Xerosis – Symptoms, causes and solutions

Most people have experienced Xerosis, or dry skin, at some stage of their life. When it becomes severe it can affect people both physically and emotionally.. Understanding the various causes and the relevant solutions helps you to tailor your routine to your skin’s needs, enhance its efficacy and control the symptoms of Xerosis.

Xerosis is the medical name for dry skin. It comes from Greek: ‘xero’ means ‘dry’ and ‘osis’ means ‘disease’ or ‘medical disorder’. Xerosis is caused by a lack of moisture in the skin, which may be the result of ageing (senile Xerosis) or due to underlying diseases such as Diabetes. The result is dry or very dry, rough and tight skin, which can progress to become extremely rough and scaly, flaky and itchy.

If you are unsure about your skin condition consult a dermatologist for a face-to-face diagnosis. 

 Skin’s ability to regulate the amount of water in its upper layers depends on three different factors:

• The efficiency of the hygroscopic molecules in the epidermal layers of skin. In normal skin, molecules such as Urea, Lactate, PCA (Pyrrolidone Carboxylic Acid), salts and amino acids attract and bind in water.
• The effectiveness of skin´s own barrier lipids (e.g. Ceramide) which perform the vital function of reducing water loss due to evaporation.

Read more in dry skin in general.

In normal skin, this delicate system works well and adapts to the skin’s hydration requirements, maintaining an adequate concentration of water in a changing environment. However, several internal (endogenous) and external (exogenous) factors can disrupt this system and cause skin to dry out. 

Xerosis is a common condition experienced by millions of people, either chronically (repeatedly) or acutely (a one-off occurrence). Just as multiple factors support skin hydration, a lack of water within the skin can present in a variety of ways. Dry skin will normally display a couple of these symptoms, while very dry skin commonly has all of these symptoms to some degree:

• Tightness is caused when the number of dead skin cells increases, leaving a layer on skin’s surface that causes it to dry out and feel tight.
• Roughness is also caused by dryness. This dryness increases the rate at which skin cells die off, leaving a thicker layer of dead cells at the skin’s surface which makes it feel rough.
• Flaky skin occurs when the large scales of the epidermis peel off and sometimes may be seen as a fine dust.
• Itching is another result of dryness and is an impulsive reaction to the discomfort caused by tight, poorly functioning skin. The urge to scratch increases according to the severity of the dryness.

Skin conditions such as Atopic Dermatitis, Keratosis Pilaris, Ichthyosis and Psoriasis predominantly cause localised areas of xerotic skin. Read more about Psoriasis, Atopic Dermatitis on face or body or about atopic children´s skin on face or body.

Always seek professional advice for a face-to-face diagnosis if you develop any of these symptoms.

Two key deficiencies in the skin have been shown to contribute to Xerosis:

A deficiency in skin barrier lipids
The cells in the horny layer are bound together by epidermal lipids. These lipids are essential for healthy skin: they create its protective barrier and bind in moisture. When lipids are missing, skin can become dry and may feel tight and rough.

A deficiency of Natural Moisturising Factors (NMF)
Skin contains several other natural moisturising factors (NMF) in addition to Urea. These are Lactate, PCA, salts and sugars. Like Urea, these NMF attract moisture and bind it into the stratum corneum, or upper layer of the skin, preventing it from becoming dry, scaly and damaged.

Several external factors initiate the physiological changes (mentioned above) that may lead to Xerosis:

The skin’s external environment – humidity, inappropriate cleansing and sunlight
- Dry skin is more common when environmental humidity is low, which occurs in the winter and sometimes during a hot summer.
- Inappropriate cleansing (washing skin too frequently with products that strip it of its natural lipids) can damage the skin’s natural barrier. 
- Sunlight can cause skin dryness as the UV light increases the rate of water evaporation from the skin. In the longer term, this can cause skin to age prematurely which affects its ability to maintain adequate hydration.

The skin’s internal environment – age, dehydration, diet, medication and disease
- Studies have reported that lipid levels in the stratum corneum reduce with ageing. This can lead to age-induced dryness.
- When the body is dehydrated skin is at greater risk of becoming dry.
- Diet is important as vital nutrients are necessary for healthy skin.
- Certain medications, particularly diuretics, cause the body to become dehydrated, which in turn can lead to Xerosis.
- Skin conditions such as Atopic Dermatitis, Keratosis Pilaris, Ichthyosis and Psoriasis include dry skin as a common symptom.
- Diabetes can also cause dry skin.

 Historically, the treatment of Xerosis has been primarily symptomatic. The aim being the short-term relief of symptoms through the topical application of lipids, mainly vegetable oils, humectants and NMF such as Urea. As more is understood about the causes and triggers of Xerosis, clinicians have discovered that a more holistic, enduring approach to treating Xerosis yields superior results. This strategy begins with avoiding, or minimising, the causes and contributing factors of Xerosis and centres on maintaining an adequate skincare routine for face and body featuring both cleansing and moisturising. 

Mild but effective skin cleansing is an essential first step before applying any emollients and moisturisers specially formulated to care for dry skin. Choose a mild cleansing product which has been proven not to compromise skin’s barrier function. This will prevent the skin from drying out and support the efficacy of subsequent skin moisturising treatments.Mild but effective skin cleansing is an essential first step before applying any emollients and moisturisers specially formulated to care for dry skin. Choose a mild cleansing product which has been proven not to compromise skin’s barrier function. This will prevent the skin from drying out and support the efficacy of subsequent skin moisturising treatments.

There are many different factors that cause and influence skin hydration. Each of these factors should be addressed in order to effectively treat Xerosis.

There are many different factors that cause and influence skin hydration. Each of these factors should be addressed in order to effectively treat Xerosis.

Urea is often deficient in dry skin and therefore a common ingredient in moisturisers. Additional causes of Xerosis are a lack of other NMF and skin barrier lipids. Supplying these vital molecules topically can restore the skin’s ability to regulate hydration.

Moisturisers containing a range of NMF (including Urea) and Ceramide have been clinically proven to provide superior skin hydration and longer-lasting moisturisation to formulas containing just Urea. This discovery represents an advancement in the treatment of Xerosis. 

The formula containing NMF and Ceramide was also shown to significantly improve skin hydration, skin barrier function, visible dryness and tactile roughness when compared to the effectiveness of other formulas. Skin tolerability was also very good.

Skincare products formulated with proven combinations of effective skin hydrating agents will address the key deficiencies of Xerosis and provide advanced therapeutic options for the treatment of this skin condition. This proven formula is used in the Eucerin UreaRepair and UreaRepair PLUS ranges for dry skin. 

Deficiency of skin lipids and moisture binding substances such as Urea and other NMF

The formula with Ceramide repairs the skin barrier and reduces moisture loss.
Urea and other NMF bind in water and relieve skin from dryness, scaliness and itchiness.

If symptoms change, or if you are unsure which treatment is best suited to your skin, please ask a dermatologist for advice.

In addition to a good cleansing and moisturising routine, it’s important to avoid factors that contribute to dry skin. The following precautions will help reduce the impact of dry skin and the need for treatment:

• Avoid dry air by spending less time outdoors in hot, arid or cold weather and by using a humidifier indoors when the heating is on.
• Reduce the time spent in hot water by having quick, lukewarm showers instead of long, hot showers or baths. 
• Using gloves when washing dishes will help to avoid direct contact with hot water and strong detergents. 
• Wear clothes made of natural materials such as cotton and silk that do not irritate the skin. Wool is natural but may cause irritation to extremely dry or atopic skin and should be avoided by people with these conditions. 
• Use a laundry detergent that is free from dyes or perfumes. These can remain on clothes after washing and might irritate dry skin.