Dry Skin

Question 0

Name the three layers of the skin from superficial to deep

Answer 0

Epidermis
Dermis
Hypodermis

Question 1

What are the many purposes of the skin?

Answer 1

Acts as a barrier to the elements/physical agents
Protects against injury
Protects from infections
Acts as a thermo-regulator protecting the body from excessive heat loss or overheating
Reduces penetration of UV radiation
Provides our physical appearance
Prevents dehydration
Synthesizes Vitamin D

Question 2

Describe the epidermis

Answer 2

Physical barrier/protects the skin from the environment
Approximately 0.1 mm thick
It is thickest on the palms of the hands and soles of the feet
It is thinnest on the eyelids
Stratum corneum is the upper layer

Question 3

Describe the dermis

Answer 3

Tough supportive connective tissue located just below the epidermis
It is important for sensation, protection and thermoregulation
It is thinnest on the eyelids and thickest on the back, palms and soles of the feet
It includes blood vessels, lymph vessels, hair follicles and sweat glands

Question 4

How does topical absorption occur?

Answer 4

It occurs through passive diffusion through the stratum corneum. The stratum corneum is a rate limiting barrier (semi-permeable membrane)

Question 5

What are three ways to increase topical absorption?

Answer 5

Increasing the temperature of the skin
Vigorous rubbing/massaging a product into the skin
Occluding the skin (ointment base/airtight dressings)

Question 6

What is a fissure?

Answer 6

A thin linear crack in the skin which is deeper than it is wide - furrow or slit on the skin

Question 7

What is a plaque?

Answer 7

A well-defined raised flat-topped lesion

Question 8

What is a pustule?

Answer 8

A circumscribed raised area which contains pus

Question 9

What are scales?

Answer 9

Flat plates or flakes found on the stratum corneum (a buildup of dead epidermal cells)

Question 10

What is the clinical name for dry skin?

Answer 10

Xeroderma or xerosis

Question 11

What are possible reasons for dry skin?

Answer 11

Inadequate water or oil on the skins surface
Deficiencies in moisture binding substances found naturally in the skin (amino acids, lactate, urea, inorganic salts)
Decreased skin barrier lipids and ceramides
Changes in the skins moisture network

Question 12

What are signs and symptoms of dry skin?

Answer 12

Feeling of skin tightness (after showering, bathing or swimming)
Mild scaling or visible peeling of outer skin layer/increased flaking of the skin
Mild to moderate itching (when left untreated)
Cracks, fine lines in skin, fissures
Skin that looks rough and is rough to touch

Question 13

What areas of the body are most affected by dry skin?

Answer 13

Legs, hand and forearms (1st to be affected)

Trunk and face also affected

Question 14

Describe the signs and symptoms of mild dry skin?

Answer 14

Mild roughness or scaling
Mild or not itching
No pain
Mild or no redness
No fissures

Question 15

Describe the signs and symptoms of moderate dry skin

Answer 15

Rough and moderate scaling
Mild or moderate itching
Some pain (mild)
Mild redness
Fissures possible

Question 16

Describe the signs and symptoms of severe dry skin?

Answer 16

Rough and severe scaling
Severe itching
Severe pain
Moderate redness
Likely to have fissures

Question 17

What are different environmental causes/aggravating factors of dry skin?

Answer 17

Electric heat, air conditioning, wood burning stoves, space heaters, fireplaces - reduces humidity in the air and creates dry air conditions
Dry, cold or low-humidity climates (can be hot climates)
Chronic exposure to sunlight and photoagin

Question 18

What are lifestyle causes/aggravating factors of dry skin

Answer 18

Bathing or showering often/use of hot/swimming in chlorinated pools
Use of harsh soaps and detergents (deodorant and antibacterial soaps are the most damaging)
Long term sun exposure damages the skin and leads to dry skin
Poor hydrating/dehydration/high intake of caffeinated beverages

Question 19

What are medical conditions that cause/aggravating factors of dry skin?

Answer 19

Skin conditions (atopic dermatitis, psoriasis)
HIV, chronic renal failure, hypothyroidism, diabetes, some cancers, radiation therapy, liver disease
Malnutrition

Question 20

What are medications that cause/aggravating factors of dry skin?

Answer 20

Accutane, retinoids, benzoyl peroxide (acne medications), chemotherapy agents, alcohol containing products (gels), diuretics (in high doses)

Question 21

How does age affect dry skin?

Answer 21

Older adults often have dry skin (arms, legs)
Ageing of the skin causes a thinning of the epidermis and decreased ability to retain moisture
Activity of sebaceous gland and sweat glands is decreased

Question 22

When assessing dry skin, what are factors that should be taken into account?

Answer 22

Location (Where on the body? How large is the area?)
Symptoms (Mild, moderate or severe? What symptoms are currently experienced? When are the symptoms better or worse? When did the symptoms start? Any recent changes to lifestyle/medications?)
Past history (Any past history of dry skin/other skin conditions? Any family history of dry skin/eczema?)

Question 23

When assessing dry skin, what types of lifestyle factors should be taken into account?

Answer 23

Personal habits (Baths or showers/length of time? Water temperature? Use of harsh or perfumed soaps? Environment?)
Previous treatments (Tried OTC products, prescription products, no products? Length of treatment if product previously used?)

Question 25

What are red flags/when should you refer someone?

Answer 25

Large areas (>30% of the body) Under 2 years old or over 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) Quality of life affected (sleep affected) Severe itching and/or inflammation present Involvement of flexural areas, neck or bottom of the feet (particularly in diabetics)

Question 26

What are the goals of treatment of dry skin?

Answer 26

Decrease or alleviate the rough, scaly skin Improve or restore skin hydration Repair the barrier function and maintain the integrity of the stratum corneum (repair the skin barrier) Relieve itching related to dry skin Educate the patient on self care management in order to prevent further skin damage

Question 27

Name different types of treatment options

Answer 27

``` Occlusives Humectants Emollients Corticosteroids Bath Oils Soaps Soapless cleansers ```

Question 28

What is the mechanism of action of occlusives? How are they applied?

Answer 28

Physically block transdermal water loss/prevents evaporation Minimize water loss to the external environment by providing an oil layer on the skins surface Apply a small amount as required

Question 29

What are the advantages and disadvantages of occlusives?

Answer 29

Advantages: Provides long lasting protection from external irritants (physically blocks). Protects skin that is scaling or cracking Disadvantages: Messy, cosmetically unacceptable, greasy feeling

Question 30

Name some examples of occlusives

Answer 30

Elta cream (often recommended for diabetic or renal patients - Petrolatum/Mineral oil/paraffin - fragrance free)

Question 31

How do occlusives work?

Answer 31

Forms a barrier on the skin that physically blocks water loss from the skins surface Very effective moisturizer (can relieve surface water loss by almost 99%) Restores the stratum corneum layer and moisturizes thes kin Recommended for dry skin on hands and feet Apply as often as required

Question 32

How do humectants work?

Answer 32

Increases water content of the skin by drawing water from the dermis to the epidermis (attract and hold water) May also enhance water absorption from the environment Urea and lactic acid containing products are often used for dry skin with fissures or when moisturizers have not worked well Recommended when moderate scaling is present or other products have failed Generally applied 2-3 times daily

Question 33

How do emollients work?

Answer 33

Fills the cracks/fissures produced by dry skin by filling the spaces around the cracks Restores skin barrier function Hydrates (decreases dryness) by sealing the moistures into the skin, softens skin, decreases itching and gives the skin a smooth feeling Effects last 2 to 3 hours then reapply Apply as often as needed

Question 34

Describe ointments

Answer 34

Usually 80% oil/20% water Useful for chronic, very dry skin and areas that have fissures (hands and feet) Require less frequent application than creams or lotions Greasy and may be difficult to spread and remove (preferred at night) 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

Question 35

Describe creams

Answer 35

Creams are half oil and half water Can be applied to areas that are moist, weeping, oozing or very dry Well absorbed, easy to spread and can be used during the day Cosmetically more acceptable than ointments Useful for the face as well as all over the body

Question 36

Describe lotions

Answer 36

Contain more water than oil Useful for hairy areas and if immediate absorption is necessary Not effective for very dry skin Easier to spread than ointments Short acting and must be applied more often than creams or ointments

Question 37

Describe gels

Answer 37

Can be drying when used for long periods of time May contain alcohol or propylene glycol which can be drying or irritating to open areas Liquefy on contact with skin and leave a thin layer of active medication Useful for hairy areas Cosmetically acceptable

Question 38

Describe bath products

Answer 38

May make surfaces slippery (increase risk of falls) if applied directly into the bath Apply small amounts after a bath directly onto damp skin (pat dry) Products containing oatmeal are used to relieve itching Occasional use only and only for those where risk of fall is not a factor

Question 39

Describe cleansers/soap substitutes

Answer 39

Use non-foaming cleansers in place of soaps (soaps, shower gels, bubble baths can remove the skin natural layer of oils and dry out the skin) Use a small amount mixed with warm water and apply to damp skin (rinse and pat dry)

Question 40

What should be kept in mind when choosing a product?

Answer 40

Patient preference, patient's age, package size (small, large, pump, tube), cost of product, ingredients (allergies to additives/preservatives, fragrance), effect of product, type of lesion (dry/moist), type of site (hairy area, face, feet)

Question 41

How can patient preference affect choosing a product?

Answer 41

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

Question 42

What are OTC product options available/recommended?

Answer 42

Fragrance free CDA recognized Cleansers: CeraVe Hydrating Cleanser OTC products: CeraVe Cream/Lotion/Facial, Eucrerin Complete Repair Lotions, Marcelle Products

Question 43

What are non-pharmacological treatment options?

Answer 43

Re-hydrate with moisturizers/bath oils (after bath) Short baths or showers (less than 10 minutes) Warm water not hot water (washes away oils and releases histamine) Pat body dry, don't rub Mild cleansers/shower gels (non-perfumed and mild products) Keep humidity of the environment higher during winter months/extreme dry heat Cover face and hands to protect them from cold, dry air Avoid products that contain perfumes or fragrances (detergents, fabric softeners) Trim nails

Question 44

What should be monitored (monitoring parameters)?

Answer 44

Rough scaly skin (daily for signs of improvement) Signs of infection (daily) Itching (daily for 7-10 days after starting treatment) Dry, flaky skin (daily)