Sjögren’s & Dry Skin

Skin manifestations are seen in many patients with Sjögren’s, however, the most common skin complaint is xerosis (dryness), which occurs in up to 50% of patients.  While the exact mechanisms for dryness in Sjögren’s are unknown, they may result from an attack on the structures that moisturize and lubricate the skin, similar to that observed in the salivary glands.  When a skin biopsy is performed, lymphocytic infiltrates are sometimes seen around the various structures in the dermis (lower layer skin), including hair follicles, oil glands, as well as eccrine (sweat) glands.  Once destroyed, these oil and sweat glands cannot be restored.

The major features of dry skin (xeroderma) are scaling, redness, itching, and cracking of the skin.  Treatment of xeroderma in patients with Sjögren’s does not differ significantly from treatment of other causes of dry skin. Suggestions for dealing with this problem include the following:

  1. Take short, lukewarm baths or showers.  Lukewarm water does not remove skin oils as completely as hot water.
  2. Use gentle bath bars (e.g. Dove or Cetaphil) or the low/no-residue glycerin bars (e.g. Neutrogena), not harsh deodorant soaps.  Often, “cleaners” are better able to control the acid-base balance of the skin than true “soaps.” Liquid cleansers (Cetaphil, Olay) sometimes contain a higher content of moisturizers than the bath bars; however, liquids may also contain preservatives that can act as potential allergens or irritants.  Therefore, any product that irritates the skin should be discontinued.
  3. After bathing, pat dry and use one or more of the moisturizing techniques mentioned below.
  4. Moisturize frequently.  In reality, there are relatively few ways of maintaining or adding to the skin’s moisture content:
  • Trap moisture in the skin, immediately after bathing or showering.  While the skin is still damp or moist, apply a thin layer of petroleum (Vaseline), bath oil (Neutrogena body oil), or even some cooking oils such as safflower oil, canola oil, or Crisco.  In general, the thicker and greasier a moisturizer is, the better it is at trapping moisture in the skin.
  • “Drag” moisture into the skin.  This is done with products that contain chemicals such as urea, glycerin, lactic, or similar “metabolic” or alpha-hydroxy acids.
  • Repair the skin’s protective barrier function and thereby retain or trap the skin’s natural moisture.  The products in this group are relatively new and are based on naturally occurring chemicals called ceramides (Aveeno Eczema Care).

5. Avoid fabric softeners, whether in the washer or in the dryer.  They may irritate or dry the skin.  Use laundry detergents that are free from dyes, fragrances, and preservatives.  Many brands have a “Free and Clear” option for laundry detergents that meet these criteria.
6. Drink plenty of water; remain well hydrated.
7. Use a humidifier, especially if the house has forced air heat, which is especially drying.
8. Swimming is permissible but may also irritate or dry the skin.  Patients should shower after swimming and then immediately use a moisturizer.