Dry and Dehydrated Skin

Skin dryness and dehydration are common, and although they are separate skin concerns the two are closely linked2,5.  If the skin is dry it will inevitably lead to dehydration, and if the skin is dehydrated, it can lead to skin dryness2,11.  Dehydration refers to a lack of water in the skin, whereas dryness refers to a lack of skin lipids and water due to a poorly functioning skin structure and physiology4,8,11.

Keeping the skin hydrated is essential as all biological processes, even those within the skin, rely on its presence1,4,11.  Without skin hydration, enzymes required for skin cell production and barrier function maintenance cannot function optimally leading to the formation of dry skin4,10,11.

 

The ability of the skin to maintain hydration relies mostly on two aspects:

1. The natural moisturising factor within the skin and its ability to hold water

2. The barrier function of the skin1,5,10,11

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Skin hydration is also influenced by the amount of sebum present on the surface of the skin, acting an extra barrier to water loss1,3.  Within the second layer of the skin, the dermis, it is hyaluronic acid that is important for the maintenance of hydration in this region11.

Causes of skin dehydration and dryness may include:

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• Air-conditioning: these systems reduce environmental humidity when used in both cooling and heating states, which draws water from the skin1,2,5,10,11

• Environmental and seasonal changes: low humidity, cold weather, exposure to wind2,4,5,8,9,10,11

• Ageing: as we age our skin barrier depletes, physiological function decreases, sebum production slows and natural moisturising factor levels are decreased, hence skin dryness and dehydration may result1,2,3,5,9,10

• UV exposure can lead to the decrease in production of filaggrin, which is an essential structural protein involved in developing our skin barrier lipids. Without these lipids, our barrier function is compromised hence it can become rapidly dehydrated and dry. UV exposure also decrease the levels of natural moisturising factor within the skin1,5,8,10,11

• Hormones: during menopause as oestrogen and progesterone levels decline there is an increase in skin dryness and dehydration10

• Mechanical disturbance of the skin barrier: scratching, rubbing of clothes or injury8,10

• Frequent skin washing with use of harsh detergents: can strip skin lipids and moisture via a reduction in the level of natural moisturising factor and skin lipids2,8,9,11

• Sodium lauryl sulphate and other detergents can increase water loss2,8,9

• Chronic diseases such as psoriasis, atopic dermatitis and diabetes1,2,5,8,10

• Malnutrition inclusive of a low protein diet10

• Psychological stress4,10

• Medications10

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Symptoms of dry skin may include:

• Scaly, flaky, rough skin

• Faint inflammation

• Dullness

• Itching

• Redness

• Tightness

• Skin cracking

• Increased incidence of skin tears, infection, dermatitis and pressure ulcers especially in the elderly2,3,4,5,8,9,10,11

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Treatment for dry and dehydrated skin is firstly focussed on prevention and then followed by maintenance2,3,5.  The optimal strategy involves moisturisation through the application of topical skincare products to rehydrate and nourish the skin, with a focus on repairing the skin barrier to reduce further water loss and subsequent dehydration1,2,5,9,11.

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Moisturisers have multiple actions on the skin and at various depths, depending on their formulation4.  They contain emollients and humectants, which soften and smooth, and draw water and hold it into the skin respectively4.  Skin cells can swell up to 50% when they are fully hydrated, such as in a humid environment6.  When the skin is hydrated, it is more supple due to an improvement in flexibility, strength and elasticity1,4,6.

To manage dry skin it is also important to use mild cleansers and avoid the use of soap due to its alkaline pH further drying out the skin2,3.  When cleansing or washing the body, it is recommended to shower or bathe with lukewarm water to prevent further dehydration2,3.

Common skincare ingredients incorporated into emollient and humectant moisturisers include glycerin, ceramides, macadamia oil, hyaluronic acid, dimethicones, triglycerides, cocnut oil, shea butter, olive oil, squalane, niacinamide, allantoin, urea, essential fatty acids, alpha hydroxyl acids, sodium PCA and vitamin E2,3,4,8,9.

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It is also suggested that drinking 6-8 glasses of water per day will influence skin hydration positively1. There is minimal high quality research that has been performed in this specific area, however a common theme is that if you increase your water intake when previously it was low, it may lead to a small increase in skin hydration1,7.

 

1Akdeniz, M., Tomova_Simitchieva, T., Dobos, G., Blume_Peytavi, U., & Kottner, J. (2018). Does dietary fluid intake affect skin hydration in healthy humans? A systematic literature review. Skin Research and technology, 24(3), 459-465. doi: 10.1111/srt.12454

2Berardesca, E., Mortillo, S., Camelli, N., Ardigo, M., & Mariano, M. (2018). Efficacy of a shower cream and a lotion with skin-identical lipids in healthy subjects with atopic dry skin. Journal of Cosmetic Dermatology, 17(3), 477-483. doi: 10.1111/jocd.12668

3Lichterfeld-Kottner, A., Lahmann, N., Blume-Peytavi, U., Mueller-Werdan, U., & Kottner, J. (2018). Dry skin in home care: a representative prevalence study. Journal of Tissue Viability, (2018), 1-6. doi: 10.1016/j.jtv.2018.07.001

4Loden, M. (2003). Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. American Journal of Clinical Dermatology, 4(11), 771-788.

5Masaki, H., Yamashita, Y., Kuotani, D., Honda, T., Takano, K., Tamura, T., Mizutani, T,m & Okano, Y. (2018). Correlations between skin hydration parameters and corneocyte-derived parameters to characterize skin conditions. Journal of Cosmetic Dermatology, (2018), 1-7. doi: 10.1111/jocd.12502

6Mojumdar, E. H., Pham, Q. D., Topgaard, D., & Sparr, E. (2017). Skin hydration: interplay between molecular dynamics, structure and water uptake in the stratum corneum. Scientific Reports, 7(1), 1-13. doi: 10.1038/s41598-017-15921-5

7Palma, L., Marques, L. T., Bujan, J., & Rodrigues, L. M. (2015). Dietary water affects human skin hydration and biomechanics. Clinical, Cosmetic and Investigational Dermatology, 8(), 413-421. doi: 10.2147/CCID.S86822

8Proksch, E., & Lachapelle, J.-M. (2005). The management of dry skin with topical emollients – recent perspectives.  Journal of the German Society of Dermatology, 3(10), 768-774. doi: 10.1111/j.1610-0387.2005.05068.x

9Shim, J. H., Park, J. H., Lee, J. H., Lee, D. Y., Lee, J. H., & Yang, J. M. (2016). Moisturizers are effective in the treatment of xerosis irrespectively from their particular formulation: results from a prospective, randomized, double-blind controlled trial. Journal of the European Academy of Dermatology and Venereology, 30(2), 276-281. doi: 10.1111/jdv.13472

10Toncic, R. J., Kezic, S., Hadzavdic, S. L., & Marinovic, B. (2018). Skin barrier and dry skin in the mature patient. Clinics in Dermatology, 36(2), 109-115. doi: 10.1016/j.clindermatol.2017.10.002

11Verdier-Sevrain, S., & Bonte, F. (2007). Skin hydration: a review on its molecular mechanisms. Journal of Cosmetic Dermatology, 6(2), 75-82. doi: 10.1111/j.1473-2165.2007.00300.x