(1997; 132 pages) [French] [Spanish]
Xerosis, or dryness of the skin, is the most common form of fine scaling seen, particularly among children and the elderly. It is usually accompanied by mild or severe pruritus and is exacerbated by environmental factors such as exposure to sunlight. In the elderly, xerosis may cause atrophoderma.
Every effort should be made to keep the skin moist. Detergents and other degreasing agents should therefore be avoided.
Baths should be tepid rather than hot, and soap should be used sparingly. In cold climates, adequate protective clothing should be worn in cold weather, and in centrally heated premises, efforts should be made to humidify the air.
Emollients such as aqueous creams and emulsifying ointments should be applied once or twice daily to affected skin in severe cases. The addition of a keratolytic agent, such as 1-5% salicylic acid or 5% lactic acid, can be helpful. Salicylic acid should be used sparingly in children because of the risk of systemic salicylism. Occlusion therapy using a 60% aqueous solution of propylene glycol may be effective in unresponsive cases where circumstances permit, but cannot be used in warm or hot climates since it may cause thermoregulatory problems and increase the risk of secondary infection. An aqueous cream containing 10% urea, which has moisturizing, keratolytic and antimitotic properties, may prove more effective than an emulsifying ointment. Sodium chloride, 0.9% solution, is sometimes added to increase the moisturizing effect. α-Hydroxy acids such as pyruvic acid and glycolic acid in concentrations of 0.5-2% have been introduced recently and appear to be useful, particularly in xerosis.
Topical or systemic administration of retinoids may be of value in certain rare forms of ichthyosis in which the hyperkeratosis is caused by hyperproliferation rather than defective desquamation. However, the improvement induced by therapy may not persist after the drug is stopped, and long-term treatment may be necessary.