Dry Skin Flashcards
What is dry skin?
- Most often caused by a lack of water in the stratum corneum/water loss from the skins surface
- May be a decrease of skin barrier lipids and ceramides
- May be genetic (deficiency in filaggrin)
What are the contributing factors for dry skin?
can be environmental, lifestyle, medical conditions, medications or ageing of the skin
What are the symptoms of dry skin?
- Mild scaling or visible peeling of outer skin layer/increased flaking of the skin
- Mild to moderate itching
- Cracks, fine lines in skin, fissures
- Skin that feels and looks rough & uneven
- Skin feels tight after showering or swimming
- May have some redness
What is the location of dry skin?
- Most likely to appear on the trunk and limbs (thighs, lower legs, abdomen & arms) but can occur anywhere on the body
- Fingertips & knuckles can be dry due to lack of flexibility and continuous pressure or stress
- Face because of exposure to the environment
- Areas that normally have high levels of moisture are not generally affected (groin & underarm)
What are the symptoms/appearance of MILD dry skin?
▪ Mild scaling & some roughness
▪ Itching may/may not be present
▪ No or minimal redness
▪ No fissures present
What are the symptoms/appearance of MODERATE dry skin?
▪ Moderate scaling & roughness
▪ Mild to moderate itching & some pain
▪ Mild redness
▪ Fissures may be present
What are the symptoms/appearance of SEVERE dry skin?
- Severe scaling & skin is very rough
- Severe itching
- Severe pain
- Fissures may be present & severe
What are the causes/aggravating ENVIRONMENTAL factors?
*Electric heat , air conditioning, wood burning stoves, space heaters, fireplaces
- Reduces humidity in the air and creates dry air conditions
*Cold, windy or very hot & dry climates
- Low humidity environment (cold/winter or desert like climates)
*Chronic exposure to sunlight & sun damaged skin
ex: sunburn
What are the causes/aggravating LIFESTYLE factors?
*Bathing or showering often/use of hot water/swimming in chlorinated pools
- Breaks down lipid barriers in the skin
*Use of harsh soaps & detergents (deodorant and antibacterial soaps are the most damaging)
*Skin sensitizers (lanolin, propylene glycol, aloe vera)
*caution when recommending emollients b/c would have these in them
*Poor hydration/dehydration/high intake of caffeinated beverages
What are the causes/aggravating MEDICAL CONDITIONS factors?
*Skin conditions (atopic dermatitis, psoriasis, acne)
*Chronic renal failure (changes in sweat glands & high phosphorous levels)
*Hypothyroidism (decreased sweat & oil gland activity)
*Uncontrolled diabetes (high blood sugar)
*HIV (low CD4 count, medications)
What are the causes/aggravating MEDICATIONS factors?
*Acne medications (remove oils or sebum from the skin)
- Isotretinoin, retinoids, benzoyl peroxide
*Some chemotherapy agents (may affect growing skin cells)
*Alcohol containing products such as gels (remove lipids from the skins surface)
*Diuretics (decreases the bodies water content)
*Statins (decrease lipids in the skin)
What are the causes/aggravating AGE factors?
- Dry skin is more common in the 65 year and older group
- Ageing of the skin causes a thinning of the epidermis and decreased ability to retain moisture
- Filaggrin is lower in aged skin
- Decreased activity & size of the sebaceous gland and sweat glands occurs as we age
- Women in their 60’s and men in their 80’s
What is included in the assessment of dry skin?
- *Location
- Where on the body?
- How large is the area?
- Symptoms
- What symptoms currently experienced?Severity?
- *Onset? Duration?
- *Any recent changes to lifestyle/medications?
*Past history
- Any *past history of dry skin/other skin
conditions?
- Any family history of dry skin/eczema?
*Red Flags?
- Personal habits
- Baths or showers/length of time?
- Water temperature?
- Use of harsh or perfumed soaps?
- Environment?
- Exposure to chlorine? Sun? low humidity?
- Previous treatments
- *Tried OTC products, prescription products, no products?
- Length of treatment if product previously used
When to refer?
- Large areas (>30% of the body)
- Under 2 years old or > 60 years old
- < 50% improvement after 7-10 days
- Monitor for changes daily
- Signs of infection (discharge, redness, pain)
- Medical conditions that impair wound healing (HIV)
- Severe itching and/or inflammation present
- Involvement of flexural areas, neck or bottom of the feet (particularly in diabetics)
What is the differential DIAGNOSIS?
- Atopic Dermatitis
- Red, ITCHY areas (usually flexural areas in adults & first seen in
childhood) - Contact Dermatitis
- EXPOSURE to allergen (can be on the hands, trunk if exposed)
- Psoriasis
- Red PLAQUES WITH SILVER SCALES (usually knees & elbows)
- Photoallergic/photosensitive reaction
- Red, itchy areas (anywhere on the BODY EXPOSED TO SUN)
What are the Goals of Therapy?
- Restore smoothness and softness to the skin
- Improve or restore skin hydration
- Repair the skin barrier
- Relieve itching related to dry skin
- Prevention of further skin damage
What are moisturizers?
- Moisturizers or emollients moisten the skin
- Used to decrease “cracks” in the skin as well as smooths and hydrates the skin
- Reduces the dry feeling
- Decreases skin tightness, pain, itching and stinging
- Combinations of emollients, humectants and occlusives
What is the Occlusive Tx?
- Forms a barrier on the skin that physically blocks water loss from the skins surface - blocks water loss
- Restores the stratum corneum layer and moisturizes the skin
- Recommended for dry skin *on hands and feet
- Apply as often as required
What are examples of Occlusive Tx?
- Plant oils: hemp oil, soybean oil, coconut oil, jojoba oil
- Beeswax, lanolin
- Hydrocarbons: petrolatum, mineral oil
- Silicones based: dimethicone
What are some ex’s of Occlusive products?
- Vaseline
- Vaseline Problem Skin Therapy
- Eucerin Original Cream/Lotion
- Eucerin Aquaphor Ointment
What are Humectants tx?
- Increases water content of the skin by drawing water from the dermis to the epidermis (attracts and holds water) or drawing from the environment
- Recommended when moderate scaling is present or other products failed
- Generally applied 2 to 3 times daily
What are examples of Humectants Tx?
- Glycerin, honey, colloidal oatmeal, alpha-hydroxy acid (AHA)
- Urea & lactic acid
What are some ex’s of Humectant products?
- Uremol 10 Cream/Lotion
- Uremol 20 Cream/Lotion
- Eucerin Complete Cream/Lotion
- Dermal Therapy Lotion
- Aveeno Cracked Skin
What are Emollients Tx?
- Fills the cracks/fissures produced by dry skin by filling the spaces around the cracks – lubricates & softens skin
- Hydrates (decreases dryness) by sealing the moistures into the skin, softens skin, decreases itching and gives the skin a smooth feeling
- Apply as often as needed (at least 3 to 4 times per day as needed)
(most common)