Pharmacists are often asked about dry skin (xerosis,

xeroderma), especially as the population ages. Dry

skin affects perhaps 75% of those 64 and older.
Patients ask for advice on preventing and treating
dry skin and which products to use when excessive
dryness has caused the skin to crack open and
sometimes to bleed….

This training module will discuss Anatomy of the

skin, Signs & symptoms, Etiology and
Pathophysiology of the dry skin, Various treatment
options available to use.

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 Anatomy of Healthy Skin
THE SKIN
The skin is the body's largest organ. It serves many
important functions, including regulating body
temperature, maintaining water and electrolyte
balance, and sensing painful and pleasant stimuli. The
skin keeps vital chemicals and nutrients in the body
while providing a barrier against dangerous
substances from entering the body and provides a
shield from the harmful effects of ultraviolet radiation
emitted by the sun. Understanding how the skin can
function in these many ways starts with understanding
the structure of the 3 layers of skin –

1. Epidermis
2. Dermis
3. subcutaneous tissue.

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 EPIDERMIS
The epidermis is the relatively thin, tough, outer layer of the skin. Most of the cells in the
epidermis are keratinocytes. They originate from cells in the deepest layer of the epidermis
called the basal layer. New keratinocytes slowly migrate up toward the surface of the epidermis.
Once the keratinocytes reach the skin surface, they are gradually shed and are replaced by
younger cells pushed up from below.
The epidermis contains 5 layers. From bottom to top the layers are named:
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum licidum
5. Stratum corneum

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 STRATUM CORNEUM
Stratus corneum is the outermost layer of the Corneocytes
Lipid Mixture
skin which actually provides the barrier function.
It has two main element to it.
1. Corneocytes
2. Lipid mixture where corneocytes are
embedded

The cells in the stratum corneum layer are

known as corneocytes. The cells have flattened
out and are composed mainly of keratin protein
which provides strength to the layer but also
allows the absorption of water. Due to its
structure it is often compared to a brick wall in
which the nonviable keratin-filled Corneocytes
are embedded in bricks in a matrix of
intercellular lipids which is like a mortar

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 DERMIS
The dermis, the skin's next layer, is a thick layer of fibrous and elastic tissue (made mostly of
collagen, elastin, and fibrillin) that gives the skin its flexibility and strength.
The dermis contains nerve endings, sweat glands and oil (sebaceous) glands, hair follicles, and
blood vessels.
For example, the fingertips and toes contain many nerves and are extremely sensitive to touch.
The blood vessels of the dermis provide nutrients to the skin and help regulate body
temperature. Heat makes the blood vessels enlarge (dilate), allowing large amounts of blood to
circulate near the skin surface, where the heat can be released. Cold makes the blood vessels
narrow (constrict), retaining the body's heat.

FAT LAYER
Below the dermis lies a layer of fat that helps insulate the body from heat and cold, provides
protective padding, and serves as an energy storage area. The fat is contained in living cells,
called fat cells, held together by fibrous tissue. The fat layer varies in thickness, from a fraction
of an inch on the eyelids to several inches on the abdomen and buttocks in some people

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 WHAT IS DRY SKIN?
Dry skin appears dull, flaky and scaly, feels rough and itchy and fine lines in the skin become
visible. This occurs most commonly on the arms and legs, but can also affect the trunk of the
body. Very dry skin is commonly accompanied by itching, which can be severe and interfere
with sleep and other daily activities. Repeated rubbing and scratching can produce areas of
thickened, rough skin that can cause painful cracks in the skin. If untreated very dry skin may
result in inflammations, eczema and other forms of dermatitis.

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 ETIOLOGY
Dry skin occurs when the skin's outer layer (the stratum corneum) is depleted of water as it
plays a critical protective role. When this layer is well-moistened, it minimizes water loss
through the skin and helps keep out irritants, allergens, and germs. However, when the
stratum corneum dries out, it loses its protective function. This allows greater water loss,
leaving your skin vulnerable to
environmental factors.

The stratum corneum has a water content of 10% to 30%.

The water comes from the atmosphere, the underlying layers of skin, and sweat.
Oil produced by skin glands and fatty substances produced by skin cells act as natural
moisturizers, allowing the stratum corneum to seal in water

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 CAUSES OF DRY SKIN
Dry Air
Dry air is probably the most common cause of dry skin, especially during the winter. It draws the
moisture right out of the skin. Dry skin during winter even gets its own name: winter itch

Long, Hot Showers & Baths

Prolonged exposure to water, especially hot water can wash away the natural oils that protect
your skin. lukewarm rather than hot water is better for dry skin problem.

Soap
Soap can quickly strip away your skin's protective oils, and we tend to use way too much of it.
Ironically, while done in the quest to rid ourselves of germs, excessive hand washing can
dry out the skin and cause it to crack and bleed, making infection much more likely.

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 CAUSES OF DRY SKIN
Aging
As people get older, skin cells reproduce less quickly, so skin is renewed less often.
There is a loss of functioning sweat and oil glands as well.

Skincare products
Some make-up and antibacterial soaps over-cleanse, removing too much oil; others
may trigger skin–irritating allergies.

Tobacco, alcohol and caffeine

Coffee and alcoholic drinks can dehydrate the body, drying skin. And smoking reduces
the oxygen available to the skin, which can slow healing as well as dry out the
epidermis, the outer layer of skin.

Itchy Clothing
Many people obstinately wear clothing that they find itchy. But no matter how much
you might love the look of a sweater, it's not worth it if it's uncomfortable

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 CAUSES OF DRY SKIN
Medications and Drugs
A number of medicines have the side effect of drying out the skin. They include drugs for
High blood pressure, like diuretics
Allergies, like antihistamines
Acne and other skin conditions, like retinoid

Medical Conditions
a. Changes in hormone levels: Dry skin often develops when people get older, especially in
women. Changes in hormone levels can cause dry skin as we age. As many as 75% of
people over 64 have dry skin.

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CAUSES OF DRY SKIN
b. Skin conditions, like eczema and psoriasis: While they usually need direct treatment,
careful use of moisturizers often helps.

c. Diabetes: Fluctuations in glucose levels can lead to dehydration, and that dries the skin
out. Given that diabetes can also slow healing and increase the risk of infections, it's
especially important for people with this condition to keep their skin healthy.

d. Hypothyroidism: Low levels of thyroid hormone can reduce the amount of oil produced by
your skin. As a result, skin becomes dry and rough and moisturizer is unlikely to help.

e. Malnutrition: Not getting the nutrients you need can leave your skin dried out. One possible
cause is an eating disorder
 SKIN DISORDER ASSOCIATED WITH DRY SKIN

Anhydrotic skin condition or Xerosis

Xerosis or anhydrosis can be caused by dehydration due to excessive washing of the skin
with hot water, over exposure of the skin to cold weather or heating systems, thereby removing
the skin’s natural oil and moisture. This condition results in the skin becoming very dry, scaly and
itchy. Xerosis may lead the upper layer of the skin (stratum corneum) to fissures, allowing
environmental irritants to penetrate the skin and causing inflammation as well as leaving the skin
open to infection which may eventually lead to serious conditions in people suffering from
diabetes.

Ichthyosis
Severe dry skin is a feature of certain genetic diseases such as ichthyosis. Symptoms include
scaly patches on the shins, fine white scales on the forearms, and rough palm

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 SKIN DISORDER ASSOCIATED WITH DRY SKIN

Winter itch
Very dry skin is a very common skin problem during winter when environmental
humidity is low and the skin is exposed to heating systems. It can occur at all ages and in people
with or without other skin problems. The symptoms most often associated with this skin disorder
include scaling, itching and cracks in the skin in the lower legs, arms, sides of the abdomen and
thighs.

Dermatitis
This skin condition is manifested by inflammations, dry skin and rashes of the skin mainly
caused by allergic reactions. Eczema and Psoriasis are forms of dermatitis which are
accompanied by very dry skin symptoms.

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 TREATMENT OPTION AVAILABLE FOR DRY SKIN
(XEROSIS)
The stepped care approach for the treatment of Dry Skin are:

1. Emollients/Moisturisers
a) Step 1 - Basic aqueous cream (w/o or o/w emulsion) based on petroleum derivatives
b) Step 2 - Above plus moisturising ingredient like Glycerine, Shea butter, cocoa butter,
olive oil etc.
c) Step 3 - Above plus additional ingredients like Urea, Lanolin, Colloidal Oatmeal,
Dimethicone, Allantoin etc.
d) Step 4 - Any of the above plus BHA/AHA or their salts (lactic acid, ammonium lactate)

2. Topical Corticosteroid
3. Topical Calceneurin Inhibitor e.g., Tacrolimus
4. Bandages and Dressings
5. Phototherapy and Systemic treatments

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 STEPPED CARE PLAN
Clear Mild Moderate Severe

Normal skin Areas of dry skin Areas of dry skin Widespread areas of dry
No evidence of active dry Infrequent itching (with or Frequent itching skin
skin without redness Redness (with or without Incessant itching
excoriation and localised Redness (with or without
skin thickening excoriation , skin thickening,
bleeding, oozing & cracking)

Body

Emollients (a or b) Emollients (c or d) Emollients (c or d) Emollients (c or d)

Mild potency corticosteroid Moderate potency Potent corticosteroid for 7-
corticosteroid for 7-14 days 14 days only
only Tacrolimus
Tacrolimus Bandages
Bandages Phototherapy

Face and neck

Emollients (a or b) Emollients (c or d) Emollients (a or b) Emollients (a or b)

Mild potency corticosteroid Mild potency corticosteroid Tacrolimus
Topical calcineurin Inb Bandages
Bandages Phototherapy

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 EMOLLIENTS
Look out for Key ingredients before recommending a emollient

Recommend on the basis of severity scale as per the stepped care approach

Recommend Keep using even after the dry skin has been treated

Recommend to use in between steroid treatment

Recommend to use more often and in larger amounts than other treatments

Recommend to a avoid soaps and other detergent

Recommend using a large quantity (250 to 500g weekly) in moderate to severe cases

Refer if no improvement
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 KEY INGREDIENTS IN EMOLLIENTS
Urea:
Improves the degree of hydration in the skin by increasing the water uptake from the dermis
level of the skin and enhances the stratum corneum water binding capacity.

Urea improves the degree of hydration in the skin by increasing the water uptake from the
dermis level of the skin and enhances the stratum corneum water binding capacity. It
also reduces the Trans Epidermal Water Loss (TEWL).

Implements an action known as hydrotropic solubilization by removing dead skin cells, thus
allowing the emollients to access deeper layers of the skin and replenish lost moisture.

Lanolin: is a skin moisturizer. It is an extremely effective emollient in restoring and

maintaining the all important hydration (moisture balance) of the stratum
corneum, and so prevents drying and chapping of the skin.

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 KEY INGREDIENTS IN EMOLLIENTS
Sodium PCA: is a naturally occurring component of human skin believed to be in part
responsible for its moisture-binding capacity.

Shea Butter : (herbal) is a moisturizer and contains Vitamins and some specific fats and
acids, that work together to provide softer, smoother, more supple skin. Clinical studies
have shown that in as little as 4-6 weeks, there have been results of smoother, softer,
and better looking skin for users of Shea Butter.

Glycerin: is part of the skin’s own natural lipid structure. As a moisturizing ingredient,
glycerin helps the skin to attract and retain its own natural moisture, leaving it feeling soft.
Rather then sitting on top of the skin, glycerin softens the skin while permitting it to breathe.

Vitamin E provides moisturizing properties for smooth silky skin, decreases harmful effects
off solar radiation and is an antioxidant.

Pro Vitamin B5 or Panthenol stimulates skin healing while providing deep moisturization.

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 KEY INGREDIENTS IN EMOLLIENTS
Allantoin: is a soothing moisturizer. It is an extract from the seedlings of many herbs and
is a proven pharmaceutical ingredient. It is especially valued for its astringent,
emollient nutritive properties, and is able to soothe and soften skin.

Aloe Vera: benefits dry and cracked skin, burns, blisters, insect bites, and allergic
reactions. Topical Aloe Vera is a natural healing agent delivered directly to skin

Dimethicone: is a silicone based emollient that also acts as a protective barrier to dry
skin. It treats and prevents dry, itchy skin or minor skin irritations.

Lactic acid: is an ‘Alpha hydroxy acid’ which is a tiny keratolytic agent that has the ability
to soften and exfoliate dead and tough skin cells and enable the growth of new healthy
skin cells. Lactic acid gently exfoliates out dry skin of the hands.

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Introducing Dermal Therapy range for Dry and Very Dry (xerosis) Skin –

1. Clinically Proven and dermatologically tested

2. Multiple key emollient ingredient in a rich moisturising base
3. Non greasy and quick absorbing
4. Added Exfoliant (keratolytic) in certain sku’s
DRY SKIN LOTION
1. Naturally derived ingredients
2. Clinically proven to moisturize up to 24
hours from a single application
3. Clinically proven to increase skin hydration
by 50% in 14 days
4. With unique Xeradin in combination with
other moisturisers

A natural formulation that provides clinical

performance equivalent to category
leaders
 Experimental data of skin hydration VERY DRY SKIN CREAM
16
14
12
10 1. Fast visible results in 1 Day
8
6 2. Contains 12.5% Urea and 1% Dimethicone. It
4
2
provides symptomatic relief for scaly skin,
0
-2
winter itch, ichthyosis, dermatitis, eczema and
after 7 days after 14 days
Untreated Very Dry Skin Cream psoriasis or any other dermatological
condition
3. Increase of skin hydration of up to 52% over a
Comparative efficacy vs. 10% Urea Cream &
Placebo
period of 2 weeks

Most potent body moisturiser with

keratolytic property for very dry
skin, when nothing else has
worked!
VERY DRY SKIN LOTION
1. 24 hour moisture lock
2. Clinically tested formula with 10% Urea &
1% Dimethicone
3. Suitable for dry skin conditions associated
with Eczema, Psoriasis and other various
dermatological conditions

Most potent body moisturiser with

keratolytic property for very dry skin, when
nothing else has worked!
 How to co-position Dry Skin lotion with Very Dry Skin lotion?

Positioning: Positioning:
Rich therapeutic Treatment regime for
moisturiser for the the management of
treatment of dry very dry skin due to
skin. Clinically additional Keratolytic
proven property

Dermal Therapy Very Dry Skin range will provide extra relief due to keratolytic properties
for added exfoliation and emollient penetration synergy.
 EXAMPLE OF EMOLLIENT STEP CARE APPROACH
Steps Types of emollients Example how Dermal Therapy fits

Step 1 Basic emollient (aqueous cream)

based on petroleum or mineral oil

Step 2 Above plus moisturising ingredient Dermal Therapy Dry Skin Lotion has added emollient
like Glycerine, Shea butter, cocoa ingredient
butter, olive oil etc.

Step 3 Above plus additional ingredients Dermal Therapy Very Dry Skin Cream with 12.5%
like Urea, Lanolin, Colloidal urea, 6% Lanolin and 1% Dimethicone
Oatmeal, Dimethicone, Allantoin
etc. Dermal Therapy Very Dry Skin Lotion with 10% urea
Step 4 Any of the above plus BHA/AHA or 3% lanolin and 1% Dimethicone
their salts (lactic acid, ammonium
lactate)

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Also don’t forget to avoid SLS containing wash and Soap for the management of dry skin,

SOAP FREE WASH

1. Naturally derived ingredients
2. Clinically proven to be less irritating
3. Using Coconut oil based cleansing agent as
opposed to sulphate based agents like SLS
which can be more irritating
4. Use high percentage of moisturising agents
like vegetable based Glycerine.

A natural formulation soap and SLS free

that provides clinical performance
 And finally other products available in Dermal range worth looking at -

Lip balm Hand balm Heel balm

• Only lip balm with urea • With 10% urea • With 25% urea
• Visible results in 1 day • Visible results in 1 day • Visible results in 3 day
• SPF 50+ option • Anti-ageing version • Clinically proven to
available also available treat diabetic
anhydrois in feet

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 For further information on products or any technical enquiry:

Amit Saha B-Pharm, M-Pharm, MBA

Group Technical Manager
LaCorium Health Australia Pty Ltd
Suit 4.01a, 59-75 Grafton St, Bondi Junction NSW 2022
Call: +612-9693 6506 (direct), +416 546 205 (cell)
[email protected]
www.lacoriumhealth.com

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