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Nearly 40% of us in Europe deem our skin to be dry. And we are often mistaken about the nature of this dry skin, as well as about the solutions to be implemented to relieve our discomfort. Did you know that there are several types of dry skin, with many differences to set each of them apart? This is what dermatologist Mélissa Mignard explained at Cosmed’s 12th JEST (Days of Scientific and Technical Exchanges), which were held on 12 October 2012 in Montpellier.

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According to a study carried out in 2007 of 4,506 people over age fifteen in eight European countries, 37.9% declare having dry skin. Of those, 48% suffer from atopy or from allergic contact eczema, 10.4% suffer from seborrhoeic dermatitis, and 8.5% suffer from rosacea. 52.4% also have sensitive or very sensitive skin, and all complain of discomfort. The problem is not insignificant.

Do you have ‘real’ dry skin?

Be careful: dry skin and dehydrated skin are often confused, but they are not the same thing.
• ‘Real’ dry skin is a permanent state of the skin, and it affects both the face and body. It is an alteration of the barrier function. It is the sign of dysfunctional physiopathological balances, which much be restored in order to repair the barrier. This is a job for a dermatologist.
• Dehydrated skin experiences only passing dryness. It can affect all skin types, even oily skin. It can be a sign of temporary acute water loss, or it can be the result of poor treatment, such as overly aggressive washing, scrubbing, or exfoliation, which alters the surface hydrolipidic film, thereby increasing water loss in the skin. It is also uncomfortable, but can be reversed rather easily, particularly with gentle daily care and a few suitable cosmetics.

Once this distinction is made, the different types of dry skin must be distinguished. Xerosis (the medical term for dry skin) can have an array of very different causes.

Constitutional xerosis

This type of xerosis is caused by problems in the way the body functions, which may be caused by different factors.

Infantile xerosis
This affects babies and children up to about age 8. Due to weak sebaceous secretions (which occur until the sebaceous glands are fully mature), the surface hydrolipidic film is not strong enough to effectively counteract the phenomena of dehydration. Gentleness in hygiene and good moisturisers are recommended. On this topic, also see the article entitled ‘ Do we wash our babies too much? ’.

Senile xerosis
This affects more than 1.5 million people aged 85 or over in France, and is a classic consequence of ageing. It is sometimes referred to as dermatoporosis, an analogy with osteoporosis, and manifests as intense itching, causing sufferers to scratch themselves. The very thin skin of the elderly can be altered easily, and one can quickly see scarring, spontaneous haematoma, and lesions of varying sizes. An effective treatment is a cream with a high concentration of hyaluronic acid.

Atopic xerosis
Atopy is a recurring inflammatory illness. It is characterised by a deficit in the cutaneous barrier and a ceramide deficiency, in combination with an immune system anomaly (Th2). It occurs in hereditarily predisposed people, who have a first-degree relative with atopy, or in patients who are sensitive to allergens. It affects 20% of children, or one out of five babies, and is associated with dry skin, itching, and eczematous lesions. It is crucial to use very gentle hygiene products that respect the hydrolipidic film. Atopy tends to disappear with age, but generally, people who had it as children will still have dry skin as adults.

Ethnic xerosis
This tends to develop in people with African skin who move to countries where humidity levels differ from those of their country of origin. To adapt, the stratum corneum becomes more compact, desquamation increases, and the affected person will attempt to remedy the problem first by increasing hygiene (more showers, exfoliation, etc.). Again, respecting the hydrolipidic film and providing complementary hydration are the best courses of action.

Xerosis caused by external factors

This is due to external factors with different causes.

Cosmetics
Too much hygiene is not necessarily a good thing. It can destabilise the skin, especially if it is practiced with products that are too harsh or strip away too much oil. Mélissa Mignard reminds us that before hydrating the skin, one must first avoid dehydrating it.

Climate
Winter xerosis is most commonly experienced by women. There are variations in the skin’s lipids, in the hydration factors, and in the hydrolipidic film, with an increase in insensitive water loss and abnormal desquamation. This dysfunction manifests in the appearance of scurf patches or eczema located between the knee and the ankle. Very painful patches may develop in the elderly with cracking eczema in particular. More than ever in the winter, the dermatologist recommended, it is important to respect the stratum corneum: showers mustn’t be too hot, hygiene products must not be used in excess, and emollient and reparative products must be used liberally.

Medicines
Taking certain medicines, especially those used in regulating cholesterol or for cardiac illnesses, will automatically result in dry skin. None of these drugs should be prescribed without moisturisers, pointed out Mélissa Mignard.

Fungal infections
Seborrhoeic dermatitis is the epitome of infections triggered by fungus or yeast. The culprit here is Malassezia, which lives naturally on our skin and is lipophilic, which means it proliferates in areas where sebum is the most abundant. It can create recurring inflammation and is associated with major desquamation. It affects 1 to 3% of the population. An antifungal product prescribed by a physician and a good moisturiser make up the basic treatment.

Rosacea
Highly disabling, rosacea particularly affects adult women aged 30 to 40. This chronic, vascular inflammatory disease affects at least 4 million people in France. But this number is undoubtedly under-estimated, as the disease is hard to ‘admit to’. It takes the form of exacerbated redness on the nose and cheekbones, combined with thickened skin on the nose. Because of this, sufferers may be mistaken for alcoholics. Rather than masking the problem with a thick layer of make-up, rosacea can be treated with antibiotics (cyclines) and proper hydration.

Keratinisation disorders

Keratinisation is the process in which living cells in the skin die off and ‘rise’ to the surface of the epidermis to be shed.

Vulgar ichthyosis
This is caused by the mutation of the coding gene for filaggrin (a skin protein) and takes the form of fine scales spread over the whole body, with an extension on the palms of the hands and soles of the feet.

X-linked ichthyosis
X-linked ichthyosis only affects men, and it is triggered by a steroid sulfatase (a skin enzyme) deficiency. It is characterised by black polygon-shaped scales.

Psoriasis
 3 million French citizens suffer from this chronic inflammatory dermatosis, which is marked by the abnormal proliferation and differentiation of keratinocytes and is associated with dry skin.

Keratosis pilaris
Keratosis pilaris develops around the hair follicles and is frequently located on the back of the arms. It is marked by the development of small red bumps which give the skin a rough appearance.

Whatever its nature, whatever its cause, dry or ‘simply’ dehydrated skin must not be taken lightly. It is skin that is in poor health, and this may have repercussions on one’s overall health.
In the most serious cases, it is often necessary to visit a dermatologist. In daily life, good habits and well-chosen cosmetics are also needed to preserve the skin’s natural hydration, a factor in beautiful, healthy skin.

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