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Do you know well atopic dermatitis ?
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Discover the causes, treatments and prevention tips for combating dry skin and restoring moisturised skin.
Summary
Dry skin, or xerosis cutis, is a condition in which the skin lacks essential hydrolipidic components, manifesting by a reduction in the quantity and/or quality of lipids and hydrophilic substances, including the natural moisturising factor (NMF).
It is more common with age, present in almost 56% of people with an average age of 75¹. It affects both men and women and can seriously alter the quality of life, especially when dry skin causes itching.
Objective signs of cutaneous dryness include dry, flaky, rough, dull, and sometimes greyish skin with reduced elasticity, a coarse-textured appearance, and wrinkles. Redness and cracks may also appear. Subjective signs of dryness include tightness, itching, and, in some cases, pain or burning sensations.
Although skin dryness can affect any part of the body, it usually involves areas with fewer sebaceous glands (glands located under the skin at the base of the hair, which help to hydrate the skin by secreting sebum) such as the legs, forearms, hands and feet.
Dry skin is a complex symptom influenced by many factors, including individual constitutional factors, environmental factors, and sometimes underlying dermatological conditions.
External causes of dry skin include the following:
Xerosis can also be a symptom of a variety of underlying dermatological and systemic diseases. Conditions such as eczema, psoriasis and ichthyosis have dry skin as their main feature. In addition, systemic diseases such as chronic kidney disease, diabetes, hypothyroidism or specific hormonal imbalances can manifest with dry or very dry skin.
Certain medications can induce or exacerbate dry skin, including retinoids, long-term topical corticosteroids, diuretics, and radiotherapy.
The integrity of the skin barrier is crucial for protection against pathogens, irritants and allergens. Damage to this barrier increases the skin's vulnerability to harmful environmental factors and can facilitate the onset of dermatological diseases. In addition, very dry and damaged skin is more likely to develop skin infections and ulcers, particularly for older individuals. Dry skin also increases the risk of contact dermatitis, underlining the importance of early diagnosis and treatment to restore the skin's barrier function and prevent possible complications.
Adopting the proper skincare routine is essential to prevent skin dryness, especially when humidity levels fall. Here are some dermatological recommendations for keeping your skin healthy and preventing it from drying out.
To minimise the negative impact of baths and showers on dry skin:
Applying a moisturiser just after washing is essential. Moisturising creams, ointments and lotions help lock in existing moisture in the skin.
Choose moisturisers and gentle skincare products that contain no irritants or allergens. Avoid those containing alcohol, alpha hydroxy acids (AHAs), perfumes or retinoids, which can remove the skin's natural lipids.
Internal hydration is essential to skin health, supporting its elasticity and biological functions. Consuming enough water daily (1.5 to 2 litres, more in hot weather or during intense physical effort) prevents dehydration and maintains the skin's internal moisture.
Topical treatment of dry skin is based on optimal hydration. Applying hydrophilic ingredients, such as glycerol or urea, is crucial. Because of their low molecular weight, these substances penetrate the stratum corneum, acting as natural moisturising factors (NMFs) or humectants, capturing and retaining water in the skin to compensate for the lack of hydration.
Lipids are essential for maintaining the skin's barrier function, preventing transepidermal water loss and improving skin hydration. Lipophilic ingredients, such as oils, fats or waxes, do not penetrate the skin due to their high molecular weight but form a protective layer on its surface. Physiological lipids such as ceramides, cholesterol and free fatty acids can restore the intercellular lipid matrix, reinforcing the skin's barrier function.
• Choice of formulation
To effectively choose a moisturising product, it's crucial to understand the composition of topical bases. There are four main categories: hydrophilic lotions (oil-in-water), lipophilic lotions (water-in-oil), hydrophilic creams and lipophilic creams. Selection should be based on the skin condition and dryness stage.
Lipid-rich moisturising products and creams are preferable for very dry skin because they reduce trans-epidermal water loss and improve hydration.
It is also essential to select products containing hydrophilic and lipophilic components capable of mimicking or restoring the skin's barrier function. Studies show that the combined use of humectants such as glycerol and lipophilic components such as vaseline significantly improves skin barrier function and hydration compared to using bases alone.
Adequate hydration and replenishment of skin lipids can also have antipruritic effects. Topical antipruritic ingredients such as polidocanol can be added to the treatment if necessary. A thorough diagnostic evaluation by a doctor is required for persistent or generalised pruritus.
If an erythema develops, it is essential to consult a doctor to determine the cause. Treatment can include soothing ingredients such as licochalcone A, adequate rehydration, and lipid replenishment.
The stratum corneum is continually renewed and undergoes a natural and generally invisible desquamation process. The desquamation becomes visible when the corneocytes are eliminated in large groups. This can occur in the case of NMF deficiency (as in atopic dermatitis) or disruption of intercellular lipids. To treat desquamation, urea is recommended regardless of clinical severity. However, due to its irritant effect, it should not be used on open lesions or for children under two years of age.
Cracks, which are often painful and can lead to infection, typically develop in areas with few or no sebaceous glands, such as the soles of the feet. To prevent them, topical preparations containing urea are recommended.
Although potentially beneficial, natural remedies should be used in conjunction with a suitable skincare regime and, in the case of skin diseases, should not replace topical treatments prescribed by healthcare professionals during a medical consultation.³ ⁴ ⁵
Vegetable oils could be natural remedies and have a place in the topical treatment of skin xerosis, but their clinical importance remains little studied. It is essential to choose them wisely according to their omega-6 fatty acid composition and extraction method, giving preference to cold-pressed oils rich in linoleic acid.
Although olive oil is traditionally valued in daily skin care, it is rich in oleic acid, a monounsaturated fatty acid that can compromise the skin barrier and increase water loss. In contrast, almond, soya, avocado and coconut oils create an occlusive protective film that reduces trans-epidermal water loss like paraffin oil.
Combining oils with humectants is more effective than using them alone. Integrating them with other moisturising treatments could offer an additional approach to maintaining skin hydration and reinforcing the skin barrier. Undesirable effects such as burning, erythema, or allergic reactions are possible. Essential oils should be avoided as they may induce allergic contact dermatitis.
Aloe vera has a moisturising action via a humectant effect due to its polysaccharides and amino acids, which attract and retain water in the epidermis. Studies show that using aloe vera extracts significantly increases skin hydration without adversely affecting the skin barrier, thanks to a humectant rather than occlusive effect.
Although aloe vera alone may not be sufficient for the topical treatment of severe cases of skin xerosis, its use as part of a broader therapeutic approach may be interesting.
Traditionally recognised for its beneficial properties, honey is an effective natural moisturiser thanks to its ability to attract and retain moisture in the skin. Its moisturising action is mainly due to its high content of sugars, such as fructose and glucose, which help keep water in the stratum corneum. In addition, amino acids and organic acids contribute to the natural moisturising factors, reinforcing its humectant effect. Nevertheless, it should be considered a complement to standard daily dermatological care rather than a stand-alone treatment.
Dexeryl emollient cream is your ally against skin dryness. Its unique composition is devoid of irritating products, such as perfumes or parabens, and rich in hydrophilic and lipophilic active ingredients:
- Glycerol draws moisture to the epidermis for immediate and lasting relief from skin xerosis.
- Vaseline and paraffin form a film on the skin's surface, protecting it from external aggression and moisture loss.
Dexeryl is your daily skincare product for supple, hydrated and protected skin.
References
1. 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.
2. AAD. Dermatologists’ top tips for relieving dry skin. American Academy of Dermatology Association. 2024 [Internet]. Disponible sur: https://www.aad.org/public/everyday-care/skin-care-basics/dry/dermatologists-tips-relieve-dry-skin
3. Vaughn AR, Clark AK, Sivamani RK, Shi VY. Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science. Am J Clin Dermatol. 2018 Feb;19(1):103-117.
4. Dal'Belo SE, Gaspar LR, Maia Campos PM. Moisturizing effect of cosmetic formulations containing Aloe vera extract in different concentrations assessed by skin bioengineering techniques. Skin Res Technol. 2006 Nov;12(4):241-6.
5. Burlando B, Cornara L. Honey in dermatology and skin care: a review. J Cosmet Dermatol. 2013 Dec ;12(4):306-13.