Coarse elbows

DR. SYLVESTER IKHISEMOJIE FROM PUNCH

When the skin overlying the elbows is described as coarse, it typically means the skin is dry, scaly and possibly itchy. Many cases of this condition may result from certain climatic factors that predispose an individual to develop such skin, or from irritation caused by fabrics, specific types of soaps, and even lotions. It may also arise from inadequate hydration, causing the skin to become thickened and rough to the point of being noticeably different. Such dryness of the elbows often leads to discolouration, making the changes readily evident even to the untrained eye.

In some cases, the changes described above are part of the symptom complexes of diseases such as hypothyroidism, psoriasis, diabetes and eczema. For the vast majority of cases, it becomes the responsibility of a doctor to identify the possible causes of these skin changes, the contributing factors, the age at which they began, and their progression. Only through such an approach can a tentative diagnosis be made, subject to confirmation, before definitive treatment is provided to the affected individual.

However, as is often observed, many individuals resort to some form of self-medication based on the advice of friends and family members before consulting a neighbourhood nurse or pharmacist. Neither of these individuals may be properly trained healthcare workers; the pharmacy attendant could be a dispenser or a plain chemist, while the itinerant nurse might be an auxiliary nurse or health assistant.

Thickened, dry elbows can significantly alter the appearance of that part of the body. The skin overlying the joint and the surrounding area often displays numerous scratch marks, typically caused by repeated scratching. This appearance alone often signals to the attending doctor that the area is intensely itchy. As a result, the skin may appear scaly and may even peel in some areas. This combination of effects creates alternating rough and smooth patches, leaving the elbows both sore and discoloured. The discomfort can escalate, with the skin eventually cracking, losing its integrity, and bleeding. This cycle of irritation and damage is often responsible for the discomfort associated with the condition.

Typically, it is only after repeated “trial-and-error” treatments—often administered by unqualified individuals such as family, friends, or local pharmacists—that affected individuals eventually seek proper medical care. The symptoms described above may worsen in hot, dry, or even cold weather, depending on the individual’s unique circumstances. Ultimately, dry skin over the elbows primarily stems from inadequate hydration and lubrication. This lack of hydration often results from insufficient fluid intake, localised irritation or an underlying disease.

Inadequate hydration, caused by a deficit of moisture, can also be linked to a decline in sweat and sebaceous gland activity. These glands are abundant during youth but gradually diminish in number and efficiency with age. Beyond these factors, several other conditions can predispose individuals to develop dry skin around the elbows. Chief among these is dehydration, for obvious reasons. When an individual consumes insufficient water or loses excessive fluids due to ambient temperature, illness, or physical activity, the body prioritises vital areas, diverting water away from less critical regions. Consequently, individuals who sweat profusely or consume large amounts of alcohol without replacing lost fluids are particularly prone to developing dry skin.

Cigarette smoking also contributes to similar damage through indirect effects. Certain chemicals in tobacco smoke reduce oxygen supply to the skin and accelerate ageing, leading to the development of coarse skin, particularly around the elbows and knees. By now, it should be evident that the combined impacts of cigarette smoking and alcohol consumption play a significant role in causing a wide range of acute and chronic conditions throughout the body.

It is also essential to note that a lack of humidity—whether during cold winters or in hot, dry climates—can exacerbate this condition. In winter, the body loses fluids rapidly due to radiation and conduction as it works to maintain normal temperatures. In hot climates, fluids are lost primarily through evaporation. In either scenario, the skin gradually dries out, visibly showing the resulting damage.

Even modern conveniences like air conditioning can contribute to dry skin when elbows are consistently exposed. Similarly, individuals who frequently engage in swimming, especially in chlorinated pools, are at risk. Without applying moisturising lotions afterwards, the skin dries out and loses its lustre over time. This can also occur when swimming infrequently but for extended periods. The same issues arise from prolonged exposure to Turkish baths, saunas, and hot water baths. Hot water strips the skin of essential oils, leaving it dry, which is also a common outcome of taking long, hot showers or other kinds of hot baths.

While the last two paragraphs primarily address dry elbow conditions caused by environmental factors, it is worth noting that certain commonly used medications can also contribute to these occurrences. One significant group of drugs responsible for such effects is diuretics, widely used to manage hypertension and various degrees of heart failure. Patients prescribed these medications must be warned about this potential side effect and encouraged to act proactively by applying moisturising lotions judiciously.