What is the first line treatment for xerosis (dry skin)?

First-Line Treatment for Xerosis (Dry Skin)

Hypoallergenic moisturizing creams, ointments, and emollients should be used once daily to smooth the skin and to prevent and alleviate skin dryness as the first-line treatment for xerosis. 1

Understanding Xerosis

Xerosis cutis (dry skin) is a common dermatological condition characterized by:

• Dry, rough skin
• Scaling
• Potential fissures or cracks
• Pruritus (itching)
• Erythema in some cases

Treatment Algorithm for Xerosis

Step 1: Basic Moisturization

• Apply moisturizers immediately after bathing while skin is still damp
• Choose formulation based on severity:
  • Mild xerosis: Lotions or creams (oil-in-water)
  • Moderate xerosis: Creams (water-in-oil)
  • Severe xerosis: Ointments (highest lipid content)

Step 2: Targeted Ingredient Selection Based on Symptoms

1. For basic xerosis:

   • Hypoallergenic moisturizing creams with urea or glycerin 1, 2

2. For scaling:

   • Products containing urea (5-10%) 3, 2

3. For fissures/cracks:

   • Urea or dexpanthenol-containing products 1, 2

4. For erythema:

   • Products with anti-inflammatory ingredients like licochalcone A 1

5. For pruritus (itching):

   • Moisturizers containing polidocanol 1
   • Consider menthol 0.5% for temporary relief 1

Application Guidelines

• Apply moisturizers at least once daily, preferably twice 1, 4
• Best applied immediately after bathing when skin is slightly damp
• Focus on affected areas, but can be applied to entire body
• Gently pat skin dry after bathing rather than rubbing 1

Additional Recommendations

Personal Hygiene

• Use gentle, pH-neutral soaps and shampoos with tepid water 1
• Avoid hot water for bathing or showering
• Pat skin dry with clean, smooth towels rather than rubbing 1
• Wear fine cotton clothes instead of synthetic materials 1

Treatments to Avoid

• Greasy creams (may worsen condition by occluding follicles) 1
• Alcohol-containing lotions or gels 1
• Excessive use of soaps 1
• Hot showers or baths

Special Considerations

• For elderly patients, more intensive moisturization may be required as skin naturally becomes drier with age 4, 5
• Patients with atopic dermatitis and xerosis may benefit from emollients that combine humectants (e.g., glycerol) with occlusives (e.g., petrolatum) 6
• Regular, consistent application is crucial to prevent relapse of xerosis 4, 6

Monitoring and Follow-up

• Assess improvement in skin hydration after 2 weeks of consistent treatment
• If no improvement or worsening occurs, consider:
  1. Increasing frequency of application
  2. Switching to higher lipid content formulation
  3. Adding products with specific active ingredients based on symptoms

The evidence strongly supports that consistent application of appropriate moisturizers is highly effective in treating xerosis, with urea-containing products showing particularly strong evidence for efficacy 2.