The Best Face Moisturizer for Very Dry Skin & Skin Toner for African-American Women

No matter how hot you look, dry skin can make you feel hopelessly uncomfortable. Celebrity physician Dr. Michael Roizen states that African-American women can experience higher rates of transepidermal (literally, “through the skin”) water loss than Caucasian women, which can make skin drier. While you’re on the hunt for the products to include in your skin care arsenal, keep your eyes peeled for those that contain natural ingredients, which your dry skin craves.

What to Look For

The best face moisturizer for über-dry African-American skin is one that contains naturally moisturizing ingredients. Read the label and look for jojoba oil, sunflower seed oil, beeswax, shea butter or coconut oil. Moisturizers containing plant extracts help nourish and tone your skin. Vitamins and supplements are other ingredients to seek. For example, vitamin E and omega-3 can enhance the overall health of your skin and promote healing. When shopping for a daytime moisturizer, sunscreen is a must, especially if you want to reverse hyperpigmentation (the higher the SPF the better). If you happen to have an uneven skin tone, look for a tinted moisturizer that contains vitamin C, which will help reduce the appearance of dark spots. Dr. Charles E. Crutchfield, associate professor of dermatology at the University of Minnesota Medical School, says that the moisturizing lotion that you choose should continually protect your face all day and keep it moisturized. If your face is really hurting because it’s so dry, look for a medicated skin moisturizer (a drugstore pharmacist can direct you to a good over-the-counter option) and make an appointment with a dermatologist.

The Skin Toner Debate

Some estheticians say that face toner is essential to rebalancing the pH of your skin after you cleanse it. Other professionals say toner is unnecessary because your skin’s pH will go back to normal after an hour or so. The choice to use skin toner is personal. If you feel like you need a skin toner to reduce the size of your pores after you wash your face, look for a toner that doesn’t contain alcohol or witch hazel because your skin will dry out even more and become ashy. Instead, spritz rosewater, lavender water, orange flower water or a mix of cooled chamomile and green teas onto your face. These natural ingredients are soothing and act like a natural astringent.

What to Avoid

While it may sound soothing, never let a moisturizer with mineral oil near your face if you want to keep it kissable. The higher levels of melanin in African-American skin can make it more sensitive to certain ingredients. Mineral oil, parabens, dioxanes, phthalates and oxybenzone can clog your pores and have the potential to irritate your skin and cause dark patches to form. If a bottle of moisturizer or toner just states that it contains “fragrances” in the list of ingredients, put it back on the shelf. An undisclosed fragrance has the potential to harm your already sensitive skin.

Your Skin Care Routine

Moisturizing your skin is only one small, yet important, step in a beauty regimen. Whenever you wash and rinse your face, do so with warm water because hot water actually causes your skin to become dry, according to Crutchfield. Even taking a hot shower can take a toll on your dry skin. Cleanse your face with a product that contains glycerin, petrolatum or hyaluronic acid but doesn’t create suds. Then gently pat your face dry with a soft towel. If you feel that you need it, spritz on some toner. Crutchfield says to finish up your skin care routine by immediately applying moisturizer to your face. To help your skin stay hydrated, drink eight cups of water a day and watch your salt intake.

Original article

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It’s summertime — time to be skin smart and sun safe – Part 1 of 2

Let’s face it: With summer comes the opportunity for all kinds of skin problems. This includes attacks by mosquitoes and ticks; sporting activities where bumps, bruises, cuts and abrasions abound; and the notorious ultraviolet radiation from the sun.

It’s always a good idea to be sun smart and sun safe. When it comes to taking good care of your skin, there are three key principles:

1) Gentle cleansing. This is extremely important to do for your skin to reduce irritation and increase cleanliness and hygiene. I recommend using non-detergent or low-detergent cleansing products such as Dove, Vanicream cleansing bar, Neutrogena products, Cetaphil and Basis. All of these work well to cleanse the skin without irritation.

2) Skin hydration. This is one of the most important things you can do for your skin. A little-known trick and one of the biggest things you can do to keep your skin hydrated is to use a gentle cleanser that won’t take away the natural oils in your skin.

In addition to the cleansers listed above, it’s also important to use a good emollient, hydrating lotion or cream. I like to use CeraVe lotion or cream because it contains a technology called a microvesicular emulsion. This means there are little microspheres of moisturizing lipids in water that break down over several hours, constantly replenishing the skin’s moisture.

There are other over-the-counter lotions that contain ammonium lactate, which will actually penetrate the skin and assist in holding water in the skin. In summer the two most important things you can do for skin hydration is to use a gentle cleanser and to use moisturizers.

The most important time to use a moisturizer is immediately after bathing or showering. As soon as you finish the bath or shower, step out and gently pat your skin dry with a cotton towel and immediately apply the moisturizing lotion, cream or emollient.

This serves two important functions: Number one, it seals in all of the water your skin has absorbed during your bathing, and secondly, it adds another layer of moisturization to help replenish the water normally lost throughout the day. This is very important in the winter when humidity levels are low and the air extremely dry.

3) Protection from ultraviolet radiation. There are mainly three types of ultraviolet radiation. Ultraviolet C is almost totally blocked out by the ozone layer. Ultraviolet B and A penetrate the ozone and can have profound effects on our skin.

Ultraviolet B, “wavelength 290-320 nanometers,” is responsible for irritation and sunburns. Ultraviolet A, “wavelength 320-400 nanometers,” is a much longer wavelength and can penetrate much deeper into the skin. This ultraviolet A actually wreaks much more havoc on our skin than most of us realize.

When we use a sunscreen, the SPF number is really a sun protection factor indicating the blocking of ultraviolet B rays, the ones responsible for burning the skin. In the old days, if you could stay out for one hour without getting burned, an SPF of 15 theoretically means 15 hours. Although in actuality this doesn’t quite hold true, that’s where the SPF number calculation comes from.

Not so long ago, most sunscreens only had an SPF factor, but they didn’t block ultraviolet A. Ultraviolet A is responsible for sun freckles, the development of wrinkles, and most importantly the development of skin cancer. Ultraviolet A can actually penetrate and break DNA, causing all kinds of signs associated with aging skin.

Next week: skin color, vitamin D, and some basics of skin protection.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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NeoStrata® Skin Active Antioxidant Defense Serum – Cosmetic Skin Care Product-of-the-month

Neostrata Antioxidant Defense Serum20% off for the the month of March 2017.

This concentrated SynerG Formula containing 8 powerful multi-action antioxidants is designed to combat oxidative damage and protect the skin from premature aging. Patented Bionic and Polyhydroxy Acids trap oxidation promoting metals like iron and help prevent sun-induced cellular damage. The potent combination of Citric Acid and Lilac, Green Tea and Chardonnay Grape Seed Extracts works together to neutralize five different types of free radicals and helps preserve healthy DNA, lipids and cellular membranes. In addition, this super potent source of EGCG Green Tea Extract protects against inflammatory mediators in the skin.

Recommended usage: Daily/AM, under sunscreen

Key Ingredients: SynerG Formula, Bionic Acids, Polyhydroxy Acids, Citric Acid, Lilac, Green Tea, Chardonnay Grape Seed Extracts

Size: 1.0 fl oz

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20% off NeoStrata® Firming Collagen Booster – February Product-of-the-Month

Neostrata Cosmetic ProductThe advanced SynerG Formula includes three clinically proven technologies, each with a unique action to target new and existing collagen. It contains Gardenia Cell Culture to preserve existing collagen by inhibiting MMP enzymes which breakdown collagen. This pure, active cell culture extract also helps enhance new collagen. In addition, Amino Acids, the chemical building blocks of collagen, work with Matrixyl® 3000 Peptides to help enhance collagen. Finally, potent NeoGlucosamine® reinforces collagen’s protective support matrix*. Healthy, stronger collagen makes skin feel firmer and appear more lifted. Lines and wrinkles are smoothed from the inside out. Use this light serum to complement your daily antiaging regimen and boost your skin’s natural rejuvenation cycle.

To book your appointment, call our MediSpa right now at (651) 209-3600 or email Natasha and get your skin glowing

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Neostrata Bionic Eye Cream

neostrata Bionic Eye Cream20% off NeoStrata® Bionic Eye Cream

This potent multi-functional eye cream targets dark circles and reduces other visible signs of aging such as puffiness, fine lines and wrinkles. Vitamin K targets the look of dark under eye circles. Lactobionic Acid, a potent antioxidant, helps prevent collagen breakdown, smoothing lines from the inside so skin appears firmer and less puffy. Green tea and cucumber extracts reduce puffiness and soothe the eye area. Fragrance-Free. Dye-Free. Paba-Free. Ophthalmologist tested. Formulated with 3% Gluconolactone, 1% Lactobionic Acid, Vitamin K, Pro-Vitamin A and Vitamin E.

Recommended usage: Twice Daily AM/PM, as tolerated

Key Ingredients: Lactobionic Acid, Gluconolactone, Vitamin K
pH 3.5
Size: 0.5 oz tube

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3 Ways To Get Skin Glowing

holiday skin care1. Get a Facial Peel

During this process, a high concentration of glycolic acid is applied to the skin for a short period of time and then chemically neutralized to end the treatment. This procedure rapidly removes the damaged layer of surface skin cells revealing fresh skin, and stimulating cell rebuilding and restructuring of deeper skin layers. This procedure can help the skin appear smoother, healthier, plumper and tighter, with more even pigmentation.
Learn about Crutchfield Dermatology’s Neostrata Facial Peel

2. Get Microdermabrasion

MicroExfoliation is a skin-revitalizing treatment that helps repair skin that is damaged from the sun, scars, acne and the unwanted effects of aging. A trained professional uses gentle abrasion and vacuum to remove the dead, outer layer of skin. MicroExfoliation using the original Crystal Free Diamond-Tome™ wands removes the dead, outer layer of skin by gently exfoliating the skin with natural diamond chips, while vacuuming the dead skin cells away in a clean and controlled manner. Removing the outer layer of dead skin leaves a smoother texture and promotes the growth of healthy new skin cells.
Learn about Crutchfield Dermatology’s MicroExfoliation

3. Begin A Skin Care Regimen

We recommend a comprehensive anti-aging regimen that you use each day. Potent professional products with active benefit ingredients. The NeoStrata Skin Active system is made up of four high-performance products, each formulated to deliver outstanding rejuvenating effects, including significant improvement in the appearance of deep wrinkles, crow’s feet, sagging and uneven pigmentation.
Learn about the Neostrata Skin Care line

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Resurfacing Skin with Microdermabrasion

Microdermabrasion on SkinMicro-exfoliation & HydroPlus Treatments The Revolutionary Solution for Age-Defying Skin

Micro-exfoliation is a skin-revitalizing treatment that helps repair skin that is damaged from the sun, scars, acne and the unwanted effects of aging. A trained professional uses gentle abrasion and vacuum to remove the dead, outer layer of skin.

Micro-exfoliation using the original Crystal Free Diamond-Tome™ wands removes the dead, outer layer of skin by gently exfoliating the skin with natural diamond chips, while vacuuming the dead skin cells away in a clean and controlled manner.
Removing the outer layer of dead skin leaves a smoother texture and promotes the growth of healthy new skin cells.

When To Use Micro-exfoliation:

  • Reduction of minor to moderate early aging and fine lines
  • Minor revision of scars
  • Sun damaged skin
  • Hyper-pigmentation reduction
  • Reduction of acne scars
  • Age spots
  • Extraction of blackhead and whiteheads

Learn all about Microdermabrasion at Crutchfield Dermatology

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A Prudent Approach to Sun

inside science(ISNS) — Dermatologist Joshua Fox’s goal is to keep patients safe from sun damage that can — in extremes — lead to skin cancer. But he realizes that often means striking a balance with patients.

That balance may include limiting the amount of time spent in the sun and avoiding the 10 a.m. to 2 p.m. window of peak sun intensity.

“It’s a negotiation,” said Fox, a practicing dermatologist and a spokesman for the American Academy of Dermatology. “I don’t think you stop living life.”

Colleagues agree with Fox, and note that sun-safe behaviors are vital to protect people from concerns that range from melanoma to premature aging.

“Our position at this time is being outdoors is part of a healthy lifestyle,” said J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society. “[Using] sunscreen is part of that.”

Don’t let sun damage fears stunt summertime fun, experts say.
Originally published:
Jul 3 2012 – 3:15pm
By:
Patricia Quigley, ISNS Contributor

Sun protection

Experts agree that sun-safe behaviors are vital to protect people from concerns ranging from melanoma to premature aging.
Image credit:
Chris J. Nicolini | ISNS
Rights information:
http://bit.ly/LDFc85

 

Lichtenfeld said that each year more than 2 million Americans are diagnosed with skin cancers, the great majority of which are classified as basal or squamous cell skin cancers. His organization estimates that in 2012, 76,250 Americans will be diagnosed with the most deadly form of skin cancer, invasive melanoma, which is more likely to spread than other skin cancers if not detected early. They estimate that in the U.S., 9,180 deaths due to skin cancer will occur this year, most from melanoma.

Litchfield added that sunscreen is not the primary protection people should rely on, and it is often applied improperly or depended on too heavily. He recommends using sunscreen with a sun protection factor, or SPF, of 30 and applying it repeatedly, along with other important barriers such as sun-protective clothing, hats and sunglasses.

Those measures can lessen the impact of excess sun, but sunburns are not the only indicator of sun damage, noted dermatologist Dina Strachan. She developed freckles on her hand soon after moving to the Los Angeles area, and knew the freckles’ significance: sun-induced skin damage.

“It wasn’t like I was out there trying to get a tan. I put sunscreen on my face every day,” said Strachan.

“There can be benefits to being outdoors in the sun, but you don’t want to deliberately tan. Tan skin is a danger signal the skin is being harmed,” Lichtenfeld said in an email.

Sun exposure triggers the production of melanin in the skin, but the resulting tan only partially shields the skin against further damage from the sun’s ultraviolet rays, Vilma Cokkinides, strategic director of Risk Factor Surveillance at the American Cancer Society, wrote in an email.

Health care providers acknowledge that there are some benefits to sun exposure. One of the most talked-about benefits is vitamin D, which forms when ultraviolet rays penetrate the skin, triggering a chain of events in the body that involves the liver and kidneys. Vitamin D is critical to bones, among other things. But the risks of exposure outweigh the benefits.

Carol Drucker, a dermatologist at The University of Texas MD Anderson Cancer Center in Houston, said that most people need 600 international units of vitamin D a day, and food and supplements are the safest way to add it. A 3-ounce serving of salmon, for instance, provides 447 IUs, and an 8-ounce serving of vitamin D-fortified milk provides 120 IUs, she said.

“We know that the sun is a carcinogen. There’s no sense to let sun protection go by the wayside in quest of vitamin D,” Drucker said.

While skin often is the focus when it comes to the sun’s impact on the body, eyes also may be a concern.

Richard Bensinger, an ophthalmologist at Swedish Medical Center in Seattle, said that sunlight is critical to the development and function of eyesight and not normally a threat to eye health. While it is possible to sunburn an eye, it is rare. Sunlight can affect cataract development and macular degeneration, but in day-to-day life the sun is not generally a high risk factor for eye damage.

“Ordinary sunglasses are perfectly fine,” Bensinger said. “The best thing you can do for any kind of health in bright sun is wear adequate sunscreen and wear sunglasses.”

Charles Crutchfield III, a dermatologist based in St. Paul and professor at the University of Minnesota Medical School, favors a pragmatic approach to sun exposure.

“I’m a realist, and I have to have credibility with my patients,” said Crutchfield, who believes telling them to avoid midday sun while on vacation is unrealistic.

“There are many benefits to sun, but you just need to enjoy it responsibly,” added Crutchfield, who noted that the sun may play a role in alleviating Seasonal Affective Disorder and may have other unidentified benefits. He suggested that if individuals are “sun smart,” use protection and avoid tanning and burning it’s acceptable to “go out and have lots of fun in the sun.”

“We were not meant to be mole people,” Crutchfield said.


Patricia Quigley is an award-winning journalist who has written for local, regional, national and international media.


Copyright © 2012 American Institute of Physics. News & media organizations seeking permission to use, republish, reprint or redistribute original ISNS content must fully credit Inside Science News Service as the original source of this content, include the author byline, and use/publish the original, unaltered form (excluding content titles, headlines, or subheadlines). Please link back to the main Inside Science website (http://www.InsideScience.org) in the reprinted/republished content. Copyright conditions and usage terms are subject to change at any time without consent or any type of prior notice. Contact Inside Science at insidescience@aip.org for the latest terms and details.

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Dr. Crutchfield in Dermatology Times

dermatology times logo
Optimize outcomes in patients with skin of color by tailoring therapies

National report — When treating patients with skin of color, dermatologists face a number of challenges, and they must choose products and therapies carefully.

skin careDiagnosis is the first challenge; common dermatological conditions may have a slightly different appearance in skin of color, depending on the hue of a patient’s skin, says Charles Crutchfield III, M.D.

“If you’re used to something looking pink or red and then you see it in brown skin, it looks completely different,” says Dr. Crutchfield, clinical professor of dermatology, University of Minnesota Medical School, Minneapolis/St. Paul, and medical director of Crutchfield Dermatology, Eagan, Minn.

Furthermore, dermatologists will encounter a number of conditions more commonly found in patients with skin of color, such as papular pityriasis rosea, razor bumps and keloids, he explains.

“One of the most significant things is the postinflammatory discoloration, both lighter and darker, that you see in inflamatory pearlsskin of color,” Dr. Crutchfield says. “Any time there is inflammation or injury you can have dramatic change in skin color — usually darker, but sometimes lighter, that has to be managed. Sometimes it can take months to correct.”

Weighing options

To help prevent postinflammatory hyperpigmentation, it’s important to choose the right skincare products, says Zoe Draelos, M.D. Preparations that are recommended in white patients may not be suitable for patients with skin of color.

“The most important concern that’s different from Caucasian skin is that you have to be sure that the products that you recommend, whether they’re prescription or over-the-counter … cause absolutely no irritation of the skin at all,” says Dr. Draelos, consulting professor of dermatology, Duke University School of Medicine, Durham, N.C., who is also in private practice in High Point, N.C.

For example, Dr. Draelos says, over-the-counter acne products containing benzoyl peroxide can be irritating in Asian, Latino and African-American patients and ultimately darken the skin. In addition, exfoliants containing glycolic acid or scrubs containing granules or beads also can irritate the skin, resulting in postinflammatory hyperpigmentation, she says.

Managing acne

In patients with acne, Dr. Crutchfield explains to them that postinflammatory changes can be a particular problem with skin of color. Therefore, they need to understand that he must address the inflammatory papules and pustules as well as the postinflammatory hyperpigmented macules that remain after acne heals. Unfortunately, patients with these macules often believe their acne has returned.

In addition to relying on products that are not irritating, Dr. Crutchfield uses anti-inflammatory products to prevent irritation. To manage dyspigmentation, he uses a combination of alpha hydroxy acids and high-dose hydroquinone or hydroquinone metabolites. He also uses a product compounded by his pharmacist that contains hydroquinone, vitamin C, retinol, kojic acid and a steroid.

A number of new products are being used to manage dyspigmentation of the skin. “Many companies are trying to get away from hydroquinone because of the safety issues that have been raised,” Dr. Draelos says. Therefore, physicians are turning to products such as arbutin and deoxyArbutin, kojic acid, lignin peroxidase (Elure, Syneron/Candela), and licorice extract products such as glycyrrhizic acid, she says.

“Sometimes, people will use a bearberry extract if they’re looking for something in the botanical realm,” she adds.

To address concerns in this population, Dr. Draelos says, cosmetic companies are testing products in people with skin of color before they go on the market. “Usually when we test a new cosmetic, we use a broad, multiethnic panel,” she says.

Furthermore, companies work to formulate products with ingredients that have a low potential for irritation and may include an anti-inflammatory to prevent irritation before it occurs, she adds.

Optimizing results

When treating dyspigmentation, Dr. Draelos educates patients about the importance of using sunscreens. “If the sun is darkening the skin and you’re using these products to try to lighten the skin, you find that you end up nowhere,” she says. “So sunscreen is very, very important, and sun avoidance is very important also.”

To maintain skin quality and health, Dr. Crutchfield also suggests moisturization and hydration. “I recommend a good moisturizing lotion that contains ceramides at least twice a day, but especially after bathing,” he says. “That goes a long way to correct dermatitis associated with dry skin.”

He suggests a combination of CeraVe Moisturizing Cream (Coria) and Vanicream Cleansing Bar (Pharmaceutical Specialties), which doesn’t strip away the skin’s natural oils.

Dr. Draelos says she finds that patients with skin of color often want to try other products.

“So I tell them to put a very, very small amount in front of their ear for five nights in a row, and if they have no trouble there, then they can use it broadly over their face.”

Following this course can sometimes prevent overall facial problems. “Predicting a problem before it occurs is always the best way to deal with it,” she says.

Disclosures: Drs. Crutchfield and Draelos report no relevant financial interests.

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Careful Attention to Aging Skin

aging well magazineCareful Attention to Aging Skin

By Jaimie Lazare
Aging Well
Vol. 5 No. 5 P. 18

Aging makes skin more susceptible to dryness. Dry skin in older adults can be simply a sign of age-related skin changes or signify underlying medical problems. Because dry skin can lead to other skin complications, it’s important to monitor carefully.

If older adults’ skin appears rough, scaly, flaky, or cracked, this can indicate xerosis, or dry skin. Although dry skin can affect anyone, it’s particularly common among older adults. Age-related dermal changes such as a thinner epidermal layer, a reduction in skin cell turnover, and the skin’s limited capacity to retain moisture contribute to xerosis.1 Over time, skin loses its suppleness, yet such physiological changes alone don’t determine whether a patient will develop dry skin. Other factors such as the environment, genetics, and ethnicity are also contributing factors.

Skin loses its elasticity as the production of collagen and elastin decreases. Additionally, hyaluronic acid isn’t produced at the same rate as in earlier stages of life, creating an imbalance between the production of hyaluronic acid and its breakdown by enzymes. Because of these changes, skin becomes progressively thinner, more fragile, less elastic, and drier. Even the natural oil-producing sebaceous glands gradually lose their ability to moisturize the skin. All of these physiologic changes contribute to the development of drier skin as people age, says Charles E. Crutchfield, III, MD, a clinical professor of dermatology at the University of Minnesota Medical School and medical director of Crutchfield Dermatology.

Even as early as the age of 40, the skin becomes more susceptible to drying. Lipids primarily act by preventing evaporation of the natural moisture in the skin, providing a barrier to water loss. Without adequate lipids, people simply lose too much water from the skin and it dries out, according to Jamie B. MacKelfresh, MD, an assistant professor in the dermatology department and director of the Dermatology Residency Program at Emory University School of Medicine in Atlanta.

Underlying Causes
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.

Crutchfield notes that older adults’ skin has an increased tendency toward dryness because of the decreased production of moisturizing sebaceous oils. As a result, the practice of taking long hot baths or showers without the application of a moisturizer or emollient immediately afterward is a common contributor to drying out older adults’ skin. Also, some older adults were raised to do a lot of scrubbing, washing, and extra cleansing of the skin, but exfoliants, harsh cleansers, and alcohol-based products such as astringents further dry aging skin that’s already predisposed to dryness, MacKelfresh says. These products remove more of the essential skin oils necessary to help keep the skin moist and retain water.

It’s also important to warn patients against using a lot of waterless antibacterial cleansers since these also contain alcohol that can dry out the skin. Even over-the-counter antiaging creams can be quite drying and actually harsh on the skin.

Assessing Xerosis
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated with dry skin.3

“A common symptom of dry skin is itching, and severe itching can lead to an itch-scratch-rash-itch cycle. The skin may become thickened in these areas from rubbing, and repeated skin rubbing in the same area may lead to chronic skin conditions called lichen simplex chronicus and prurigo nodularis,” says Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.

Crutchfield stresses the importance of asking patients how long they have been dealing with dry skin. Assessing the duration of the skin dryness is important because it may be a condition called ichthyosis, which is a congenital defect that can develop with time and aging. If the dry skin appears to be severe or has occurred suddenly, it would require further investigation, he says.

MacKelfresh agrees on the importance of identifying the time of onset. “If somebody comes on with brand new dry skin that sort of came out of nowhere, then that is a clue that we might want to look into other things. For instance, heat stroke could be an underlying disease that is causing dry skin. Also, fungal infections of the skin can be a common cause, particularly in nursing homes and other care settings. So if it’s new and different, we definitely need to pay attention to make sure we’re not missing something else,” she says.

Many older adults may not be bothered by their dry skin. While performing a general exam, physicians will likely see dry skin on the legs. After looking at the legs, be sure to examine a patient’s arms. Ask whether he or she is experiencing flaking, itchy, irritated, or even sore skin, MacKelfresh says.

Crutchfield notes that while assessing dry skin is fairly easy, there are some rare issues physicians need to be aware of, especially in patients of color. On the lower leg, a condition called ichthyosiform sarcoidosis can occur, also with generalized exfoliating dermatitis, which can be confused with dry skin. Under these circumstances it’s appropriate to look for internal malignancy, according to Crutchfield.

While studies addressing the differences in ethnic skin are limited, one study has reported greater transepidermal water loss and desquamation in African American skin.4 Pichardo-Geisinger says that while transepidermal water loss appears to occur more in African Americans due to the characteristics of the stratum corneum and reports have pointed out that people of Anglo-Saxon origin have more fair, dry thin skin, the clinical focus doesn’t rely heavily on such factors. “I believe dry skin is due more to internal or external factors than race or ethnicity,” she says.

Conservative Treatment to Start
“We almost always start patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.

“If that’s still not working, then there are some other products that contain alpha-hydroxy acids, which will help break down some of those thickened, dry skin cells. And you can find some of those over the counter. Beyond that … there are sometimes areas where you actually need to calm the skin inflammation with a cortisone-based cream,” MacKelfresh says.

Crutchfield recommends that his patients gently pat dry their skin with a cotton towel after a bath or shower, then apply a liberal amount of emollient moisturizing lotion. “The most important thing in preventing dry skin is using a gentle cleanser that does not contain harsh detergents, such as Vanicream cleansing bar and a good moisturizing emollient such as CeraVe cream or AmLactin XL lotion,” he says.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.

“I recommend a fragrance-free regimen,” Pichardo-Geisinger says, “which consists of mild soaps and moisturizing lotions on a regular basis, particularly over-the-counter products with ceramides, such as Cetaphil Restoraderm or CeraVe, and products with oatmeal, like Aveeno Eczema Therapy; Vaseline Clinical Therapy is also excellent. A lactic acid lotion will improve the skin condition. Excellent over-the-counter products such as AmLactin 12% or Aqua Glycolic, which restore the skin’s adequate moisture balance, are recommended. In some cases a topical steroid cream needs to be used.”

As a precaution, only mild corticosteroid creams such as hydrocortisone should be applied to sensitive skin areas, which include the face, underarm, and groin. Using strong corticosteroid creams such as clobetasol for a long period of time may lead to skin problems such as thinning, stretch marks, and skin breakdown.5

Pichardo-Geisinger recommends that older adults avoid strong soaps and detergents, wear cotton and natural fiber clothing, avoid wool clothing, drink plenty of water, use a humidifier in the home when necessary, and limit sun exposure.

Special Cases
MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s body but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.

MacKelfresh concluded that her patient’s condition was caused by the seasonal change, and her xerosis had transformed into dermatitis. She prescribed a topical steroid cream and provided the patient with careful instructions to use only gentle soap, take short warm (never hot) baths or showers, and apply a thick moisturizer within three minutes of bathing. By her four-week follow-up appointment, the patient’s skin had improved dramatically, and she no longer needed the steroid cream.

It’s important to carefully evaluate patients’ dry skin, particularly those with preexisting conditions such as diabetes or dementia. For those patients, be sure to do a thorough exam by looking for dry skin areas before they become problematic. “In a diabetic patient, if it’s left too long and they’re already having foot ulcers, more dry skin could just make them more prone to dermatitis and ulcers,” MacKelfresh says. “Make sure the caregiver in the situation of a patient with dementia or the physician who’s caring for a diabetic is also on board with your plan. So utilizing multiple members of the team is going to be key in those scenarios as well.”

Whether or not older adults are able-bodied and mobile, Crutchfield suggests using triamcinolone cream twice per day for one week to control itching in dry skin with an inflammatory component.

As the number of baby boomers in the United States grows, it is becoming increasingly important for clinicians to recognize and treat elder patients for skin problems. While prevention is key, treating dry skin is fairly easy and affordable.

— Jaimie Lazare is a freelance writer based in Brooklyn, New York.

 

Advice for Patients
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:

Wash gently. Avoid hot baths, frequent showering or bathing, and excessive skin scrubbing. Keep the water warm because hot water tends to strip away the natural oils produced by the skin. Use mild cleansers for the face and body such as Dove unscented, Cetaphil Restoraderm, CeraVe, or Aveeno. Avoid overwashing with harsh soaps and overusing alcohol-based products such as sanitizers and cleansing agents that are drying to the skin.

Hydrate skin. Keeping dry skin hydrated is the best way to avoid potential problems such as itchiness and cracking. The best recommendation is to use a fragrance-free moisturizer. Among the effective products available over the counter are Cetaphil Restoraderm, CeraVe, Aveeno Eczema Therapy, Vaseline Clinical Therapy, AmLactin 12%, and Aqua Glycolic.

Prevent itch. Elderly skin care is all about preventing dry skin. Aging skin requires special attention because it’s prone to dryness, which leads to itch and scratching. Moisturizing the skin will keep it hydrated and help to prevent the itch-scratch-rash-itch cycle.

Pay attention. Examining elderly patients should always include evaluating their skin for signs of cancer or other conditions. Be sure to look for new growths or moles that appear to be changing. Identify skin changes such as peeling, chapped, red, or pruritic skin.

Check patients’ feet. In older individuals the skin of the feet often gets dry and becomes susceptible to corns, calluses, warts, and fungal infections. Inspect patients’ feet and remind them (or their caregivers) to examine their feet. It is important to check the feet regularly, especially in patients with diabetes.

— JL

 

References
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.

2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.

3. Lazare J. Ambiguous itching. Aging Well. 2011;4(3):22-24.

4. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860.

5. Cole GW. What is the treatment for dry skin? http://www.medicinenet.com/dry_skin/page5.htm. Last reviewed January 18, 2012. Accessed July 1, 2012.

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