Dry skin is a very common skin problem and is often worse during the winter when environmental humidity is low (i.e., "winter itch"). It can occur at all ages and in people with or without other skin problems.
The appearance of dry skin
The normally fine lines in the skin become more visible, the skin feels rough and appears dull and flaky. In more advanced cases, fish net-like cracks resembling the fine fracture lines of cracked porcelain can occur. Dry skin occurs most commonly on the arms and legs, but can also affect the trunk of the body. Dermatologists often call dry skin "xerosis" or "asteatosis".
Problems associated with dry skin
Dry skin very commonly produces itching, which can be severe and interfere with sleep and other daily activities. Repeated rubbing and scratching can produce areas of thickened, rough skin (lichenification). Dry, thickened skin can crack, especially in areas subject to chronic trauma (e.g., hands and feet), causing painful cracks in the skin (fissures). Dry skin and scratching may result in a dermatitis when the skin becomes red (inflamed) in addition to dry and scaly. Round, scaly, itchy, red patches scattered over the legs, arms and trunk (nummular eczema) may also appear.
The appearance of yellow crusts or pus in these areas indicates that a bacterial infection is developing. This would require specific antibiotic therapy from your dermatologist or family physician.
If your skin is very dry, or if you have an associated red dermatitis, it is a good idea to seek the advice of your dermatologist or family physician
Causes of dry skin
The outermost layer of the skin is called the stratum corneum. (This is the layer that peels off after a sunburn). The stratum corneum consists of dead skin cells embedded in a mixture of natural oils (lipids) that are made by underlying living skin cells. These natural skin oils keep the water inside our body from escaping into the air and also keep irritating substances and germs from entering the body. Both the skin oils and the dead skin cells hold a certain amount of water in the stratum corneum and it is this stratum corneum water that helps keep the skin soft, pliable and smooth.
Dry skin results when there is not enough water in the stratum corneum for it to function properly. One way this can happen is when protective oils in the stratum corneum are lost and the water that is normally present in the skin is allowed to escape. Too much soapy water, exposure to harsh chemicals, the normal aging process and certain types of skin diseases are some of the causes of decreased amounts of protective skin oils. As the stratum corneum dries out it shrinks and, as it shrinks, small cracks can occur. This exposes the underlying living cells to irritating substances and germs in the environment.
Treatment of dry skin
An important aspect of treatment is to identify and tackle any factors that may be contributing to the dry skin. Water alone (especially hot water) can actually worsen the problem of dry skin by removing the normal, protective skin oils. Hot, soapy water depletes the natural skin oils to the greatest degree. Water followed by the application of oil such as a moisturizer is of great benefit for dry skin.
Showering to avoid dry skin:
- You should take a short bath or shower (no more than 10 minutes) only once in a 24 hour period.
- Bathing should be in warm rather than hot water.
- Soap should be used minimally and where/when need (for example, under the arms, the groin and genitals, the feet, and the face).
- Mild soaps should be used (unscented, those designed for sensitive skin).
- After showering, quickly and gently pat the skin partially dry with a towel (do not rub!).
- Within three minutes of getting out, apply moisturizer to seal the water in the skin before it evaporates.
- Bath oil can be directly rubbed into the skin after showering or bathing, but should not be added to the water.
- Moisturizers should be reapplied liberally during the day and evening when possible, especially to those areas prone to dryness.
Treat any red dermatitis (eczematous) patches with a topical cortisone (steroid) cream or ointment for a 5 to 15 day course. Over-the-counter strength cortisone creams and ointments can occasionally be helpful, but prescription strength products are often required to calm down this type of dermatitis. Make sure you understand where the cortisone cream or ointment is to be applied (only on the red patches unless instructed otherwise) and how often you should apply it (no more than twice daily). When using both a cortisone product and a moisturizer, always use the cortisone first and the moisturizer second.
Be careful about using other over-the-counter anti-inflammatory and itch-suppressing creams or lotions. Many of these products contain chemicals that can irritate or cause allergic reactions in dry, dermatitic skin. A good general rule is if anything that you apply to your skin causes more burning and itching than you started with, you should stop using it until you can talk with your doctor about it. Anti-itch products containing pramoxine (e.g., Prax, Pramosone) or menthol and camphor (e.g., Sarna) are generally safe to use. However, these products are not treating the cause of skin dryness, they are only temporarily treating the itching that accompanies skin dryness.
Any way that you can increase the humidity level in the air of your home and workplaces would be advisable. If not already present, you should consider adding a humidifier to the central heating system of your home. If you use a portable humidifier, make sure it is used in your bedroom at night.
Long-term prevention and control
Dry skin is usually a long-term problem that recurs often, especially in winter. When you notice your skin beginning to get dry, resume your moisturizing routine and avoid the use of harsh soaps. If the itchy, dry, skin rash returns, use both the moisturizers and the prescription steroid cream or ointment.
There are basically two types of moisturizers: facial moisturizers and body moisturizers. Most facial moisturizers on the market relate largely to makeup and cosmetic concerns.
There are four basic classes of body moisturizers: ointments, oils, creams and lotions (listed in decreasing order of moisturizing power). It should be noted that all of the moisturizer products mentioned in this article are available without prescription.
- Ointment moisturizers
- The have the greatest ability to trap moisture in the skin, but they have the greasy consistency and feel of Vaseline Petroleum Jelly. Examples of effective ointment moisturizers include Aquaphor and plain Vaseline Petroleum Jelly. Some common household products, such as Crisco vegetable shortening, can also be used as very inexpensive body moisturizers. The key to using an ointment is to apply small amounts and rub it in well.
- Oil moisturizers
- These are less greasy but still effective. Examples of oils that can be applied directly to the skin include baby oil, mineral oil, vegetable oil, and bath oil. It is preferable to apply bath oils after getting out of the tub or shower, just as you would other moisturizers, directly to damp skin immediately after a light toweling off to partially dry the skin.
- Cream moisturizers
- These are usually white and disappear when rubbed into the skin without leaving a greasy feel. Examples of effective cream moisturizers include Original Eucerin Cream, Aquaphilic, Cetaphil Moisturizing Cream, Vaseline Cream, Eutra/Elta, Nutraderm, Moisturel, Nivea, Nutraplus, Complex-15, Carmol, Pen-Kera, and Neutrogena Hand Cream (especially helpful for dry, chapped hands).
- Lotion moisturizers
- These are suspensions of oily chemicals in alcohol and water. Examples of popular lotion moisturizers include Vaseline Intensive Care, Nutraderm Keri, Lubriderm, Curel, and Complex 15, Nivea, U-Lactin, Neutrogena, Nutraplus, Eutra Lite, Moisturel, Complex-15, Lac-Hydrin 5.
Some moisturizers contain chemicals that can cause skin irritation or allergic reactions in some people (e.g., fragrances, preservatives, alpha hydroxyacids, urea, sunscreens). If one brand of moisturizer gives you problems, try another in the same class that has a different set of ingredients.
Everyone in our department hopes that the information presented above will help you, your family, or someone else you know to get through the winter season with less dry and itchy skin than ever before.
Department of Dermatology