lipid barrier
- Pure hydrophilic Vaseline — occlusive of choice to avoid transepidermal water loss
- Low potency topical corticosteroids such as 1% hydrocortisone (temporarily indicated if there is associated scratching eczema).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4