Older patients are encouraged to moisturize and avoid contributors to dry skin.
Birmingham, Ala. - Thinning, drying skin is a natural process of aging. There's no cure or any way to stop it, so the issue for dermatologists becomes how to manage it.
Boni E. Elewski, M.D., professor of dermatology at the University of Alabama in Birmingham, says even the elderly don't always recognize xerosis for what it is.
"The elderly have a big problem with dry skin. Dry skin usually develops in everyone over the age of 60 to varying degrees, but it has a tendency to progress.
She says the condition has both exogenous and endogenous causes.
"Natural lipids, particularly ceramides, are not produced to the same extent as people age as they were when they were younger, so the skin has the tendency to dry out.
"The water-binding capacity of the stratum corneum layer is reduced, owing to decreased synthesis of natural moisturizing factors," Dr. Elewski says.
The result is that skin can become dry, rough and scaly.
"Externally, cold weather, low humidity and the tendency of a lot of elderly to get cold easily so they keep their houses hot all contributes to xerosis. They may sit close to a heater - even here in Alabama, which is truly amazing - or they may bathe or shower in very hot water. With all that stirred in a pot, the elderly end up with very dry skin," Dr. Elewski says.
The main thing doctors can do is educate patients on those factors, and encourage them to change behaviors to reduce the risk of dry skin progressing to eczema.
"If you're only treating dry skin, the way to approach it is to encourage the use of mild soaps such as Dove (Unilever) or Cetaphil (Galderma) - soaps that will not remove more of the lipids that are already being depleted because of age.
"There are behaviors that may have worked fine for people when they were younger, but which contribute to xerosis as they age," Dr. Elewski says.
Dr. Elewski details basic advice doctors can provide their patients to help manage their dry skin:
"Patients look at me like I'm crazy because they feel they need to get into a hot shower. I suggest they turn the water on hot to warm the shower area, then before getting in, set the water temperature like they would for bathing a baby - lukewarm," she says.
"They want to select a good moisturizer. I like CeraVe (Coria Laboratories); that's a very good product. Cetaphil is a good product. Eucerin and Neutrogena all have good products on the market," Dr. Elewski explains.
Creams containing alpha- or beta-hydroxy acids, urea-based creams, or those with high concentrations of propylene glycol are often recommended.
"A lot of my elderly patients do water aerobic exercises and that's a chlorinated environment that makes the skin very dry. I tell them to shower immediately after they finish and to moisturize their skin," Dr. Elewski says.
"If the skin has deteriorated beyond simple xerosis and patients are developing eczema, then we have to look at using topical steroids to control it. Triamcinolone is a reasonable steroid to use on the legs," Dr. Elewski says.
She says men with xerosis are more challenging patients because they don't want to moisturize their skin. They're not used to moisturizing their skin, as it's more acceptable for women to use moisturizers.
"If they complain creams are greasy, I tell them they only feel that way when their skin is oily. Once it starts drying out, the moisturizers don't have that same greasy feel.
"Sometimes a body wash such as Neutrogena Rainbath or Olay Body Butter may be helpful - something that conditions and moisturizes the skin as it cleans," Dr. Elewski says.