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Winter Skin: Treating Xerosis

Winter Skin: Treating Xerosis

Humectant-rich emollient containing high amounts of urea, a component of skin’s natural moisturizing system, relieves xerosis by removing scales, increasing skin hydration and reducing abnormal skin thickness, according to a recent study1 published in Skin Research and Technology.

In the randomized, bilateral, controlled and evaluator-blind study, the researchers set out to generate data on a new humectant-rich formulation (15% alphahydroxy acids and 15% urea) in the treatment of normal skin as well as in dry feet with hyperkeratosis and cracked skin with fissures. Changes in permeability and effectiveness of the product after once- and twice-daily applications to the feet were monitored. 

The first part of the study included 12 healthy volunteers and the second part 50 patients with hyperkeratotic feet. Researchers evaluated skin changes using non-invasive biophysical measurements of skin barrier function (transepidermal water loss [TEWL]), erythema, thickness (ultrasound) and hydration (conductance). The humectant-rich formulation increased skin hydration, removed scales and reduced thickness of hyperkeratotic skin. Skin barrier function was improved in normal skin, but no changes in TEWL were noted in the feet. No difference between once and twice-daily applications was found. Stinging was noted by some patients.

Researchers concluded that the humectant-rich formulation efficiently relieved the xerosis on the feet without inducing any weakening of the skin barrier function. 

“Study results showed that even normal skin became more resistant to external insults such as low humidity and was able to more efficiently hold moisture after use of the new cream,” says Joshua Fox, MD, founder and medical director at Advanced Dermatology PC, in Roslyn Heights NY, commenting on the study. 

Another xerosis study2 published in 2012, demonstrated positive results with topical formulation containing glyceryl glucoside, natural moisturizing factors and ceramide, and concluded the formulations represented a new approach for the treatment of xerosis by addressing multiple key deficiencies in skin hydration.

The study assessed the effects a light formulation, an oil-in-water emulsion, and rich formulation, a water-in-oil emulsion, for the treatment of xerosis with 2 double-blind, vehicle-controlled trials (both formulations); a double-blind, randomized regression study (rich formulation); and a single-blind tolerability study (light formulation). A total of 169 subjects were enrolled and 154 completed the studies. The majority of patients were between 50 and 80 years of age with very dry skin. The 2 formulations were applied twice daily for 2 weeks, for 5 days in the regression study, and twice daily for 2 weeks in the tolerability study. 

Vehicle-controlled studies of light and rich formulations demonstrated significantly improved hydration at Weeks 1 and 2 versus the untreated site and vehicles, and significantly reduced transepidermal water loss versus untreated site and basic vehicle. Both products significantly decreased visible dryness and tactile roughness. In the regression study, Rich formulation maintained significant moisturization 6 days after treatment discontinuation. Light formulation reduced symptoms of itching, burning, tightness, tingling and feeling of dryness. 

Prevalence and Treatment

While people of all ages can develop dry skin, a 2011 study3 in Dermatology found that xerosis is highly prevalent in the elderly, with more than half of those age 65 or older coping with the condition. A history of atopy, especially atopic dermatitis, is associated with an increased risk of xerosis in the elderly. 

Xerosis is multifactorial. Other triggers include over-cleansing the skin, bathing too frequently or with excessively hot water, living in areas with cold, dry winters or low humidity, heating the home or workplace with central heating systems, and over-exposing skin to the sun. 

While dry skin cannot always be prevented, encouraging patients to modify their daily routine can help treat existing symptoms. Dr. Fox recommends “commonsense measures” to patients, such as using oil-based and humectant-rich moisturizers frequently, especially after bathing; and selecting products containing high amounts of urea and alpha-hydroxy acids. He also instructs patients to avoid bathing or showering in very hot water or for long periods or excessively; use gentle soaps and cleansers without added dyes, fragrances or alcohol; avoid utilizing washcloths or loufas and pat the skin dry gently (no rubbing) after bathing. 

Finally he reminds patients to stay hydrated by drinking water, avoid scratching affected areas and use a home humidifier to increase the moisture level in the air.   Even though it might be cold outside, he also reminds patients to continue to use a sunscreen on all exposed skin when heading outdoors.

These tips can help most patients get quick relief or prevent the problem from worsening. If problems persist, the patient will be instructed to return to be checked for an infection or another skin condition unrelated to xerosis like psoriasis, eczema or atopic dermatitis.

  

References

1. Lodén M, von Scheele J, Michelson S. The influence of a humectant-rich mixture on normalz skin barrier function and on once- and twice-daily treatment of foot xerosis. A prospective, randomized, evaluator–blind, bilateral and untreated-control study. Skin and Tech. 2013; 19(4):438–445.

2. Weber TM, Kausch M, Rippke F, Schoelermann AM, Filbry AW.  Treatment of xerosis with a topical formulation containing glyceryl glucoside, natural moisturizing factors, and ceramide. J Clin Aesthet Dermatol. 2012;5(8):29-39.

3. Paul C, Maumus-Robert S, Mazereeuw-Hautier J, Guyen CN, Saudez X, Schmitt AM. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology. 2011;223(3):260-265. 

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