#AskID : Prof Niki Ralph about dry skin!

We asked Prof Niki Ralph:
Dry skin refers to skin that feels dry to touch. Dry skin is lacking moisture in the outer layer (stratum corneum) and this results in cracks in the skin surface which is also called xerosis.
Dry skin can affect males & females of all ages but is commonly seen in childhood in association with atopic dermatitis which affects approximately 20% of Irish children and 10% of adults. Another dry skin condition which starts in early childhood, also seen in families, is Ichthyosis (fish-scale skin).
As we age, with each decade our skin loses more oil resulting in dry skin, especially in those aged 60 years and above. Dry skin may also appear later in life and be associated with underlying diseases and conditions such as:
Postmenopausal women
Chronic renal disease
Treatment with medications such as diuretics & oral retinoids.
Certain factors may also cause dry skin:
• Low humidity
• Overuse of air conditioning/central heating
• Direct heat from a fire/radiator/fan heater
• Excessive bathing, especially with use of soaps/detergents
• Over-use of products containing alcohol (Handsanitizers)
The clinical features of dry skin include dull, rough/scaly skin which is less flexible/pliable and may have a cracked appearance and it may also become inflamed and therefore appear pink/red. The commonest site for dry skin are the shins, however it can affect any body site.
It may be complicated by the development of atopic dermatitis (Eczema), Asteatoic eczema/eczema craquelae, commonly seen in older people especially on the lower limbs. Discoid/nummular eczema which is a form of dermatitis seen in younger individuals, especially those who wash their skin excessively in unsuitable soaps/detergents resulting in pink/red disc/coin shaped scaly patches on the body.

For those who suffer with dry skin they are more prone to complications which include:
Infection - as bacteria/viruses can penetrate the skin’s barrier more easily
Contact allergy - Detergents/preservatives/fragrances etc.. also penetrate the impaired skin barrier
Treatment for dry skin:
▫️Regular use of emollients/moisturisers, liberal application once or twice daily, more frequently when skin is flared
Emollients added to the bath/while showering
▫️Eliminating aggravating factors:
​- Showers/baths that are too hot, use lukewarm water instead
​- Reduction in bathing/showering duration – less than 10mins
​- Avoidance of heavily fragranced products/soaps/detergents which contain preservatives and alcohol
​Keep nails short to avoid damage to the skin’s surface due to scratching.
Improving the skin barrier function will result in less itch, less redness/irritation of the skin, reduction in skin infections and more pliable/flexible skin with less cracking/fissuring of the skin.
Cream based emollients are easier to use during the day as they are absorbed more easily, however for those with very dry skin a more greasy emollient may be required especially before bedtime. Prescription therapies may be used such as topical steroids if one has dermatitis or Calcineurin inhibitors for those who need maintenance therapy/treatment for sensitive sites such as the face. Cotton gloves/socks at night aid the absorption of topical therapies for hand dermatitis/dry skin on the feet.
My go to product for dry skin due to its ease of application and due to the fact it is licensed for use since birth, is @larocheposay Lipikar AP+ M Baume/Lipikar Syndet wash for bath/shower.
For those with Ichthyosis or especially dry feet UREA based emollients are best such as Re-Life 20-30% for bodies, La Roche Posay Isourea, Ameliorate and Flexitol heal balm.