- Ivan Bristow
How common is dry skin in adults?
Dry skin (or to give it it’s proper dermatological term – xerosis) is an extremely common condition we see in the podiatry clinic. It ranges from slight dryness right through to irritation, excoriation and fissuring in some patients. The feet are more prone to the condition because of the lower number of sebaceous glands on the lower leg and foot. In addition, there are many reasons why it may manifest such as bathing habits, illness, skin disease or even drug therapy. Having dry skin can also be a risk factor for the development of other problems such as eczema and allergic dermatitis, at any age. Hence, why as podiatrists we should be vigilant in advising all our patients with dry skin to regularly apply moisturisers.
Despite the condition being a universal problem, data is lacking on how common the condition is amongst the general population. Some studies have looked at it as part of skin surveys or of specific age groups such as the elderly, but few have looked more broadly at the general population.
Earlier this year a study was published in the Journal of the European Academy of Dermatology & Venerology (or JEADV to give it its easier name). The study (1) based in Germany was well supported with over 48 000 working age adults who were assessed by dermatologists. The survey was for skin cancer screening but alongside this basic data was collected on skin type, problems and dryness. The average age of the workers surveyed was 43. The study showed that 29% of working age adults had dry skin. The data also showed that this was more prevalent in older adults, but gender made no difference. The interesting part was also how they used a statistical technique called logistic regression to calculate if dry skin was a predictor for the development of other skin conditions.
Those with dry skin were also more likely to develop various forms of dermatitis or eczema, fungal skin infections and interestingly, warts. A rate of 29% is significant but as they implied this increases with age with rates of xerosis in older subjects increasing to over 50-90% (2). What this study suggests is that attention should be paid to all those with dry skin as advice on use of appropriate moisturisers and skin care can be effective at reducing dry skin but more importantly potentially prevent the development of conditions such as eczema which can increase in prevalence as we age.
From a podiatric perspective, it was interesting to see how dry skin can predispose to fungal infection and verrucae. We often associate the two infections with swimming pools and wet changing rooms as this is the main reservoir of infection. However, looking from a different perspective, one must think how the infection infiltrates the skin. The skin when healthy is a formidable barrier to most organisms but changes in hydration can render it more permeable to infection. We know when the skin is damp that this poses a risk, hence leisure facilities are often quoted as the main culprit but think of the converse situation. Dry skin also affects the natural barrier function potentially allowing ingress of infection. This perhaps in part may explain the older patient with a wart who never goes swimming we see from time to time in clinic?
Ultimately, this can only reinforce what we already suggest to patients – the regular use of emollients can be effective in reducing dryness and keeping your skin healthy but just as importantly, reduce the chances of developing other skin problems such as eczema and fungal or viral skin infections.
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1. Augustin M, Kirsten N, Körber A, Wilsmann-Theis D, Itschert G, Staubach-Renz P, et al. Prevalence, predictors and comorbidity of dry skin in the general population. J Eur Acad Dermatol Venereol. (in press).
2. Lichterfeld A, Lahmann N, Blume-Peytavi U, Kottner J. Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes. Int J Nurs Stud. 2016;56:37-44.