Xerosis (Dry Skin) in Older Adults

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
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.

(BPAC NZ 2014; Better Health Channel 2018; Chinniah & Gupta 2014)

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 and C, HIV) Hormonal changes (e.g. menopause, pregnancy) Certain psychological conditions (obsessive-compulsive disorder, anorexia, alcohol and drug abuse) Excessive sweating Dehydration Weight loss
Environmental factors	Low-humidity climate Cold, dry air Direct heat (e.g. central heating, wood-burning stoves, fireplaces) Air conditioning Chronic sun exposure and damage Soaps or detergents with harsh ingredients Irritation from rough clothing etc.
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 2019; BPAC NZ 2014; Augustin et al. 2019; Cafasso & Sullivan 2018; Oakley 2015)

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 2019)

Potential Complications of Xerosis

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

(Oakley 2015)

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:

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 2015; BPAC NZ 2014)

Additionally, patients may require topical steroids or topical calcineurin inhibitors (seek medical direction) (Oakley 2015).

Preventing Xerosis in Older Adults

xerosis prevention patting skin dry — Drying the skin by patting it gently and thoroughly rather than rubbing vigorously may help to prevent xerosis.

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)
Treating skin conditions.

(Oakley 2015; BPAC NZ 2014; VIC DoH 2015; Ciconte 2017)

Additional Resources

References

Augustin, M, Wilsmann-Theis, D, Körber, A, Kerscher, M, Itschert, M D & Staubach, P 2019, ‘Diagnosis and Treatment of Xerosis Cutis – a Position Paper’, Journal of the German Society of Dermatology, https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.13906
Best Practice Advocacy Centre New Zealand 2014, ‘“Seventh Age itch”: Preventing and Managing Dry Skin in Older People’, Best Practice Journal, no. 63, viewed 28 April 2021, https://bpac.org.nz/bpj/2014/september/dryskin.aspx
Better Health Channel 2018, Healthy Ageing - the Skin, Better Health Channel, viewed 28 April 2021, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/healthy-ageing-the-skin
J, Cafasso & D, Sullivan 2018, Xerosis Cutis, Healthline, viewed 28 April 2021, https://www.healthline.com/health/xerosis
Chinniah, N & Gupta, M 2014, ‘Pruritus in the Elderly – a Guide to Assessment and Management’, Australian Family Physician, vol. 43, no. 10, viewed 28 April 2021, https://www.racgp.org.au/afp/2014/october/pruritus-in-the-elderly-%E2%80%93-a-guide-to-assessment-and-management/
Ciconte, A 2017, Xerosis, Australasian College of Dermatologists, viewed 28 April 2021, https://www.dermcoll.edu.au/atoz/xerosis/
Mayo Clinic 2019, Dry Skin, Mayo Clinic, viewed 28 April 2021, https://www.mayoclinic.org/diseases-conditions/dry-skin/symptoms-causes/syc-20353885
Oakley, A 2015, Dry Skin, DermNet NZ, viewed 28 April 2021, https://dermnetnz.org/topics/dry-skin/
Victoria Department of Health 2015, Preventing Skin Problems, Victorian Government, viewed 28 April 2021, https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/skin/skin-preventing

Test Your Knowledge

Question 1 of 3

One of your clients, Sue, enjoys washing her body with a fragrant soap that she has been using for many years. However, she has recently developed xerosis. What would be the best solution?

Let Sue continue to use the fragrant soap she likes.

Suggest that Sue tries swapping her fragrant soap for an unscented, soap-free alternative of her choosing.

Confiscate Sue’s fragrant soap.

Author

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