Feature ArticleDry Skin in Older Adults
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Dry Skin in Older Adults
Dry skin is estimated to affect between 30% to 60% of all older adults.4, 5 Changes in the skin related to normal aging may increase the likelihood of dry skin. With age, the number of small blood vessels is reduced, resulting in a diminished supply of blood and nutrients to the skin. The number of sweat and sebaceous glands, as well as in lipid production, are reduced in the skin. Thinning of the epidermis and elastic fibers that provide dermal support reduces the strength of the barrier layer
Dry Skin and Systemic Disease
Dry skin is a common symptom of several chronic systemic diseases, including hypothyroidism, diabetes mellitus, end-stage renal disease, liver disease, and human immunodeficiency virus (HIV). Appropriate treatment of the underlying disease contributes to resolution of dry skin. Hypothyroidism promotes abnormal lipid synthesis and can reduce sweat and oil gland activity. These are the factors thought to be associated with the development of dry skin.6 The prevalence of dry skin in patients with
Lifestyle and Dry Skin
Lifestyle factors associated with dry skin include inadequate food or fluid intake, exposure to sunlight and dry climates, and the use of alkaline cleansers. Men infected with HIV who lacked adequate food intake were twice as likely as non-HIV-infected men to have dry skin. Nutritional state affects the structure and function of the body organs, including the skin. Adequate fluid intake is important to maintaining adequate skin hydration. Healthy older adults are recommended to drink 1,500
Dry Skin Assessment
Despite the prevalence of dry skin in the elderly, no standardized clinical instrument has been adopted in practice or used in research to assess it. There are 4 instruments in the literature that measure dry skin severity and treatment effectiveness: the Black and Gaspar Foot Assessment Tool (BGFAT),18 Skin Condition Data Form (SCDF),19 Bauman Skin Type Indicator (BSTI),20 and the Wehr Xerosis Grading Scale.21 Only the SCDF has had testing of its psychometric properties, and its validity and
Intervention Options
The main interventions for the management of dry skin include topical treatments, fluid management, moderation of sun exposure, and disease management of any exacerbating conditions. The skin indicators of tissue integrity include the restoration of skin smoothness and suppleness as manifested by decreased skin scaling and flakiness, repair of cracking and redness, and resolution of hyperkeratosis, rash, or itching associated with skin dryness.
Summary
Dry skin is a disruption of the surface of the skin due to inadequate oil or water content. Signs of dry skin include flaking, scaling, cracking, and redness. Dry skin is associated with normal aging changes, making it a common problem for older adults. It can also be related to environmental conditions, comorbid illnesses, and skin care regimes. Optimal topical treatments containing a physiologic mixture of ingredients that reduce transepidermal water loss and replenish the lipids lost in dry
JENNIFER HURLOW, GNP-BC, CWOCN, Nurse Practitioner, Plastic Surgery Group of Memphis, Memphis, TN.
References (44)
- et al.
Xerosis in hypothyroidism: a potential role for the use of topical thyroid hormone in euthyroid patients
Med Hypotheses
(2001) - et al.
Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease
J Am Acad Dermatol
(2003) Understanding and treating various skin types: the Baumann Skin Type Indicator
Dermatol Clin
(2008)- et al.
A pilot quality-of-life instrument for pruritus
J Am Acad Dermatol
(2008) - et al.
Glycerol regulates stratum corneum hydration in sebaceous gland deficient (asebia) mice
J Invest Dermatol
(2003) - et al.
Preventing and treating dehydration in the elderly during periods of illness and warm weather
J Nutr Health Aging
(2009) Addressing the skin-care needs of the older person
Br J Community Nurs
(2007)- et al.
Clinical concerns: management of dry skin
J Gerontol Nurs
(1994) Skin aging and dry skin
J Dermatol
(2004)Dermatologic problems in the elderly
Lippincotts Prim Care Pract
(1997)
Eczema and dry skin in older people: identification and management
Br J Community Nurs
Dermatological care of the diabetic foot
Am J Clin Dermatol
Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis
Liver Int
Skin barrier structure and function and their relationship to pruritus in end-stage renal disease
Nephrol Dial Transplant
Prevalence and factors associated with dry skin in HIV infection: the FRAM study
AIDS
Pressure ulcers among the elderly
JAMA
Assessment of effects of an additional dietary natural mineral water uptake on skin hydration in healthy subjects by dynamic barrier function measurements and clinic scoring
Skin Res Technol
Functional characteristics of the stratum corneum in photoaged skin in comparison with those found in intrinsic aging
Arch Dermatol Res
Seasonal variability in the biophysical properties of stratum corneum from different anatomical sites
Skin Res Technol
Physiological and subjective responses to low relative humidity in young and elderly men
J Physiol Anthropol
The effect of washing and drying practices on skin barrier function
J Wound Ostomy Continence Nurs
Nursing innovation for dry skin care of the feet in the elderly: a demonstration project
J Gerontol Nurs
Cited by (29)
The Itch–Scratch Cycle: A Neuroimmune Perspective
2018, Trends in ImmunologyCitation Excerpt :Beyond AD, the recognition of additional itchy skin disorders with distinct etiologies suggests that inflammation may not always be a necessary component the itch–scratch cycle. Clinically, dry skin itch is a condition in which chronic itch develops independently of overt skin inflammation and is thought to be due to physiological changes associated with aging, temperature, and humidity that dry out the skin [22–25] (Figure 1C). In addition, there are several primary chronic itch disorders such as PN, chronic idiopathic pruritus (CIP, also known as generalized pruritus of unknown origin), as well as neuropathic itch disorders such as brachioradial pruritus [26], notalgia paresthetica [27], and scalp pruritus [28].
Skin care in nursing: A critical discussion of nursing practice and research
2016, International Journal of Nursing StudiesAge-related decrease in sensitivity to electrical stimulation is unrelated to skin conductance: An evoked potentials study
2014, Clinical NeurophysiologyCitation Excerpt :The human body is naturally resistant to current flow, with more than 99% of this resistance within the skin (Fish and Geddes, 2009). With aging, however, the skin undergoes progressive structural and physiological changes, including a reduction in the number of small blood vessels, sweat and sebaceous glands, as well as of lipid production (Denda et al., 1993; Hurlow and Bliss, 2011). These age-related modifications are likely to result in decreased transepidermal water loss, which also occurs in the elderly (Conti et al., 1995).
The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: A prospective study
2014, International Journal of Nursing StudiesCitation Excerpt :First, the frequency of lotion application may not be related to improvement of the skin after lotion application but, instead, may reflect the need for alleviating the dryness of the skin. For alleviating the dryness of skin, lotion should be applied in an adequate dose, with adequate frequency, and by the correct method (Hurlow and Bliss, 2011); thus, lotion application, even more than once a day, may be inadequate to alleviate the dryness of the skin (Hurlow and Bliss, 2011). Further, the frequency of lotion application may reflect the severity of disease of the subjects in the DFU group.
In vivo skin biophysical behaviour and surface topography as a function of ageing
2013, Journal of the Mechanical Behavior of Biomedical MaterialsCitation Excerpt :The opening of the hysteresis loop for the indentation test is typical of a viscoelastic behaviour. The origin of the increase of the hysteresis loop might be explained by the age-dependent skin water loss due the decrease of blood vessels and lipid synthesis in elderly skin as well as the deregulation of epidermal barrier function (Hurlow and Bliss, 2011). On the one hand, the decreasing water content of the dermis results in a higher concentration of proteoglycans and ions within interstitial fluid and consequently increases its apparent viscosity.
JENNIFER HURLOW, GNP-BC, CWOCN, Nurse Practitioner, Plastic Surgery Group of Memphis, Memphis, TN.
DONNA ZIMMARO BLISS, PhD, RN, FAAN, FGSA, Professor, University of Minnesota School of Nursing, Minneapolis, MN.