Dry skin in dermatology: a complex physiopathology

Dry skin (xerosis) is a common dermatosis affecting people of varying skin types and ages and various areas of the body. It is associated with both skin thickening and skin thinning and is triggered by both exogenous (e.g. climate, environment, lifestyle) and endogenous (e.g. medication, hormone fluctuations, organ diseases) factors. Skin requires a water content of 10–15% to remain supple and intact. This water is either ‘static’ (i.e. bound) or ‘dynamic’. The predominance of hydrophobic substances in intercellular constituents is a means of regulating the humidity of the skin. Emollients, highly effective treatment adjuncts in the management of all dry skin disorders, help to restore damaged intercorneocyte lipid structures and increase the water content of the skin, helping to reduce scaling and improving its barrier function.     

养老机构老年人皮肤健康状况调查及影响因素分析

目的:调查洛阳市养老机构老年人皮肤健康现状并分析影响因素,为构建老年人皮肤健康状况监测及干预体系提供依据。方法:本研究为横断面研究。采用分层随机抽样法,选取2019年11—12月在洛阳市7家养老机构居住的489名老年人为研究对象,使用自行编制的老年人皮肤健康状况调查问卷、简易智力状态检查量表（MMSE）、一般情况及疾病...     

Environmental dew point and skin and lip weathering

Xerosis represents a physiological response of the stratum corneum (SC) to environmental threats. The influence of the environmental dew point (DP) is not fully understood. This parameter is the air temperature at which the relative humidity is maximum. This study aimed to assess the relationship between the environmental DP and the water‐holding capacity of the skin and lower lip vermilion. For comparison, SC property was evaluated after occlusive application of cooled and uncooled hydrogel pads. Electrometric measurements using a dermal phase meter (DPM) device were performed on the back of the hands, the cheeks and the lower lip of 40 healthy menopausal women. Assessments were performed in the outdoor conditions during winter and spring. The same measurements were recorded after hydrogel pads, at room temperature or cooled to 4 °C, were placed for 15 min on the test sites. The environmental DP was recorded at each evaluation time. The SC water‐holding capacity was discretely influenced by the DP. In the open‐air environmental conditions, a positive linear relationship was found on the cheeks between the DP and DPM values. The relationship was weaker on the lips. Conversely, a consistent increase in DPM values was recorded immediately after removal of the cooled and uncooled hydrogel pads. The observations made in the open‐air testing conditions are consistent with the predicted events following the Arrhenius law. By contrast, the combination of cooling and occlusion by the hydrogel pads is responsible for the reverse effect on the SC.     

Dry skin (xerosis) in patients undergoing maintenance haemodialysis: the role of decreased sweating of the eccrine sweat gland

The aetiology and the pathophysiological mechanisms underlyingthe development of dry skin in uraemia are still unclear, butthe hydration status of stratum corneum clearly influences theappearance of skin. The xerotic skin texture is often referredto as ‘dry skin’ and has been suggested as a causeof uraemic pruritus. To understand the aetiology of dry skinin uraemia we measured the status of skin surface hydrationof uraemic patients with the corneometer and skin surface hydrometer,the functional capacity and the urea concentration of stratumcorneum and the response of eccrine sweat gland to sudorificagent (0.05% pilocarpine HCL) in 18 age-matched haemodialysispatients and 10 healthy volunteers. We also performed the watersorption-desorption test to uraemic and control subjects afterapplication of urea in various concentrations. Uraemic patient'sskin showed decreased water content compared to control subjects.However, we found no correlation between dry skin and pruritus.Although the urea concentration of the horny layer in uraemicpatients was elevated compared to control subjects (28.2 ug/cm2vs 5.04 ug/cm2, P<0.05), its moisturizing effect to relievepruritus is questionable because its artificial applicationrevealed no improvement of the functional capacity of hornylayer in concentration 5 times higher than the physiologicalconcentration. Uraemic patients showed decreased sweating responseto sudorific agent. In conclusion, the functional abnormalitiesof eccrine sweat glands may be account for dry skin in uraemicpatients at least in part, but there is no correlation betweenxerosis and pruritus.     

Quantitative Analysis of Stratum Corneum Lipids in Xerosis and Asteatotic Eczema

Sphingolipids, a major constituent of intercellular lipids, are an important determinant for both water-holding and permeability barrier function in the stratum corneum. To assess the pathogenic role of sphingolipids in the stratum corneum of dry skin disorders such as xerosis and asteatotic eczema in leg skin, ceramides were quantified by thin layer chromatography after n-hexane/ethanol extraction of resin-stripped stratum corneum and evaluated as μg/mg stratum corneum. In healthy leg skin (n=49), there was age-related decline in the total ceramide, whereas xerosis (n=25) and asteatotic eczema (n=16) suffering significantly reduced water-holding properties, exhibited no definite decrease, rather slight increase in ceramide quantity with the same composition of each individual ceramide as compared to healthy age-matched controls. These data indicate that the seemingly elevated level of ceramide is an artificial effect due to inflammatory processes which result from susceptibility to dryness. Analysis of sebum-derived lipids present in the stratum corneum revealed that there was a significant decline in free fatty acids in xerosis and asteatotic eczema as compared to age-matched healthy controls, and a similar decline in triglycerides in the above three groups when compared to younger controls. Although the observed decrease in the stratum corneum lipids may well explain the high incidence of winter dry skin in older people, the progression toward asteatotic eczema can not be accompanied solely by a decrease in ceramide quantity, suggesting that the evolution of xerotic skin is associated with other moisturizing factors and/or environmental stimuli.     

Similar appearance,different mechanisms: xerosis in HIV,atopic dermatitis and ageing

Xerosis is one of the most common dermatologic disorders occurring in the elderly and in patients with atopic dermatitis (AD) and human immunodeficiency virus (HIV) infection. Xerosis has been linked to an impaired skin barrier function of the stratum corneum. Using Raman microspectroscopy, we concentrated on deeper skin layers, viable epidermis and dermis of 47 volunteers and associated molecular alterations to the evolution of xerosis and the skin barrier, for example, lipid, water and antioxidant content. A decrease in lipids within the viable epidermis is found for elderly and HIV‐patients. Lipid and water values of AD patients and their healthy reference group are similar. Decreases in lipids and simultaneous increases in water are found in the dermis for HIV and AD patients in comparison to their healthy reference groups. Excessive levels of epidermal carotenoids, mainly lycopene, in HIV‐patients were found potentially leading to adverse effects such as premature skin ageing.     

The use of a rigid gas permeable lens in ocular cicatrical pemphigoid

Ocular cicatrical pemphigoid is a chronic, progressive, auto-immune disease characterised by shrinkage of the conjunctiva, entropion, trichiasis, xerosis and, finally, reduced vision from corneal opacification. The long-term prognosis is always very poor, although systemic immunosuppressive chemotherapy, topical retinoids and contact lens wear are beneficial. Various types of contact lenses are useful in managing tins disease. In the case described, an RGP lens was used to improve vision, surface wetting and the physiological and visual prognosis.     

Use of the Reviscometer® for measuring cosmetics-induced skin surface effects

BACKGROUND/PURPOSE: The Reviscometer RVM600 that measures resonance running time (RRT) has been shown to be inversely related to the skin stiffness. However, very few publications describe the use of this instrument for testing the effect of cosmetic products. METHODS: Slight xerotic skin condition was induced by using an alkaline soap for 1 week. Skin has then been rehydrated with a lotion or further dehydrated and dried with sodium lauryl sulfate (SLS). Skin condition at the different stages of the study was evaluated by visual assessment for dryness and redness and by non-invasive methods (Corneometer, Cutometer, Reviscometer, Evaporimeter and squamometry). RESULTS: All methods showed highly significant changes after the slight drying phase with the soap usage. They illustrated skin repair after lotion treatment and further skin impairment after SLS application. Nevertheless, the Reviscometer was able to better statistically discriminate between the treatments (water, lotion, SLS) than the Cutometer . Measurement of the RRT along the transversal axis of the forearms was the most sensitive for differentiating between normal and dry skin and between the treatments on the basis of skin mechanical properties. CONCLUSION: The Reviscometer RVM600 is a sensitive instrument able to detect slight skin surface effect of cosmetics. Combined with published literature on the interpretation of RRT measurements on polymeric gel or in different skin conditions (elderly skin and photoaged skin), the Reviscometer looks to be a recommendable instrument to measure slight changes in SC stiffness/suppleness induced by cosmetic products.     

Relationship between activity of daily living and asteatosis in the lower legs among elderly residents in long‐term care institutions: a cross‐sectional study

This cross‐sectional observational study investigated the relationship between the level of activities of daily living (ADL) and asteatosis in the lower legs among elderly residents. We enrolled 173 residents from a long‐term care health facility and two special nursing homes for elderly persons in the Tokyo metropolitan area and Oshima Island, Japan. The level of ADL was measured by the Barthel Index. The relationship between the Barthel Index total score and the presence of asteatosis in the lower legs diagnosed by a dermatologist was analysed by multivariate logistic regression analysis. Among the residents, 79·2% had asteatosis in their lower legs. An increase of 1 point in the Barthel Index total score was significantly associated with a decreased probability of lower leg asteatosis after adjusting for age, sex and the type of institution (adjusted odds ratio = 0·982; 95% confidence interval: 0·966–0·998). A higher level of ADL is associated with a lower probability of having asteatosis in the lower legs among residents in long‐term care institutions. Nurses should pay specific attention to residents with limited ADL for initiating preventive care for asteatosis.