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Dry Skin

What is dry skin?

Dry skin refers to skin that feels dry to touch. This occurs when the skin is lacking moisture in the outer horny cell layer (stratum corneum) and this results in cracks in the skin surface.

Dry skin is also called xerosis, xeroderma or asteatosis (lack of fat).

Who gets dry skin?

What causes dry skin?

Both males and females of all ages can be affected. There is some racial variability in water and lipid content of the skin.

  • Dry skin that starts in early childhood may be one of about 20 types of ichthyosis (fish-scale skin). There is often a family history of dry skin.
  • Dryness is commonly seen in people with atopic dermatitis. 
  • Nearly everyone > 60 years has dry skin.

Dry skin that begins later may be seen in people with certain diseases and conditions, such as:

  • Postmenopausal females
  • Hypothyroidism
  • Chronic renal disease
  • Malnutrition and weight loss
  • Subclinical dermatitis 
  • Treatment with certain drugs such as oral retinoids, diuretics and epidermal growth factor receptor inhibitors. 

People exposed to a dry environment may experience dry skin, for example:

  • Low humidity: in desert climates or cool, windy conditions
  • Excessive air conditioning
  • Direct heat from a fire or fan heater
  • Excessive bathing
  • Contact with soap, laundry detergents and solvents
  • Inappropriate topical agents such as alcohol
  • Frictional irritation from rough clothing or abrasives.

Dry skin is due to abnormalities in the integrity of the barrier function of the stratum corneum, which is made up of corneocytes.

  • There is an overall reduction in the lipids in the stratum corneum.
  • The ratio of ceramides, cholesterol and free fatty acids may be normal or altered.
  • There may be a reduction in the proliferation of keratinocytes.
  • Keratinocyte subtypes change in affected skin with a decrease in keratins K1, K10 and increase in K5, K14.
  • Involucrin (a protein) may be expressed early, increasing cell stiffness.
  • The result is the retention of corneocytes and reduced water-holding capacity.

The inherited forms of ichthyosis are due to loss of function mutations in various genes (listed in parentheses below):

  • Ichthyosis vulgaris (FLG)
  • Recessive X-linked ichthyosis (STS)
  • Autosomal recessive congenital ichthyosis (ABCA12, TGM1, ALOXE3)
  • Keratinopathic ichthyoses (KRT1, KRT10, KRT2).

Acquired ichthyosis may be due to:

  • Metabolic factors: thyroid deficiency
  • Illness: lymphoma, internal malignancy, sarcoidosis, HIV infection
  • Drugs: nicotinic acid, kava, protein kinase inhibitors (eg EGFR inhibitors), hydroxyurea.