Xerosis
Also known as: Dry Skin, Xerosis Cutis, Asteatosis
Description
Xerosis is pathologically dry skin resulting from impaired barrier function and reduced water-holding capacity of the stratum corneum. It is extremely common, affecting virtually all ages, and is a precursor to or comorbidity of many dermatological conditions including atopic dermatitis, ichthyosis, and asteatotic eczema.
Symptoms
- Rough, scaly skin texture
- Tightness and discomfort
- Fine cracks and fissures
- Pruritus (especially in elderly — senile pruritus)
- Dull, ashy appearance
- Asteatotic eczema (eczéma craquelé) in severe cases
Causes & Triggers
- Low humidity and cold weather
- Excessive bathing with hot water and harsh soaps
- Ageing (reduced sebaceous and sweat gland function)
- Underlying skin diseases (atopic dermatitis, psoriasis)
- Systemic conditions (hypothyroidism, diabetes, renal disease)
- Medications (retinoids, diuretics, statins)
Severity Classification
Treatment Ladder
- 1 Foundational: Switch to gentle syndets, reduce bath temperature and frequency
- 2 Mild–Moderate: Emollient therapy — apply within 3 min of bathing ("soak and seal")
- 3 Moderate: Emollients with humectants (hyaluronic acid, glycerin, urea)
- 4 Fissured: Barrier repair creams (ceramide-based) + occlusive layer at night
- 5 Eczema craquelé: Short course of topical corticosteroids + intensive emollients
Relevant Compounds
Allantoin
Skin protectant — promotes healing of fissures
Allantoin is a naturally occurring nitrogenous compound found in botanical extracts (particularly co…
Aloe Vera
Hydrating and soothing botanical
Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…
Ceramides
Restores intercellular lipid matrix
Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…
Cholesterol
Barrier repair — completes the ceramide-cholesterol-fatty acid triad for optimal moisture retention
Cholesterol is an essential component of the stratum corneum lipid matrix, constituting approximatel…
Dimethicone
Emollient — smooths skin surface and reduces moisture loss
Dimethicone is an FDA-approved skin protectant and the most commonly used silicone in dermatological…
Glycerin
Primary humectant — restores stratum corneum hydration and reduces TEWL
Glycerin is the most widely used humectant in skincare and cosmetic formulations. A naturally occurr…
Hyaluronic Acid
Humectant — draws and retains water in stratum corneum
Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…
Jojoba Oil
Biomimetic emollient — wax esters integrate into the stratum corneum lipid matrix, reducing TEWL and restoring skin softness
Jojoba oil is a liquid wax ester extracted from the seeds of the jojoba shrub (Simmondsia chinensis)…
Lactic Acid
Humectant and ceramide booster — enhances hydration and restores barrier lipids
Lactic acid is an alpha hydroxy acid (AHA) with a larger molecular weight (90.08 Da) than glycolic a…
Linoleic Acid
Essential fatty acid — replenishes stratum corneum ceramide linoleate, reinforces lamellar lipid barrier, reduces TEWL
Linoleic acid is an essential omega-6 polyunsaturated fatty acid (PUFA) that cannot be synthesized e…
Niacinamide
Stimulates ceramide synthesis and improves barrier
Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…
Olive Oil
Occlusive emollient — provides temporary moisture retention, but caution advised due to oleic acid-mediated barrier disruption with prolonged use
Olive oil is a natural plant-derived emollient obtained from the fruit of Olea europaea, composed pr…
Palmitamide MEA
Barrier-supportive lipid — promotes ceramide synthesis in keratinocytes and reduces itch associated with dry skin
Palmitamide MEA (palmitoylethanolamide / N-palmitoylethanolamine) is an endogenous fatty acid amide …
Panthenol
Provitamin B5 — hydration and barrier strengthening
Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…
Petrolatum
Gold-standard occlusive — maximally prevents water loss and supports stratum corneum hydration
Petrolatum is the gold standard occlusive agent in dermatology, reducing transepidermal water loss (…
Phytosphingosine
Lipid precursor — supports ceramide synthesis and strengthens intercellular lipid barrier
Phytosphingosine is a sphingoid base naturally present in the stratum corneum, where it serves as a …
Polyglutamic Acid
Ultra-high-capacity humectant — provides 5,000× water-binding capacity on the skin surface, dramatically reducing TEWL and improving stratum corneum hydration
Polyglutamic acid (γ-PGA) is a high molecular weight biopolymer composed of repeating glutamic acid …
Shea Butter
Occlusive emollient — forms a rich lipid barrier, reduces TEWL, and restores stratum corneum hydration in severely dry skin
Shea butter is a fat extracted from the nuts of the African shea tree (Vitellaria paradoxa). It is u…
Sodium PCA
NMF-replenishing humectant — restores the most abundant hygroscopic component of the NMF, enhancing stratum corneum water-holding capacity
Sodium PCA (sodium salt of pyrrolidone carboxylic acid) is the most abundant amino acid derivative i…
Squalane
Emollient — mimics sebaceous lipids
Squalane is the hydrogenated (saturated) form of squalene, a naturally occurring lipid produced by h…
Vitamin E
Antioxidant emollient — protects lipid barrier
Vitamin E is a fat-soluble antioxidant vitamin and a key component of the skin's natural antioxidant…
Suggested Cosmetics
Lifestyle Tips
- Bathe in lukewarm water for less than 10 minutes
- Use soap-free cleansers (syndets) with physiological pH
- Apply emollient immediately after bathing on damp skin
- Run a humidifier indoors during winter months
- Wear cotton clothing next to skin — avoid direct wool contact
- Stay well hydrated and consider omega-3 supplementation
When to Refer
- Suspicion of underlying systemic cause (thyroid, renal, diabetes)
- Ichthyosis or inherited keratinisation disorders
- Development of asteatotic eczema or recurrent secondary infections
- Not responsive to appropriate emollient regimen