Evaluation of a Once-Daily Moisturizer Used to Treat Xerosis in Long-Term Care Patients

  • Wed, 9/3/08 - 10:25am
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Author(s): 
Dasie Wilson, RNC, MPA, ET, CWCN, COCN; and Denise Nix, RN, MS, CWOCN

T he body’s largest organ, the skin provides a barrier between an individual and the environment. The skin performs many functions — it protects against infectious micro-organisms, ultraviolet light, noxious substances, and excess fluid/electrolyte loss and provides the means for thermoregulation, sensation, metabolism, and communication.1 The stratum corneum (horny layer) is continuously exposed to the outside environment and provides the first line of protection, serving as a vital part of the body’s immune system.2

Xerosis (dry skin) is characterized by pruritic, erythemic, dry, scaly, cracked, or fissured skin (see Figure 1) and is a result of the loss of natural moisturization factors and barrier abilities, as well as epidermal water loss. Some bathing and skin treatment practices also are believed to contribute to or exacerbate dry skin.1,3-5 Xerosis occurs most often on the legs but may be present on the hands and trunk. It is a problem for 59% to 85% of people older than 64 years6; it is one of the most common dermatological conditions found in long-term care.7 Evidence suggests that xerosis increases the risk for additional clinical problems such as discomfort, pruritus, infection, skin tears, and pressure ulcers.8-11 The purpose of the product evaluation was to determine whether a new therapeutic moisturizing cream decreases the symptoms of xerosis.

Literature Review

Pathology. In healthy skin, skin cells called corneocytes detach from neighboring cells and are replaced by younger cells from the deeper layers. This orderly process of skin cell loss from the skin surface (desquamation) is controlled primarily by two intercellular components, corneodesmosomes and lipids, that provide for the maintenance of tissue thickness. Corneodesmosomes bind the corneocytes to maintain intercellular cohesion and tissue integrity and eventually must be broken down for desquamation to be effective. In healthy skin, this process, corneodesmolysis, eliminates the corneodesmosomes.12 In xerotic skin, corneodesmosomes persist and disturb the orderly desquamation process, resulting in the formation of visible, powdery flakes on the skin surface.13

Free water also is necessary to control the corneodesmolysis process. Adequate lipid content is required to retain the free water. Inadequately hydrated skin cannot provide this free water; therefore, deficits in both skin hydration and lipid content play a key role in xerosis.12 Consequently, the skin’s inability to retain moisture and provide an effective barrier directly affects the development of xerosis.14,15

A number of situations impact the skin’s moisture depletion. For example, xerosis tends to relapse in the winter when humidity is low.12 The daily use of cleansers and/or bathing without replacing natural skin emollients results in epidermal water loss and a depletion of skin lipids.16 Pre-existing disease states (ie, end-stage renal disease, nutritional deficiency, thyroid disease), therapies (eg, radiation), and medications render an individual more susceptible to xerosis.17

The link between xerosis and pruritus, infection, skin tears, pressure ulcers and pain.

Pruritus. Pruritus is the unpleasant sensation that elicits the urge to scratch. It has been cited as the most common and distressing anti-inflammatory skin condition.18 Although pruritus has several different causes, xerosis is thought to be associated with up to 85% of pruritus cases.3

References: 

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