Sicca: Causes, Common Regions, and Potential Treatments

Dryness in the body, known as sicca symptoms, can be uncomfortable and disruptive. It commonly affects the eyes, mouth, nasal passages, and skin, leading to irritation and potential complications. While often associated with Sjögren’s syndrome, sicca symptoms can also result from other conditions or environmental factors.

Differences Between NonSjögrens And Sjögrens

Sicca symptoms have various causes, but distinguishing between Sjögren’s syndrome and non-Sjögren’s sicca is crucial for effective management. Sjögren’s syndrome is a systemic autoimmune disorder, whereas non-Sjögren’s sicca includes conditions that cause dryness without the same immune-driven mechanisms. Though both lead to similar discomfort, their origins and progression differ.

Sjögren’s syndrome is characterized by systemic inflammation and glandular dysfunction. Research in The Lancet Rheumatology (2023) highlights that the disease primarily targets exocrine glands, causing chronic dryness due to lymphocytic infiltration and glandular destruction. This reduces tear and saliva production over time and may involve systemic symptoms like joint pain, fatigue, and organ complications. Non-Sjögren’s sicca, by contrast, does not involve immune-mediated damage but can still cause significant discomfort.

Non-Sjögren’s sicca can stem from medication side effects, hormonal imbalances, and environmental influences. A JAMA Internal Medicine (2024) review found that antihistamines, antidepressants, and diuretics frequently reduce tear and saliva production. Additionally, conditions like diabetes and thyroid disorders can alter fluid balance and glandular function. Unlike Sjögren’s syndrome, where glandular damage is often irreversible, non-Sjögren’s sicca may improve when the underlying cause is addressed.

Diagnosis also differs. Sjögren’s syndrome is identified through serological tests, such as anti-SSA/Ro and anti-SSB/La antibodies, and objective measures like the Schirmer test for tear production. A 2023 Arthritis & Rheumatology study reported that up to 70% of Sjögren’s patients test positive for these autoantibodies. In contrast, non-Sjögren’s sicca cases typically lack these markers. Additionally, labial salivary gland biopsies in Sjögren’s patients often reveal focal lymphocytic sialadenitis, a hallmark of the disease, absent in non-Sjögren’s sicca.

Common Body Regions Affected

Sicca symptoms often lead to persistent discomfort in multiple areas, primarily the eyes, mouth, nasal tissues, and skin.

Eyes

Ocular dryness, or keratoconjunctivitis sicca, is a frequent manifestation of sicca symptoms. It occurs when tear production is insufficient or evaporates too quickly, causing irritation, redness, and a gritty sensation. A 2023 Ophthalmology study found that individuals with sicca-related eye dryness often experience reduced tear breakup time (TBUT), leading to blurred vision and light sensitivity.

The tear film has three layers: lipid, aqueous, and mucin. Dysfunction in any of these can contribute to dryness. Meibomian gland dysfunction (MGD), which affects the oil-producing glands in the eyelids, is a common cause of evaporative dry eye. Prolonged screen use also reduces blink rates, worsening tear film instability. Artificial tears, warm compresses, and regular screen breaks can help manage symptoms.

Mouth

Oral dryness, or xerostomia, affects speech, chewing, and swallowing. Saliva is essential for lubrication, digestion, and bacterial control. A 2024 Journal of Dental Research review noted that persistent xerostomia increases the risk of dental caries, oral infections, and difficulty wearing dentures.

Salivary gland hypofunction can result from medications, dehydration, and systemic conditions. Dysfunction in the parotid, submandibular, and sublingual glands leads to thickened saliva, a burning sensation, and altered taste perception. Sialogogues like sugar-free lozenges or prescription medications such as pilocarpine may stimulate saliva production, while hydration and saliva substitutes provide relief.

Nasal Tissues

Nasal dryness can cause discomfort, congestion, and an increased risk of nosebleeds. The nasal mucosa relies on a thin mucus layer to trap dust, allergens, and pathogens while keeping airways moist. A Rhinology (2023) study found that heated indoor air during winter exacerbates nasal dryness by reducing mucosal hydration.

Certain medications, including decongestant sprays and antihistamines, can also decrease mucus production. Saline nasal sprays and humidifiers help restore moisture, and applying a thin layer of petroleum jelly or nasal emollients can prevent excessive dryness.

Skin

Cutaneous dryness can lead to itching, flaking, and irritation. The stratum corneum, the skin’s outermost layer, acts as a barrier to water loss. When compromised, transepidermal water loss (TEWL) increases, causing dryness and sensitivity. A 2024 Journal of Investigative Dermatology study found that individuals with sicca-related skin dryness often have reduced ceramide levels, essential for hydration.

Low humidity, harsh soaps, and frequent washing can further deplete the skin’s moisture. Emollients with ceramides, hyaluronic acid, or glycerin help restore hydration, while avoiding long, hot showers and using mild cleansers minimizes moisture loss.

Potential Contributing Factors

Sicca symptoms arise from a mix of physiological and environmental influences. Medications, particularly anticholinergic drugs like tricyclic antidepressants and antihistamines, reduce tear and saliva secretion. Diuretics, commonly prescribed for hypertension, can also decrease overall body hydration, worsening dryness.

Hormonal fluctuations significantly impact moisture regulation, especially in women. Estrogen and progesterone influence exocrine gland function, and declining estrogen levels in postmenopausal individuals often lead to increased dryness. A Menopause (2023) study found that nearly 60% of postmenopausal women reported ocular or oral dryness. Thyroid dysfunction, particularly hypothyroidism, can also alter bodily secretions, leading to thicker, less effective tears and saliva.

Environmental conditions further contribute, particularly in dry climates, high-altitude locations, and indoor settings with heating or air conditioning. Occupational factors, such as working in poorly ventilated environments like airplane cabins, can also exacerbate symptoms. Frequent digital screen use reduces blink rates, worsening ocular dryness.

Diagnostic Methods

Diagnosing sicca symptoms involves patient history, clinical evaluation, and objective testing. Physicians assess symptom patterns, medication use, and underlying health conditions to differentiate between temporary environmental causes and persistent dysfunction. Common complaints include burning, grittiness in the eyes, difficulty swallowing dry foods, and nasal congestion.

Objective tests help determine severity and underlying causes. The Schirmer test, which measures tear production with filter paper under the lower eyelid, identifies ocular dryness. A reading under 5 mm after five minutes suggests significant tear deficiency. For oral dryness, sialometry measures saliva flow rates, and salivary gland ultrasonography detects structural changes like reduced gland size or increased echogenicity.

Symptom Management Approaches

Managing sicca symptoms requires a tailored approach based on severity and underlying causes. Environmental and lifestyle modifications can improve mild cases, while persistent symptoms often need targeted treatments.

Artificial tears and lubricating eye drops, especially preservative-free formulations, help with ocular dryness. Severe cases may benefit from punctal plugs to reduce tear drainage or cyclosporine eye drops to improve tear production. For oral dryness, saliva substitutes and sugar-free lozenges provide temporary relief, while pilocarpine or cevimeline may stimulate saliva production. Nasal dryness responds well to saline sprays and humidifiers, while skin hydration is best maintained with emollients containing ceramides or hyaluronic acid.

A multi-pronged strategy helps mitigate discomfort and reduces the risk of complications like infections or tissue damage.