Dry Skin: Types, Risk Factors and Treatment

‘Dry skin’ (medically termed as ‘Xerosis’, ‘Xeroderma’ or ‘Asteatosis’) is a skin condition that relatively produces less sebum than normal skin. Resultantly, the outer skin layer (epidermis) lacks the lipids and epidermal proteins that are required to retain the moisture. It makes the skin dehydrated; giving it a dull, rough, scaly and cracked appearance. Also, leading to irritation and itching, that sloughs off into flakes or scales. Dry skin tends to affect any body part, though it is more common on the arms, hands, and legs.

It is generally not a serious condition and is very common during the winters, due to less moisture content in the air. It can also be caused due to extreme climatic condition (warm/cold), hot showers, harsh chemicals or soaps and can be usually be treated with the help of good moisturizers. However, in cases where the dry skin tends to be chronic or severe, it could signal some underlying medical condition. In such cases, it becomes paramount to seek dermatological treatments.

Types of Dry Skin:

Dry skin is also medically referred to as ‘Dermatitis’ and there are many different dry skin (dermatitis) types:

1) Contact Dermatitis: This is a skin inflammation, that gets triggered in contact with a particular allergen/substance. It is a common condition and the symptoms tend to be unpleasant, but usually subside on its own. Contact Dermatitis can affect any part of the body, depending upon the areas of the skin which are exposed to that particular allergens/irritants. The common types of Contact Dermatitis are Allergic Contact Dermatitis, Irritant Contact Dermatitis, and Contact Urticaria.

1a) Allergic Contact Dermatitis (ACD) is observed in genetically-susceptible individuals and the ones who in, that tend to be allergically reactive towards specific allergens. In this type of condition, the skin takes up to 48 to 96 hours to develop reactional symptoms. When the skin comes in contact with a new ‘allergen’ (substance that makes the immune system responds by causing the skin to react), it gets detected and stored in the memory of the immune system, undergoing a process of sensitization. Thus, as the skin gets persistently exposed to the substance, the immune system recognizes it and develops an itchy reaction.

1b) Irritant Contact Dermatitis (ICD) is very common and affects the external layer of the skin upon single exposure to strong irritants (substances that damage the external layer of the skin). If the skin gets in contact with an irritant such as harsh chemical, or heat or is rubbed too hard, it causes the epidermal layer to break and get inflamed.

1c) Contact Urticaria (CU) also termed as ‘Hives’ is an ephemeral localized inflammation that occurs when an offending substance gets in contact with the skin. CU can be immunological or non-immunological. Non-immunological CU occurs in individuals without any kind of previous exposure to an allergen causing mild local skin reactions. While, Immunological CU develops in individuals whose immune system has been priorly exposed to such allergens.

The risk factors triggering Contact Dermatitis are:

• Nickel and Cobalt in metal jewelry/objects, clothing press studs/snaps and zippers
• Latex gloves and rubber wears
• Plants such as mango, oak, poison ivy and sumac which contain an allergic element (Urushiol)
• Preservatives/Disinfectants containing Formaldehyde
• Medications (Antibiotics/Steroids/Antihistamines)
• Skincare products such as hair dyes, deodorants, mouth rinses, body washes, cosmetics that contain Balsam of Peru.
• Leather shoes/clothing that contains Potassium dichromate
• Products that tend to be reactive in the sun, such as sunscreens/sunblocks that tend to cause Photoallergic Contact Dermatitis.
• Airborne elements such as pollen, sprays, insecticides

2) Atopic Dermatitis (AD): Atopic Dermatitis also known as ‘Eczema’ is a condition that causes redness and itchiness to the skin. Though common in children, it can develop at any age. It is a long-lasting chronic condition and appears intermittently. It is accompanied by two other medical ailments such as Asthma/Hay fever. There is no cure for this condition, however, preventive measures can help relieve the symptoms.

The risk factors contributing to Atopic Dermatitis are:

• Majority cases of Ichthyosis are genetic that begin during childhood, while in adults it can be acquired due to certain medical conditions. It is caused due to genetic mutation inherited from either of the parents. A defective gene inherited from a single parent tend to have a milder form of disease in the children.

And children with two inherited defective genes tend to have a severe form of IV. There has been no cure for this condition. However, with appropriate treatment, the symptoms can be managed.

• As per the research studies, certain food allergies to dairy products (such as yogurt/cheese), nuts and shellfish also tend to aggravate the symptoms of AD.
• AD also tends to affect people with lessened quantity of a protein (filaggrin) in the skin skincare the protein is vital in maintaining adequate hydration in the skin.
• As per research studies, individuals with weakened immune systems to tend to be affected by AD.

3) Seborrheic Dermatitis (SD): SD is a papulosquamous skin condition that causes patchy, red skin and severe dandruff. It mainly occurs on the scalp, though, it can also affect the oil-prone areas of the body (such as the face, eyelids, ears, eyebrows, chest, and sides of the nose). SD is a prolonged condition that requires continual treatment; however, a good skin-care regimen can help to minimize the symptoms.

The risk factors that contribute to Seborrheic Dermatitis are:

• It occurs when sebaceous glands secrete too much oil and the other factor being, Malassezia, a fungus that naturally occurs in the skin oils. Due to the abnormal growth of the fungus, it causes the skin to produce more oil than required.
• Also, infants can develop this condition due to hormonal fluctuations that tend to occur in a carrying mother. The hormonal changes stimulate the oil glands of the infant causing excess production of oil resulting in skin irritation, scaly and patchy scalp. In infants, this condition is termed as cradle cap.
• As per research studies, there is a potential link between SD and other health ailments such as HIV and Parkinson’s disease. The other factors that induce SD flare-ups are sunlight, radiating heat and extensive topical therapy.

4) Ichthyosis Vulgaris (IV): IV (also termed as ‘fish scale disease’ or ‘fish skin disease’) is an inherited skin condition that causes extremely dry, scaly and thickened skin due to accumulation of dead skin cells. There are around 20 types of Ichthyosis and IV one of the most common types affecting 95% of people. Most of the cases are mild and limited to certain body areas. However, certain cases can be severe and occur on other body parts such as back, arms, abdomen, and legs. In serious cases, IV may cause deep, painful cracked soles/palms.

The risk factors that lead to Ichthyosis Vulgaris (IV) are:

• In this condition, the natural sloughing/shedding process of the skin gets slowed down. This leads to excessive accumulation of protein (keratin) in the outer skin layer. The symptoms of IV tend to worsen in winters.
• It is also caused as a result of other medical conditions such as cancer, kidney/thyroid disease or other skin ailments such as Atopic dermatitis/Keratosis pilaris.
• Certain drugs/medications also have also been linked to IV.

5) Psoriasis: Psoriasis is an auto-immune, chronic inflammatory skin condition that accelerates the life-cycle of skin cells. It results in red, scaly skin due to the speedy build-up of skin cells. The extra, over-grown skin cells are scaly white with red patches, that tend to be painful and itchy. These scales occur essentially on the joints (elbows/knees) and also on the face, hands, feet, neck and scalp. In rare cases, it can affect the mouth, nails and genital area.

The risk factors contributing to Psoriasis are:

• Though researchers are unsure about the causes of Psoriasis, it occurs due to malfunctioning of the immune system. T cells that are the part of the body’s immune system help in fighting infections. However, in individuals with Psoriasis, the T cells attack the healthy cells on mistake.

This erroneous phenomenon results in the production of new skin cells, that are pushed up and accumulated on the outer skin surface. It causes plague-like conditions on the skin leading to psoriasis.

• Also, genetics, contribute to the development of this Psoriasis. As an individual with an immediate family member is at higher risk of developing this condition. There is no cure for it, however, preventive measures can help in managing the symptoms.
• Stress tends to trigger or worsen the symptoms of Psoriasis and make them appear intermittently.
• Skin injuries can further cause irritation to the skin, leading to increased immune response that aggravates the condition.
• Dry and cold weather conditions with less sunlight can further aggravate the symptomatic condition of Psoriasis.
• Certain drugs/medications to worsen the symptoms of Psoriasis.

Treatment:

• In cases of all the dry skin condition types, it is paramount to refrain from scratching the skin in order to prevent the further aggravation of infection.
• To treat dry skin symptoms, use of mild soaps and warm water is recommended. And different types of baths (such as oil baths, oatmeal baths, baking soda baths, vinegar baths, bleach baths) are particularly effective for the symptoms of AD/eczema-like skin conditions.
• Use of anti-itch topical applications such as Calamine lotion/hydrocortisone creams can help to soothe the symptoms of dry skin.
• In cases of CD/AD, use of anti-histaminic drugs can help in relaxing the symptoms.
• Application of emollients (creams/ointment/lotions) tend to be effective in managing various dry skin conditions. It enables to retain water and acts as a protective shield.
• Application of topical corticosteroids in the affected areas, upon prescription by a skin expert in cases of CD/AD/Psoriasis.
• Photo-therapy that uses Ultra-Violet (UV) light on the affected skin areas (in cases of CD/AD/Psoriasis) helps improve its appearance.
• Immunosuppressant treatments/calcineurin inhibitors that help in suppressing the inflammatory symptoms in dry skin.
• Anti-histamines (such as cetirizine, fexofenadine, and diphenhydramine) are helpful in treating skin conditions of severe itching caused due to AD. Also, use of wet-wraps, wherein wet strips or gauzes are applied on the cleaned and moisturized skin areas to enhance the moisturizing/hydrating effect.
• Alitretinoin capsules are prescribed in cases of severe conditions of Eczema.
• For mild conditions of SD affecting the scalp/body, topical anti-fungal shampoos/creams such as zinc pyrithione, selenium sulfide, ketoconazole or coal tar can help in managing the symptoms. However, in severe cases, non-corticosteroids such as pimecrolimus or tacrolimus may be advised.
• For skin conditions with IV, soaking the affected skin areas in lukewarm water/saltwater or giving a gentle rub with pumice stone can help in reducing the scaling. Moisturizers with exfoliating chemicals (such as salicylic acid, lactic acid, alpha hydroxy acid, glycolic acid) can help in smoothening the skin.

In severe symptomatic conditions, using oral medications containing Vitamin A (such as acitretin/isotretinoin) can help in slowing down the excess skin cell production.

• In individuals with Psoriasis, exposure to sunlight and artificial UV radiations, help in slowing down the cell renewal process, thus minimizing the scaled and inflamed appearance.
• The topical creams/solutions containing Vitamin D (such as Calcipotriene and Calcitriol) help in treating mild to moderate condition of Psoriasis. Anthralin medication also helps in limiting the growth of skin cells, thus removing the scales and making the skin smooth.
• Salicylic acid also enables to facilitate shedding of the dead skin cells, by reducing the growth of skin cells. Coal tar sourced from the coal helps in minimizing the scaling and inflammation of the skin.
• Medicines such as Methotrexate and Cyclosporine suppresses the immune system by limiting the production of skin cells. Biologics (drugs that cause changes in the immune system) help in treating Psoriasis are etanercept, infliximab, adalimumab, ustekinumab, golimumab, apremilast, secukinumab, and ixekizumab. These drugs are administered intravenously.

Conclusion

Other natural products or therapies that can help in hydrating, moisturizing and relieving itchy skin include virgin/cold-pressed Coconut oil, Sunflower oil and Cardiospermum (plant extract that reduces inflamed and itchy skin). Topical application of Aloevera extracts, Fish oil (Omega-3 fatty acids) and Oregano grape can also help to soothe the symptoms of Psoriasis.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/17716284
2. https://www.ncbi.nlm.nih.gov/pubmed/17642836
3. https://www.ncbi.nlm.nih.gov/pubmed/15492432