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)
What are ex’s of Emollient Tx?
- Ceramides, lanolin, mineral oil, castor oil, cocoa butter, fatty acids, lipids
What are ex’s of Emollient products?
- CeraVe Cream Lotion
- Glaxal Base Cream/Lotion
- Cetaphil Creams/Lotions
- Aveeno Lotions/Creams
What is the recommended order of Moisturizers?
recom. an emollient mosterizer 1st & then occulusive or humectants
What is the application of moisturizers?
- Apply to moistened skin (3 to 5 minutes after a shower and towel drying)
- Lightly applied along the hair follicle direction (rub gently)
- Dependent on skin dryness & product, can be applied 1 to 3 times daily
Cautions:
* Irritation (lactic acid, urea, propylene glycols)
* Allergic contact dermatitis (Lanolin, propylene glycols, fragrances, aloe, olive oil, tea tree oil)
What are Ointments?
*Usually 80% oil & 20% water
*Useful for chronic, VERY dry skin and areas that have fissures (hands & feet)
*Requires less frequent application than creams or lotions
*Greasy and may be difficult to spread & remove (preferred at night)
**CAN BE APPLIED TO HANDS & FEET
* NOT to be used on the face or skin folds
* NOT to be used on areas that are moist, weeping, oozing, infected or acne prone areas
What are Creams?
- Creams are half oil and half water
- Can be applied to areas that are moist, weeping,
oozing or very dry - Absorbed well, easy to spread and can be used multiple times per day/night
- Cosmetically more acceptable than ointments (less greasy than ointments)
- Can be applied to the face, body, hands, feet (all areas)
What are Lotions?
- Contains more water than oil
- Not effective for very dry skin (unless used many times per day)
- Easier to spread than ointments or thick creams
- Short acting and must be applied more often than
creams or ointments - Can be applied to the face and entire body
- Useful for hairy areas (scalp)
What are Gels?
- May contain alcohol or water-based (hydrogel)
- Can be drying or irritating to open areas
- Liquefies on contact with skin and leaves a thin layer
of active medication - Can be used on the face and on hairy areas (scalp)
- Acne, scalp, psoriasis and seborrheic treatments
- Cosmetically acceptable but easily removed by sweating
What are the Bath Products?
- Oils
- Provide a layer of oil on skin that prevents moisture from evaporating
- Can make surfaces slippery (may increase risk of falls) if applied directly into the bath
- Colloidal oatmeal products
- Used to relieve itching
What are ex’s of Bath Products?
- Colloidal oatmeal
Aveeno Bath
(Colloidal Oatmeal)
Aveeno Bath Oil
(Mineral Oil, Colloidal Oatmeal)
What are Cleansers/Soap Substitutes?
- Ideal cleanser should be:
- Soap free
- Fragrance free (decrease sensitivity)
- Rich in emollients
- Does not disrupt the pH
- Synthetic cleansers (less irritation)
- Use a small amount mixed with warm water and apply to damp skin (rinse and pat dry)
What are non-pharmacological treatments?
- Re-hydrate with moisturizers
- Within 3 to 5 minutes of bathing while skin is still damp
- Short baths or showers
- Less than 10 minutes to decrease the drying of the skin
- Warm water NOT HOT
- Hot water washes off the natural oils
- Pat body dry (do not rub)
- Less irritation to the skin
- Mild cleansers/shower gels
- Non-perfumed & mild products for dry skin are best - Some research states to avoid all soaps
- Loose fitting cotton/linen clothing
- Allows moisture wicking
- Keep humidity of the environment higher during winter months/extreme dry heat (humidifiers)
- 50% in winter and 30% in summer months
- Prevents drying of skin
- Cover face and hands to protect them from the cold, dry air
- Avoid products that contain perfumes or fragrances
(detergents, fabric softener) - May cause allergic dermatitis or worsen the itching
- Trim nails
- Prevents scratching the area leading to an increased risk of infection
What is the monitoring of rough scaly skin? What are the goals?
DAILY for signs of improvement for 7-10 days after starting treatment (with moisturizers or non- pharms)
Skin to feel smoother
Skin to be less irritated/red/rough
What is the monitoring of itching skin? What are the goals?
DAILY for signs of improvement for 7-10 days after starting treatment
Itching is less (no scratching)
What is the monitoring of itching skin? What are the goals?
DAILY for signs of improvement
Soft, hydrated skin
Choosing a Product?
- *Patient preference
- Patient’s age
- Package size (small, large, pump, tube)
- Cost of product
- Ingredients (allergies to
additives/preservatives, fragrance - Effect of the product
- Type of lesion (dry/moist)
- Type of site (hairy area, face, feet)
Patient preference?
- How easy is the product to apply?
- How long does it take to rub in?
- Does it absorb into the skin easily?
- How does it feel when applied (greasy, irritating, stinging)
- What does the skin feel like after application? (smooth, less itchy)
- Does the product smell/have fragrance?
*If a patient does not like a product, they will not use it
What is the summary?
- Assess your patient and determine what may be the main cause of the dry skin (environmental, medical)
- Determine if patient should be referred or if the condition is self treatable
- Choose a product that will be most effective & suitable/preferable for your patient
- Provide the patient with SPECIFIC non-pharm/non-drug advice that will prevent worsening of the condition
- Provide a monitoring plan for your patient
