This review discusses aging-associated alterations in epidermal function leading to xerosis and related pruritus and maintaining or restoring a healthy skin barrier using skincare, specifically ceramides-containing (CER-containing) skincare.
MATERIALS AND METHODS
The project used a modified Delphi process comprising face-to-face discussions followed up online.11,12
Literature Review
The structured literature searches (01 August 2022) on PubMed and Google Scholar, as a secondary source, of the English-language literature (2010--July 30, 2022) were performed by a dermatologist and a physician/scientist (searchers). Additionally, the searchers manually reviewed the selected literature for additional resources. The searches prioritized studies on mature skin xerosis, SC barrier function, and skincare benefits using cleansers and moisturizers. The searches for mature* skin included senile xerosis, xerosis in aging skin, and xerosis in the elderly, and explored present clinical guidelines, treatment options, and therapeutic approaches addressing mature skin xerosis using the following terms:
Mature* skin xerosis AND skin barrier physiology OR function OR dysfunction OR depletion of stratum corneum lipids OR atopic dermatitis.
Mature* skin xerosis AND skincare OR cleansers OR moisturizers OR emollients OR ceramides OR ceramides containing skincare OR efficacy OR safety OR tolerability.
The searches yielded 42 papers deemed clinically relevant to mature skin xerosis and skin care to promote a healthy skin barrier and potential mitigation of xerosis using over-the-counter (OTC) skincare and CER-containing cleansers and moisturizers.
Role of the Panel
The panel of 7 dermatologists (panel) convened for a meeting (September 3, 2022) to review unique aspects of xerosis in mature skin and the skin barrier changes and to discuss nuances in the treatment and maintenance of mature skin using gentle cleansers and moisturizers.
From the selected literature, the searches (AA and TE) and MG drafted 13 statements. During the meeting, the draft statements underwent the panel's evaluation at a workshop, followed by a plenary discussion adopting 5 statements using evidence from the literature coupled with the panel's opinions and experiences. The second step consisted of a post-meeting review by individual advisors of the manuscript.
Statement 1: The exact etiology of xerosis is not entirely understood and likely depends on several genetic and environmental mechanisms.
A healthy skin barrier function depends on the complex interplay among SC pH, desquamation rate, and the appropriate ratio of intrinsic lipids.13,14 The lipids comprise approximately 20% of the volume of the healthy SC and are composed of CERs (40-50%), cholesterols (20-33%), and free fatty acids (7-13%).13,14 Further lipids include cholesterol-3-sulfate (0-7%) and cholesteryl esters (0-20%).13,14 The slightly acidic surface of healthy skin is required to maintain the SC barrier, inhibiting the growth of pathogenic microorganisms.13 Skin acidification plays a vital role in SC barrier health and activates enzymes in the extracellular processing of SC lipids.13 The SC pH influences barrier homeostasis, integrity, cohesion, and antimicrobial defense mechanisms.13,15,16
