VisualDx - Diagnosis Details - Immunocompromised, HIV or AIDS: Xerosis

706.8 – Xerosis

Xerosis, also called dry skin, refers to a condition of rough, dry skin texture with fine scale and, occasionally, fine fissuring. It is often pruritic. The pathogenesis involves a decrease in the amount of lipids in the stratum corneum and a deficiency in the water-binding capacity of this layer.

Xerosis is associated with a number of environmental factors and/or disease states, such as low humidity, frequent bathing, harsh soaps, ichthyoses, atopic dermatitis, hypothyroidism, Down syndrome, renal failure, malnutrition and malabsorptive states, HIV, lymphoma, liver disease, Sjögren's syndrome, carcinomatosis, and certain drugs.

The incidence of xerosis increases with age; nearly all individuals over the age of 60 have some degree of xerosis.

Look For

Dry, dull, rough skin with fine bran-like scales that flake off easily. In more advanced stages, the stratum corneum may begin to exhibit a polygonal pattern of superficial cracks and fissures with erythema.

Asteatosis is most prominent on the lower extremities, trunk, and dorsal hands, usually sparing the head, neck, palms, and soles.

Diagnostic Pearls

Inquire about bathing habits (frequency, type of soap used, water temperature). Hot water, frequent or prolonged bathing, and the use of soaps worsen asteatosis.

Differential Diagnosis & Pitfalls

Stasis dermatitis
Atopic dermatitis
Nummular dermatitis
Allergic contact dermatitis
Scabies
Ichthyosis vulgaris
Seborrheic dermatitis
Tinea corporis
CTCL (mycosis fungoides)

Best Tests

This is usually a clinical diagnosis. Further testing may reveal a systemic cause:

Thyroid function
Renal function
Liver function

Test for HIV, malabsorption, cancer, or Sjögren's syndrome if clinical suspicion warrants.

Management Pearls

Encourage bathing in tepid water and gently patting rather than vigorously rubbing the skin dry.

Therapy

Treat any underlying conditions, if possible.

Patients should be instructed to avoid too frequent baths or showers. Mild soap substitutes (Dove®, Tone®, Purpose®, or Cetaphil® cleanser) should be used.

Encourage liberal use of emollients and humectants (especially after bathing). Ointments such as petroleum jelly or Aquaphor® work well. Eucerin®, Cetaphil creams, and Vanicream™ are also excellent moisturizing agents.

References

Proksch E. The role of emollients in the management of diseases with chronic dry skin. Skin Pharmacol Physiol. 2008;21(2):75-80. PubMed Id: 18187966

Ghali FE. Improved clinical outcomes with moisturization in dermatologic disease. Cutis. 2005 Dec;76(6 Suppl):13-8. PubMed Id: 16869177

Wilson D, Nix D. Evaluation of a once-daily moisturizer used to treat xerosis in long-term care patients. Ostomy Wound Manage. 2005 Nov;51(11):52-60. PubMed Id: 16319447

Lodén M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol. 2003;4(11):771-88. PubMed Id: 14572299

Norman RA. Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther. 2003;16(3):254-9. PubMed Id: 14510882

Kumar B, Saraswat A, Kaur I. Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients. Clin Exp Dermatol. 2002 Jan;27(1):8-13. PubMed Id: 11952660

Keenan WF. Comparative efficacy of two different formulations on xerosis. J Am Acad Dermatol. 1990 Oct;23(4 Pt 1):769-70. PubMed Id: 2229516

Wehr RF, Krochmal L. Considerations in selecting a moisturizer. Cutis. 1987 Jun;39(6):512-5. PubMed Id: 3608578

Associated Findings

Body Location
Dorsum of Hand
Fingers
Forearm
Lower Leg

Distribution
Widespread

Medications
Cimetidine
Clofazimine
Cytarabine
Hydroxyurea
Indinavir
Lithium

Signs and Symptoms
No Fever (Afebrile, Apyrexial)

Temporal
Developed Acutely Over Days to Weeks
Developed Steadily Over Weeks to Months
Eruption 6 to 30 Days After Drug

Medical History
Down's Syndrome