Understanding and Treating Dry Skin: Causes and Symptoms

Understand the causes and symptoms of dry to very dry skin and discover how to restore moisture for healthy skin.

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Summary

Definition and symptomatology of dry skin

Dry skin, or cutaneous xerosis, is a common condition characterised by a lack of lipids (fats) in the outermost layer of the skin, the epidermis¹ ² ³ ⁴.

Recognising dry skin: signs and symptoms¹ ² 

  • Subjective symptoms of dry skin
    Subjective symptoms include : 
    - Sensation of tightness: Often felt after showering, bathing or swimming, reflecting a lack of skin hydration.
    - Itchy skin (or pruritus): Scratching or rubbing to relieve this itching can lead to excoriations.
    - Pain: Particularly in the case of cracks.
  • Clinical signs
    These skin symptoms are visible on physical examination of the skin:
    - Rough, uneven texture.
    - Scaling and cracking: Scaling (commonly known as "peeling skin") can intensify with prolonged dryness, leading to cracks and fissures. Deep cracks can affect weight-bearing areas, such as the heels, with thickened areas (calluses) around the edges.
    - Reticulated or cracked surface.
    - Redness and inflammation (erythema): The skin becomes irritated or inflamed sometimes. 
     

Difference between dry and very dry skin.¹

The distinction between dry and very dry skin is based on the severity of skin symptoms. However, rather than using the terms "dry skin" and "very dry skin", doctors classify skin dryness as mild, moderate or severe:

  • Mild dryness: This condition involves superficial roughness and minor scaling. Individuals may experience little to no skin itching and generally feel no pain. It may be accompanied by minimal or no erythema and does not involve cracks. 
  • Moderate dryness: The skin becomes rougher with clearly visible desquamation. Symptoms include mild to moderate itching, pain, and discrete erythema. Cracks may begin to appear but remain shallow. 
  • Severe dryness: This is characterised by extreme roughness and intense desquamation. Individuals suffer from severe skin itching and significant pain. At this stage, cracks are more frequent and can vary in depth and severity. Managing severe dryness may require medical consultation for specific treatments, including intensive skin hydration with highly occlusive and reparative products, to effectively relieve symptoms and repair the skin barrier.

Is dry skin a sign of illness?¹ ² 

Although dry skin is often the result of environmental factors or inappropriate care, it can sometimes be a sign of an underlying disease
Dermatological conditions that cause dry skin include atopic dermatitis, psoriasis and cutaneous ichthyosis.
Other general pathologies (hypothyroidism, severe renal failure, HIV, some cancers, neuropathies, etc.) can also be accompanied by skin dryness.
Finally, diuretics, retinoids, anti-androgens, and radiotherapy can cause skin dryness.

If other symptoms accompany dry skin, persist despite appropriate moisturising treatments, or worsen, it is advisable to consult a dermatologist to assess the possible presence of a dermatological or systemic disease requiring specific treatment.

What causes dry skin?

Biological Mechanisms of Cutaneous Dryness² ³

Biological Mechanisms of Cutaneous Dryness² ³

Dry skin results from a complex water imbalance in the outermost layer of the skin, known as the stratum corneum (SC). This layer can be compared to a brick wall, where the skin cells, called corneocytes, represent the bricks and are surrounded by a lipid 'cement', acting like a mortar.

Corneocytes are rich in keratin, a protein that helps keep the skin hydrated and supple. Around these "bricks", lipid "cement" is essential for : 

  • maintaining hydration by preventing water from evaporating.
  • the cohesion of corneocytes.
  • the skin renewal process (keratinisation).

The skin's hydration mechanism is based on two aspects:

  • ‘Static’ water binds to the natural moisturising factors (NMF) in the corneocytes. NMFs attract and retain water molecules, ensuring the hydration of the stratum corneum.
  • ‘Dynamic’ or transepidermal water passes through the different layers of the skin from the dermis to the surface. 

When the skin barrier is altered, such as by a reduction in lipid production or an anomaly in the keratinisation process, the skin loses its ability to retain water, leading to dryness. 

Causes of dry skin¹ ².

On one hand, the skin's structure prevents water loss and, on the other, protects the skin against allergens and irritants. However, various factors, particularly environmental, can weaken this protective skin barrier:

  • Age and skin ageing: Dry skin is common in older people due to the reduced activity of the sebaceous and sweat glands.
  • Climate: The skin is generally drier in winter and during hot weather, as these conditions reduce humidity and dry out the skin.
  • Heating and air conditioning: Heating systems and air conditioning reduce the humidity in the air, contributing to skin dryness.
  • Bathing, showering and swimming: Frequent showering or bathing, especially in hot water and for long periods, can alter the skin's lipid barrier. Swimming, particularly in chlorinated pools, has a similar effect.
  • Soaps and detergents: Many cleansing products, particularly antibacterial products and high-foaming liquid soaps, remove lipids and, consequently, water from the skin.
  • Exposure to the sun: The sun and heat dry the skin. The damage caused by ultraviolet (UV) rays penetrates the epidermis and breaks down the collagen and elastin in the dermis.
  • Tight clothing and compression therapy: These can increase the risk of skin dryness and aggravate existing dryness through friction.

Care and treatment for dry skin

The main aims of treating dry skin are restoring physiological lipids to the epidermis, improving skin hydration, optimising the skin's barrier function, and encouraging epidermal differentiation.

Prevention of dryness and moisturising skin care.² ⁴

Preventive measures include using gentle cleansers and adopting skin care practices that do not compromise the skin's lipid barrier:
Baths and showers: Limit the frequency and duration (around 5 minutes) of baths and showers and use lukewarm water. Avoid hot water and aggressive washing to preserve the skin's lipid barrier.

Gentle cleansers: Choose gentle, non-alkaline cleansers with a pH close to the skin's. Syndets (dermatological or soap-free soaps) are less irritating and can help reduce skin itching thanks to their lower pH.

Moisturisers: Apply nourishing oil-based creams regularly, as they are more effective at hydrating the skin than water-based lotions. Ointments, which are oilier, are particularly useful for preventing dryness. For best results, apply to damp skin after bathing.

Clothing: Avoid clothing that is too tight, rubbing and irritating textiles such as wool and synthetics.

Humidifiers: Use humidifiers in your home, especially in winter, to help retain skin moisture.

Internal hydration: Maintain good hydration by drinking at least 1.5 to 2 litres of water a day.

Local care and treatment of dry skin

Care products for dry skin aim to improve skin hydration, compensate for the lack of lipids and reinforce the skin's barrier function. A combination of hydrophilic (water-retaining) and lipophilic (lipid-retaining) ingredients is preferable to mimic and restore the components of the skin barrier :

  • Hydrophilic components: These ingredients, such as glycerol and urea, are crucial for attracting and retaining water in the stratum corneum. Their low molecular weight allows them to penetrate the skin effectively, acting as natural moisturising factors (NMFs) or humectants, reducing trans-epidermal water loss and improving skin hydration.
  • Lipophilic ingredients: Due to their high molecular weight, these ingredients (vaseline, silicones) form a protective layer on the skin's surface without penetrating it, helping to reduce trans-epidermal water loss. They also participate in the renewal of the lipid matrix between cells (ceramide, vegetable oils), which is essential to the skin's barrier function.

Solid paraffin or Vaseline is recognised as the most effective lipophilic ingredient. It acts as an occlusive, forming an oily barrier that prevents water from evaporating, preserving the skin's moisture content while facilitating the repair of the skin barrier.²

In the event of redness or pruritus, skin-soothing or antipruritic ingredients can be added to the formulations.

Recommended treatments for very dry skin² ⁴

For very dry skin, lipid-rich formulas such as nourishing creams, balms or ointments are recommended to prevent dryness and maximise skin hydration.

In the case of moderate to severe dryness, a medical consultation with a dermatologist may be necessary to:
diagnose any underlying skin disease, such as eczema, establish a personalised care strategy and prescribe specific treatments. 
 

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DEXERYL Emollient Cream: The Essential Ally for Dry and Very Dry Skin

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• Vaseline and paraffin form a protective film on the skin. 
• Glycerol hydrates the epidermis by attracting water molecules.

Choose DEXERYL Emollient Cream, your daily ally for keeping skin healthy, supple and hydrated.
 

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References    

1. Andriessen A. Prevention, recognition, and treatment of dry skin conditions. Br J Nurs. 2013 Jan 10-23;22(1):26-30.

2. Gade A, Matin T, Rubenstein R. Xeroderma. 2023 Oct 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.

3. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007 Sep ;21 Suppl. 2 :1-4.

4. Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Diagnosis and treatment of xerosis cutis - a position paper. J Dtsch Dermatol Ges. 2019 Nov ;17 Suppl. 7:3-33.

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