Makindo Medical Notes

📖 About

• Very common in the elderly, especially those in nursing or residential homes 🏡.
• Represents loss of normal skin barrier function, often recurrent and chronic.

🧬 Aetiology

• 🌬️ Environmental factors: dry air, central heating, low humidity (winter, deserts, high altitude, travel, dehumidifiers, fan heaters).
• 🧼 Excessive washing with soaps and detergents that strip lipids from the stratum corneum.
• 👵 Ageing skin → reduced sebaceous and sweat gland activity, thinner epidermis.
• Comorbidities such as hypothyroidism, malnutrition, or chronic renal disease may worsen xerosis.

🩺 Clinical Features

• Dry, cracked, and flaky skin – especially over shins, arms, and trunk.
• “Craquelé skin” – resembles cracked porcelain or dried riverbeds.
• May progress to xerotic eczema with erythema, pruritus, and excoriations.
• Secondary complications: cellulitis 🦠 due to skin barrier breakdown.

🔍 Differentials

• Atopic dermatitis (eczema).
• Contact dermatitis (allergic/irritant).
• Psoriasis (plaques with silvery scale).
• Ichthyosis vulgaris (hereditary, lifelong scaling).
• Hypothyroidism-associated dry skin.

🧪 Investigations

• Usually a clinical diagnosis.
• Consider TFTs if features suggest hypothyroidism 🦋 (fatigue, weight gain, bradycardia).
• Assess for diabetes or renal disease if recurrent/severe.

💊 Management

• 🛁 Reduce bathing frequency; avoid hot baths/showers and harsh soaps.
• 🌡️ Increase humidity at home (humidifiers, avoiding overheated rooms).
• 💧 Regular application of emollients (e.g. E45, aqueous cream, urea-based creams for severe cases).
• Switch to soap substitutes or gentle cleansers.
• Topical corticosteroids only if eczematous changes are present.
• Monitor for recurrence and secondary infection (cellulitis).

📚 References

• British Association of Dermatologists – Dry Skin (Xerosis) guidance.
• Rook’s Textbook of Dermatology.
• DermNet NZ – Xerosis (Dry Skin)