What is the treatment for xerosis?

Treatment for Xerosis

The first-line treatment for xerosis is the regular application of emollients, specifically urea- or glycerin-based moisturizers, combined with proper bathing practices to avoid further skin dryness. 1

Understanding Xerosis

Xerosis (dry skin) is characterized by:

• Dry, cracked, and fissured skin
• Pruritus (itching)
• Scaling and desquamation
• Possible erythema in severe cases

Treatment Algorithm

First-Line Treatment: Skin Hydration and Barrier Repair

1. Bathing Practices

   • Daily lukewarm baths (30 minutes or more) 1
   • Avoid hot water which further dries the skin
   • Use mild soaps or soap-free cleansing bases 1
   • Avoid excessive use of soaps 1
   • Gently remove scales during bathing (with soft sponges or microfiber cloths) 1

2. Immediate Post-Bath Moisturization

   • Apply emollients immediately after bathing while skin is still damp (within 3 minutes) 1
   • This "soak and seal" method maximizes moisture retention

3. Emollient Selection Based on Severity

   • Mild xerosis: Lotions or light creams
   • Moderate xerosis: Creams or light ointments
   • Severe xerosis: Ointments (higher lipid content) 2

4. Recommended Emollient Ingredients

   • Urea-containing products (5-10%): Particularly effective for scaling 1
   • Glycerin-based moisturizers: Effective humectants 1
   • Products with ceramides: Help restore skin barrier function 2
   • For fissures/rhagades: Products containing urea or dexpanthenol 2
   • For pruritus: Consider products with polidocanol 2

5. Application Frequency

   • Apply emollients at least twice daily 1
   • More frequent application (3-4 times daily) for severe xerosis

For Persistent or Severe Xerosis

1. Topical Steroids for Inflammatory Component

   • Short-term use of mild to moderate potency topical steroids for inflamed areas 1
   • Class V/VI topical corticosteroid (such as hydrocortisone 2.5%) for facial application 3
   • Avoid long-term use to prevent skin atrophy

2. For Significant Pruritus

   • Non-sedating oral antihistamines (cetirizine or loratadine 10mg daily) 3
   • For nighttime pruritus: Consider hydroxyzine 10-25mg at bedtime 3
   • For severe pruritus: Consider gabapentin 100-300mg three times daily 3

Special Considerations

Elderly Patients

• Higher prevalence of xerosis due to age-related skin changes 4
• May require more frequent application of emollients
• Avoid products with potential sensitizers like lanolin, aloe vera, and parabens 4

Environmental Modifications

• Increase ambient humidity (30-60%) 4
• Avoid excessive heating or air conditioning which can dry the skin 4
• Wear smooth cotton clothing rather than wool or synthetic fabrics 1

Treatment Pitfalls to Avoid

1. Avoid greasy creams for facial xerosis as they may cause folliculitis due to occlusive properties 1

2. Avoid topical acne medications on xerotic skin as they may worsen dryness 1

3. Avoid alcohol-containing lotions or gels which can further dry the skin 1

4. Avoid hot showers/baths which strip natural oils from the skin 2

5. Avoid scratching which can lead to excoriations and secondary infections 4

Expected Outcomes

With proper treatment, most patients experience significant improvement in xerosis symptoms within 1-2 weeks. Regular emollient use not only treats existing xerosis but helps prevent recurrence, improving overall skin health and quality of life 5.