Pathogenesis (disease development)
The older a person gets, the more the structure of the different skin layers changes:
- The skin becomes thinner.
- The number of stored sweat glands becomes less or sebaceous gland secretion is reduced (time course of sebaceous gland production: drop after birth, increase with puberty, maximum circa 25 years of age, then gradual decline).
- The fat layers, collagen fibers and elastic fibers decrease.
- The blood circulation decreases.
The skin is more vulnerable and wounds heal more slowly.
Exsiccation eczema is a chronic eczema, which occurs on due to decreased sebum secretion of the skin (sebostasis).
Desiccation eczema is manifested by the appearance of typical reticular reddish tears of the cornea (eczéma craquelé), reminiscent of a dried riverbed, and subsequent inflammation of the skin. If left untreated, it develops into reddish-brownish, scaly, infiltrated plaques (areal or squamous substance proliferation of the skin) in the further course.
Etiology (causes)
Biographic causes
- Age – age (here: from the second half of life).
- Hormonal factors: menopause (female menopause; climacteric), andropause (male menopause).
Behavioral causes
- Nutrition
- Malnutrition
- Malnutrition
- Fluid deficiency
- Consumption of stimulants
- Alcohol (woman: > 20 g/day; man > 30 g/day).
- Tobacco (smoking)
- Washing behavior: excessive use of:
- Soaps or shower products
- Bath additives
- Brushing or rubbing the skin (→ in older people, this washes off the already thinner sebaceous film of the skin – the skin loses even more moisture)
- Use of alcohol-containing cleansing agents
Causes due to disease
- Association with hepatopathies (liver disease), malignant lymphoma (lymphoma).
- Anorexia nervosa (anorexia).
- Atopy (tendency to hypersensitivity reactions), e.g. atopic eczema (neurodermatitis).
- Vulgar ichthyosis – cornification disorders of the skin.
- Xeroderma (dry skin)
Medication
- Cimetidine (H2 antihistamine)
- Desiccant medications
- Diuretics
- Retinoids (isotretinoin)
- HIV protease inhibitors (indinavir).
- Hormones
- Hormonal contraceptives (birth control pills) and antiandrogens.
- Estrogens (sebostasis/inhibition of sebum formation).
- Indinavir (antiviral)
- Monoclonal antibodies – bevacizumab, pertuzumab, trastuzumab.
- Lipid-lowering drugsPsychotropic drugs
- Tyrosine kinase inhibitors (TKIs) – dasatinib
Environmental exposure – intoxications (poisonings).
- Irritants (chemicals, solvents)
- Air conditioning (dry air)
- Overheated rooms
- Dry room climate
- Sun (frequent sunbathing)
- Winter (cold) → reduction of sebaceous gland secretion.
Other causes
- Dialysis (blood washing)
