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. Xeroderma is usually due to a lack of fat in the skin due to decreased sebum production (sebostasis).
Etiology (Causes)
Biographic causes
- Age – age (here: from the second half of life).
- Hormonal factors:
- Menopause (female menopause; climacteric).
- Andropause (male menopause)
- Somatopause – decline in STH secretion (somatotropic hormone (STH), English “human growth hormone”: growth hormone) with consecutive STH deficiency in middle-aged and advanced adults.
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
Disease-related causes
Blood, hematopoietic organs – immune system (D50-D90).
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Dehydration (lack of fluid).
- Hypernatremia (excess sodium)
- Hypothyroidism (hypothyroidism) or latent hypothyroidism.
- Underweight
Skin and subcutaneous tissue (L00-L99)
- Atopic eczema (neurodermatitis)
Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).
- Amenorrhea
- Primary amenorrhea: absence of menarche (first menstrual period).
- Secondary amenorrhea: no menstrual bleeding for > 90 days with an already established cycle.
Injury, poisoning, and certain other sequelae of external causes (S00-T98).
- Sick-building syndrome (SBS) – clinical picture from the field of occupational and environmental medicine; occurs as a reaction to pollution of enclosed spaces, but may also be due to psychological factors.
Medication (drugs that can lead to a reduction in sebaceous gland production (sebostasis)).
- Cimetidine (H2 antihistamine).
- Desiccant medications
- Diuretics
- Retinoids (acitretin, 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 agents
- Psychotropic drugs
- Tyrosine kinase inhibitors (TKIs) – dasatinib
- See also under “Pruritus due to drugs” if applicable.
Environmental pollution – intoxications (poisonings).
- Irritants (chemicals, solvents)
- Air conditioning (dry air)
- Overheated rooms
- Dry room climate
- Sun (frequent sunbathing)
- Winter (cold) – cold-dry climates; dry heating air (→ reduction of sebaceous gland secretion).
Other causes
- Dialysis (blood washing)
- Skin aging
