Dry or Oily Skin in .NET

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Dry or Oily Skin
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Many patients describe themselves as having either dry or oily skin In reality, however, these two processes are not mutually exclusive Dry skin is caused by a lack of moisture in the SC Oily skin is caused by increased secretion of the sebaceous glands It is possible to have dry skin on parts of the face and oily skin in the T-zone area This is commonly called combination skin In addition, one may have oily skin on the face and dry skin on the body because of a lack of sebaceous glands on the arms and legs
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ETIOLOGY OF DRY SKIN
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Dry skin is a result of decreased water content in the SC, which leads to abnormal desquamation of corneocytes5 SC hydration is largely a property of corneocytes within the outer SC (stratum disjunctum), because corneocytes within the lower SC (stratum compactum) are relatively dehydrated and unable to absorb water when exposed to hypotonic
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Atopic Dermatitis
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FIGURE 11-1 Dry skin exhibiting the characteristic overlying white scale
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Atopic dermatitis is a multifactorial disorder characterized by dry skin Multiple studies have suggested that an insuf ciency of ceramides in the skin is an important pathophysiologic factor in this condition37 However, in a study that looked at patients with xerosis, the de ciency in water-holding properties was not accompanied by an insuf ciency of ceramides38 Researchers also found that sebum levels did not play a signi cant role in the etiology of xerosis when studied in atopic patients They hypothesized that xerosis could be caused by an aberration of the lamellar structures of intracellular lipids in the SC Interestingly, mutations in the laggrin gene have been described in patients with atopic dermatitis39,40 In fact, laggrin mutation is the rst strong genetic factor identi ed in atopic dermatitis A defect in laggrin would result in a structural cutaneous defect because it normally aggregates with keratin laments in the stratum granulosum to form macro laments that impart strength to this layer41 In addition, a defect in laggrin would lead to a decrease in NMF, a by-product of laggrin that has hygroscopic properties A decrease in secretions of lamellar bodies, which would lead to a decrease in fatty acids and ceramides, has been reported in atopic dermatitis patients42
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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stress6,7 Rawlings et al demonstrated that desmosomes remain intact at higher levels of the SC and desmoglein I levels remain elevated in the superficial SC of individuals with dry skin as compared to controls8 This occurs because the enzymes necessary for desmosome digestion are impaired when the water level is insufficient, which leads to abnormal desquamation resulting in visible clumps of corneocytes that cause the skin to appear rough and dry9 (Fig 11-2A and B) These clumps of corneocytes lead to the phenotype known as dry or scaled skin In darker skin types, this perturbation of desquamation is associated with a grayish skin color and is labeled ashy skin Essentially, ashy skin is dry skin in a dark-skinned person The skin barrier resembles a brick and mortar type structure with the bricks representing the keratinocytes and the mortar mimicking the lipids that surround the keratinocytes in a protective coating The lipids are arranged in lipid bilayers as illustrated in Figure 11-3 The skin barrier exhibits several important functions such as preventing evaporation of water, which is known as TEWL
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The barrier also helps keep out unwanted compounds such as allergens and irritants Injured barriers render one more susceptible to contact and irritant dermatitis Lastly, the barrier displays a defensive role or mechanism against infections and this SC defense depends on corneocyte function and the surrounding extracellular matrix10
syndrome are examples of TG-1 and loricrin defects, where impaired skin barrier is clearly present
Extracellular Matrix and SC Lipids
The extracellular matrix surrounding the corneocyte is a lipid-rich component necessary for maintaining the epidermal barrier Lamellar bodies that are secretory organelles located in the stratum granulosum play a key role in forming this lipid bilayer barrier by releasing their contents in the junction of the stratum granulosum and SC They contain a mixture of lipids (ceramides, cholesterol, and fatty acids), lipid-processing enzymes, proteases (responsible for epidermal desquamation), and their inhibitors This extracellular lipid of the SC is well known to be responsible for that layer s water barrier function12 The lipid mixture that is delivered by lamellar bodies is composed of 50% ceramides, approximately 15% fatty acids, and approximately 25% cholesterol13 It has been stated that alterations in any of these three components can cause a
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