Xerosis: Recognition & Management of Severe Dry Skin

In this article, Dermal Therapy tackles the challenging condition of severe dry skin (xerosis), bringing you expert insights from Amit Saha, Registered Pharmacist and Head of Technical & Innovation at Dermal Therapy.

Key Takeaways:

• More Than Moisturiser: Persistent xerosis may indicate impaired skin barrier function and often requires targeted management beyond standard moisturisation. In simple terms, if your skin stays dry no matter how much you moisturise, there may be something deeper going on that needs a more targeted approach.
• Multiple Triggers: Xerosis can be triggered by environmental factors, systemic conditions like diabetes, medication side effects, and underlying dermatological conditions such as atopic dermatitis or psoriasis.
• Know the Signs: Key symptoms include scaling, skin roughness, erythema (redness), pruritus (itching), tightness, and fine fissuring – particularly on the extremities.
• Urea is Key: Standard moisturisers may not be enough. Keratolytic emollient formulations containing Urea improve hydration while facilitating desquamation of hyperkeratotic skin – in other words, they help soften and gently shed the build-up of thickened, rough skin that traps dryness underneath, while locking moisture back in.

What is xerosis?

Xerosis, commonly referred to as severe dry skin, is a frequently encountered dermatological condition that can significantly affect skin integrity, comfort and quality of life. While mild dryness is common, persistent xerosis may indicate impairment of the skin barrier and often requires targeted management beyond routine moisturisation. Think of the skin barrier as a protective seal – when it’s compromised, moisture escapes and irritants get in more easily.

What causes xerosis?

A range of intrinsic and extrinsic factors may contribute to xerosis. Environmental exposure to low humidity, cold climates, excessive bathing and harsh cleansing agents can disrupt epidermal hydration – essentially stripping the skin of its natural moisture faster than it can replenish.

In addition, xerosis may occur secondary to systemic conditions such as diabetes mellitus, where altered sweat gland function and reduced skin hydration are common.

Medication-induced xerosis is also well recognised, particularly with treatments such as systemic retinoids, oncology therapies and other agents associated with reduced sebaceous activity or epidermal turnover. Several dermatological conditions such as atopic dermatitis, psoriasis or keratosis pilaris are commonly associated with xerosis too.

What does xerosis look like?

Clinical presentation may include:

• Diffuse scaling and flaking
• Skin roughness
• Erythema and irritation (redness and inflammation)
• Pruritus (persistent itching)
• Sensations of tightness
• Fine fissuring, particularly affecting the extremities (small cracks or splits in the skin, most commonly on the hands, feet and lower legs)

Early recognition and intervention are important to minimise progression, reduce discomfort and decrease the risk of secondary bacterial infection resulting from impaired skin barrier function. Cracked or broken skin can create an entry point for bacteria, so addressing dryness early is important.

How should xerosis be managed?

Management should focus on restoration of the epidermal barrier and maintenance of skin hydration. Standard cosmetic moisturisers may provide insufficient benefit in moderate to severe xerosis. In these cases, keratolytic emollient formulations containing ingredients such as Urea may assist by improving hydration while helping to shed the build-up of thickened, dead skin cells. This means using a moisturiser that does more than sit on the surface – one that actively deeply hydrates the layers underneath at the same time.

Alongside targeted moisturisation, there are a few simple habits that can make a real difference. Swap harsh soaps for a soap-free cleanser, keep showers shorter and lukewarm rather than hot, and apply your moisturiser as soon as you get out of the shower or bath to lock in hydration while your skin is still damp.

The Dermal Therapy Very Dry Skin Range

When managing xerosis, targeted topical therapy is key. Dermal Therapy’s Very Dry Skin range offers a complete system designed to restore the skin barrier, improve hydration and address the underlying causes of severe dryness.

• Very Dry Skin Wash A nourishing soap free wash designed to cleanse, hydrate and soften very dry skin. Hypoallergenic and SLS free, it combines rich emollients with urea to gently exfoliate without stripping the skin of its natural oils.
• Very Dry Skin Cream A thick and rich body cream with 12.5% urea and 1% dimethicone, offering a rich blend of emollients for intensive moisturisation. Clinically proven to increase skin hydration by 52%, with visible results in just 1 day. 
• Very Dry Skin Lotion An ultra-hydrating, light lotion ideal for dry and cracked skin, containing 10% urea, 1% dimethicone and vitamin E. Non-greasy and quick absorbing, it keeps skin feeling hydrated and smooth for 24 hours.

Further Reading:
Explore more expert content from Dermal Therapy:

• Why Urea is the Magic Ingredient for Preventing & Treating Cracked Heels 
• Xerosis or Very Dry Skin
• From Dry to Dewy – Dr. Michela Sorensen’s Tips for Dry Skin
• Moisture Matters: Unlocking the Secret to Hydrated Skin with Dermal Therapy’s Very Dry Face Cleanser
• Managing Dry Skin with Diabetes: Moisturising & Tips