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What Is Xerosis, and Could It Be Responsible for Your Acne?

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

Xerosis (pronounced zee-roe-sis) is a chronic condition of dry skin. It’s more common in the elderly than it is in other age groups. One of the odd symptoms of xerosis is the development of acne. Even if you didn’t get whiteheads and blackheads at the age of 17, you just might at 47 or 57 or 67 or 77 if you don’t keep xerosis under control.

Dry Skin Acne
Chronically dry skin known as Xerosis may be a symptom of some types of acne.

How The Skin Keeps Moist

The task of keeping moisture in the skin and admitting tiny amounts of moisture into the skin falls to the layer of skin known as the stratum corneum. Most of the cells in the stratum corneum have reached the end of their life cycle, the DNA in their nuclei and the activities of their organelles already shut down. Since they don’t need to continue to absorb nutrients and food, the cell membranes break down into a substance called ceramide.

It is ceramide that both absorbs and retains moisture1, and holds this outermost layer of the skin together. The living cells just below the stratum corneum have an ability to “pump” water in and out so that we never become waterlogged while taking a bath or a shower or a swim. Ceramide is the substance that makes our skin wrinkle when we spend a long time in water.

Why The Skin Dries Out

There are certain causes of dry skin that affect just about everyone more or less equally. Here are just a few2:

And there are certain causes of dry skin that link back to disease conditions.

The skin absorbs moisture into ceramide. In turn, ceramide forms as skin cells mature and break down at the end of their life cycle. If some disease condition interferes with the production of new skin cells, then at some point there won’t be enough old skin cells to break down into ceramides. The skin will dry out and flake, usually causing itchiness.

Some conditions can interfere with the normal production of skin cells at any time during life. Eczema (also known as atopic dermatitis) causes dry skin, as do hypothyroidism and kidney disease. Psoriasis causes dry skin through a different process. Psoriasis causes skin cells to multiply so quickly that they stack up on the skin, unable to receive oxygen and nutrients, dying in large numbers and causing peeling and itch.

The most common health condition that causes dry skin after the age of 50, however, is something most people have never heard of. It’s a condition called venous insufficiency. Venous insufficiency can cause flaking and itching of the skin that can be almost unbearable4 if it’s not treated, and make large patches of skin so tight that the skin that doesn’t flake away is infested by blackheads.

What Is Venous Insufficiency?

The veins carry blood back to the heart. Veins in the lower half of the body use valves to ensure that blood flows against gravity back to the heart. When high blood pressure is left untreated for a long time, the valves begin to fail5 and the tissues they serve begin to die. Itchy skin is usually a sign of superficial venous insufficiency in which the smallest veins fail and skin fails to regenerate but deeper, larger veins continue to supply the muscles beneath the skin.

The first places venous insufficiency will cause dry skin are the shins and heels, and then the tops of the feet and the calves of the legs. On the legs there can be drying skin and then skin wounds that take a long time to heal. The toenails may start growing very slowly and become too tough to trim. Blackheads that just won’t come out of the skin are a sign of advanced disease.

What Can You Do About Venous Insufficiency?

Moisturizer only treats one symptom of venous insufficiency, but you should use a lot of it nonetheless. Keeping your skin moist and smooth helps prevent infections that in some cases can even lead to amputation of the leg.

Even more important than moisturizer is wearing compression stockings. These garments are tighter at the toes and looser at the middle of the calf, forcing blood back up into the leg as it is needed. They are very different from the bandages that are sometimes used for venous sufficiency. It is absolutely critical that the compression stocking does not act as a tourniquet at the middle of the leg (or the middle of the thigh, in some stockings). The stocking has to force blood up but also allow it to flow back down. The compression stockings used in hospitals to prevent blood clots after surgery do not have enough pressure to make a difference in venous insufficiency.

And what else can you do to prevent skin damage caused by venous insufficiency?

  • Avoid standing in place or sitting in the same position6 for long periods. Locking the knees makes it difficult for blood to flow back to the heart through the veins.
  • If your leg muscles are still intact, use them as much as you can. Walking, swimming, and bicycling are all great activities for people who have chronic venous insufficiency.
  • Moisturize every day. Even if your skin looks fine, use moisturizer. The best time to moisturizer is right after you towel off from your shower. Taking a shower briefly increases the moisture content of your skin about 500%. You need to remove any visible drops of water from your skin, but putting a moisturizer on your skin just as soon as your towel off helps the ceramides in your skin retain that moisture.
  • Skin-identical ingredients, often labeled as ceramides, are desirable in any moisturizer7 you use on your legs.
  • If you develop an infection, see a doctor right away. Antibiotic creams usually don’t do much good when the underlying problem is insufficient circulation to your skin.

References:

  1. Coderch L., López O., de la Maza A., Parra J.L. Ceramides and skin function. American Journal of Clinical Dermatology. 2003;4(2):107-29.
  2. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. Journal of the European Academy of Dermatology and Venereology. 2007;21Suppl2:1-4.
  3. Mukhopadhyay P. Cleansers and their role in various dermatological disorders. Indian Journal of Dermatology. 2011;56(1):2-6.
  4. Duque M.I., Yosipovitch G., Chan Y.H., Smith R., Levy P. Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. Journal of the American Academy of Dermatology. 2005;53(3):504-8.
  5. Patel S.K., Surowiec S.M. Venous Insufficiency. StatPearls. 2019.
  6. Azma K., Mottaghi P., Hosseini A., Salek S., Bina R. Venous insufficiency after prolonged standing: Is joint hypermobility an important risk factor?. Advanced Biomedical Research. 2015;4:98.
  7. Lynde C.W., Andriessen A., Barankin B., Gannes G.D., Gulliver W., Haber R., McCuaig C., Rajan P., Skotnicki S.P., Thomas R., Toole J., Vender R. Moisturizers and Ceramide-containing Moisturizers May Offer Concomitant Therapy with Benefits. The Journal of Clinical and Aesthetic Dermatology. 2014;7(3):18-26.
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