Xerosis Cutis in the Aging Population: an Approach to Diagnosis and Treatment
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INVITED COMMENTARY
Xerosis Cutis in the Aging Population: an Approach to Diagnosis and Treatment Frank Lacy 1
&
Carolyn Ziemer 1
Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this paper is to identify risk factors for dry skin in the elderly as well as to outline a treatment approach to xerosis in the elderly population. Recent Findings Females and those with darker skin types are at higher risk for dry skin. Certain medications such as diuretics and statins also are associated with higher incidence of xerosis. Ceramide-containing moisturizers help to play a protective role. Summary A detailed medication review is warranted for all patients with dry skin. In the elderly, xerosis is a result of a complex interplay of genetic, behavioral, and comorbid factors. Prior to treatment for xerosis cutis, evaluation for an underlying primary inflammatory disease of skin should be ruled out. Keywords Xerosis . Dry skin . Pruritus . Itching . Moisturizer . Elderly
Introduction The skin is a complex organ with a simple purpose: to help the body withstand the forces it is subjected to by the environment. The skin is composed of 3 layers: epidermis, dermis, and subcutis. The outermost layer, the epidermis, plays the largest protective role and is the most vulnerable of these layers to external influences. Not surprisingly, the epidermis is the layer most affected by xerosis cutis, or dry skin.
Pathophysiology Proper function of the epidermis is reliant upon maintenance of cell-cell adhesion to form a tight barrier as well as adequate “coating” of this layer which is supplied by water and lipids. The cornified cell envelope is a cross-linked protein and lipid structure that is surrounded by extracellular lipids [1]. This structure replaces the plasma membrane in the top layers of
skin. Several different gene aberrations in this process have been identified in genetic disorders of ichthyosis, leading to a fish-scale appearance of the skin. Variation in filaggrin, a protein essential to the epidermal barrier function of the skin, is a major predisposing factor to xerosis, atopic dermatitis, and ichthyosis [2]. While atopic dermatitis typically improves with age, a patient with an underlying history of this condition is more likely to develop xerosis. In addition to genetic predispositions to disorders of dry skin, the natural aging process also increases the risk of xerosis. With age, transepidermal water loss has been shown to increase, which predisposes the skin to dryness [3]. Reductions in sebum, or oil, production over time also increase skin dryness. Sebaceous glands are most active after puberty and in young adults. While the number of sebaceous glands in the skin is preserved throughout life, the rate of oil production decreases steadily with a large drop off after menopause in women and a slower decrease in men [4]. This results in an overall reduction in the amount of lipids in the stratum corneum, compromising its function as a
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