Dry Skin

The Skin Center

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Dry Skin

2-1-10 

Authors: Almira Yang, BS and N. Alai, MD, FAAD

 

What is dry skin?

Dry skin, also known as xerosis, is a very common skin condition characterized by abnormal or excessive dryness of skin. While dry skin tends to affect males and females equally, older individuals are typically much more prone to dry skin. The skin in elderly individuals tends to have diminishing amounts of natural skin oils and lubricants. Areas such as the arms, hands, and particularly lower legs tend to have more dry skin issues.

Dry skin may be a mild, temporary condition lasting a few days to weeks. Dry skin may also become a more severe, long term skin problem for some. Symptoms of dry skin may include discomfort from skin tightness and itching. In addition, external factors such as weather can affect the severity of skin dryness. For example, cold or dry air and winter weather can worsen dry skin. Individuals whose occupations require more frequent hand-washing and sanitizing may experience dry skin more often. Dry skin may also be a side effect of some medications or a symptom from an underlying physiological disorder, like an overactive or underactive thyroid gland.

Skin is normally covered by sebum, which is the natural oil product of sebaceous glands. Sebum helps to prevent skin dehydration. When the skin’s fatty oils are stripped away, the skin loses its protection and loses moisture more easily. As skin becomes dry, it also may become more sensitive and prone to rashes and skin breakdown. Dry skin may be an entirely invisible skin condition, or may cause a fine dry powder-like appearance of the skin. Untreated, dry skin may become irritated and result in a red rash.

Simple prevention and treatment measures are very effective in the treatment of dry skin. Basic dry skin prevention steps include avoidance of harsh soaps and chemical cleansers. Treatment generally requires more frequent and regular applications of bland emollients and moisturizers. Untreated, dry skin may result in complications including rashes, eczema, secondary bacterial infections, cellulitis, and skin discoloration. Fortunately, most cases of dry skin are mild and can be easily remedied.

 

What causes dry skin?

There is no single cause of dry skin. Dry skin causes can be classified as external and internal. External factors are the most common underlying cause and are the easiest to address. External factors include cold temperatures and low humidity, especially during the winter when central heaters are used. Internal factors include overall health, age, genetics, family history, and a personal history of other medical conditions like asthma, allergies, and atopic dermatitis. In particular those with thyroid disease are more prone to developing dry skin.

External factors causing dry skin:

  • Over-washing with harsh soaps
  • Over use of sanitizers and cleaning agents
  • Cold temperature
  • Low humidity

During winters, individuals may tend to take longer, hotter showers and baths. This prolonged exposure to hot water can strip off the natural oil from the skin, making the skin unprotected. Skin that feels overly tight after bathing may indicate excess removal of natural skin oils.  

One of the most common factors causing dry skin is frequent application of harsh soaps. The type of soap may have a large impact on dry skin. Soap can abruptly take away skin oils. The more often skin is scrubbed with soap, the easier the skin dries out. Bathing with harsh soaps such as Ivory, Irish Spring, Coast, Safeguard, Shield, Lever 2000, and Zest can worsen dry skin.

Moreover, dry skin may persist or worsen if using moisturizers improperly or choosing an inadequate moisturizer. Sometimes, the material of different clothing can also affect dry skin. Some materials such as wool or synthetic fibers tend to irritate the skin and worsen dry skin.

Dry skin condition may be caused by taking some medicines as well. Some examples are drugs for high blood pressure, allergies, and acne. Occasionally, a dry skin problem can be a sign of an internal medical condition. For instance, aging may inherently make people more prone to developing dry skin. Aging especially in women may cause an increased susceptibility to dry skin due to changes in hormone levels. In addition, eczema, psoriasis, diabetes, hypothyroidism, and malnutrition are all known to be associated with dry skin.

What are signs and symptoms of dry skin?

The key symptom of dry skin is itching. People who have dry skin can often find rough, dry, red patches on their skin, and these patches are often itchy. Typically affected skin areas include arms, hands, lower legs, abdomen, and in areas of friction, such as ankles and soles. In more severe cases, cracks and fissures may evolve.

Symptoms:

  • Itching
  • Rough dry skin
  • Red patches

The itchy feeling may worsen the severity of dry skin. Itching can lead to the development of the “itch-scratch” cycle. That is, as a person feels itching, he or she scratches in response, which exacerbates the itch, and so on. The “itch-scratch” cycle is often seen when conscious control of scratching is low or absent, for instance during sleep.

Most common dry skin areas:

  • Lower legs
  • Hands
  • Forearms

Constantly scratching and rubbing the skin may cause the skin to become thick and leathery in some cases. For others, small, red, raised bumps may appear on their skin, and these bumpy spots can be irritated, opened and infected if scratched.

How is dry skin diagnosed?

Generally, dry skin can be easily diagnosed by physically examining and visually inspecting the skin by a physician or dermatologist. While the skin condition can appear on any type of skin at any age, the elderly and individuals who frequently expose to harsh soaps or detergents are more prone to developing this condition. In addition, a thorough medical history and review of the family history can help support the diagnosis of dry skin. Based on the medical history, other medical conditions may be ruled out or considered. In more difficult cases, a skin biopsy may be helpful to confirm the diagnosis and direct the treatment plan. Sometimes, a skin culture and sensitivity testing may be performed by gently swabbing the skin to exclude bacterial, fungal, or yeast infections.

Does dry skin cause winter itch?

Winter itch is a common name for the skin symptom of generalized itching in the winter. It is primarily caused by dry skin and is most common in the elderly. Winter itch caused by dry skin may also be seen commonly in those with a history of eczema, allergies, or asthma. External factors including cold temperatures, low humidity, and the use of central heat tend to worsen dry skin. Therefore, some people refer the condition of dry skin in the winter as “winter itch.”

Do genetics play a role in dry skin?

Dry skin may be caused by a genetic condition called ichthyosis. There are many types of ichthyosis. Ichthyosis vulgaris is the most common type and it is a severe dry skin condition, often of the front of the lower legs. Ichthyosis vulgaris causes dry, fish like scales. Less severe types of dry skin may tend to run in families.  Dry skin is also more common in atopic dermatitis which is thought to have a genetic component.

What medical conditions cause dry skin?

Certain physiological changes and medical conditions may cause dry skin. The onset of dry skin may be due to aging or hormonal changes, as seen in menopausal women. In some cases, individuals who have medical conditions such as hypothyroidism, diabetes, or malnutrition (i.e. deficiency of vitamin A) may suffer from xerosis.

  • Hypothyroidism
  • Hyperthyroidism
  • Diabetes
  • Malnutrition
  • Allergies

Do any medications cause dry skin?

Medications for medical conditions including high blood pressure, (i.e. diuretics), allergies (i.e. antihistamines), and acne (i.e. retinoids like Retin A) may also dry out the skin.

What is the treatment for dry skin?

The main treatment for dry skin is frequent, daily lubrication. Because most cases of dry skin are due to external causes, external treatments like creams and lotions can be applied and effectively control the skin breakout. Often, dry skin can be calmed down by applying a bland over-the-counter moisturizer. Once other causes of dry skin have been ruled out, the main goals of treatments are to stop the itching, prevent loss of water, and restore skin hydration.

Light moisturizing lotions for mild dry skin

  • Cetaphil lotion
  • Lubriderm lotion
  • Amlactin 12% lotion

Highly moisturizing products for severe dry skin

  • Vaseline
  • Aquaphor
  • Crisco  vegetable shortening

Since itch is an important factor in dry skin, prescription anti-itch medications can be applied to help control the itchy feeling and prevent the skin condition from worsening. Often topical steroid creams like hydrocortisone cream are added to the use of an over the counter moisturizer. When the itchy patches are relatively small, topical corticosteroid creams can be applied to localized areas to decrease inflammation and control itching.

In addition, Mimyx and Atopiclair are the two non-steroidal ceramide-based creams that are newly approved by the U.S. Food and Drug Administration and can be applied to help restore water in the skin. They do not contain topical steroid or calcineurin inhibitors, and share similar functions and effectiveness of low-potency topical steroids.

Oral corticosteroids, such as prednisone pills, may rarely be prescribed for severe cases of dry skin with rash. Oral steroids are reserved for highly resistant dry skin and itching which involve larger areas of body and cases that fail to improve with creams and lotions.

Anti-itch creams include

  • Hydrocortisone 1% cream  (mild strength)
  • Pramasone 2.5% cream (mild strength)
  • Triamcinolone 0.1% cream ( medium strength)
  • Clobetasol 0.05% cream (strong strength)

As a general rule of thumb, only mild corticosteroid creams like hydrocortisone should be used on the face, underarm, and groin areas. Long-term application of strong corticosteroid creams like clobetasol may cause serious adverse effects including skin thinning, stretch marks, and skin breakdown. Oral corticosteroids may cause temporary or permanent thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. Patients taking corticosteroid should be closely monitored by their health care provider to adjust the dosage to the minimum dose required for relief of symptoms.

Oral antihistamines such as diphenhydramine, hydroxyzine and cetirizine may also alleviate generalized itching in dry skin.

Anti-itch oral medications:

  • Hydroxyzine (Atarax)
  • Diphenhydramine (Benadryl)
  • Cetirizine  (Zyrtec)
  • Loratidine (Claritin)

What are possible complications of dry skin?

A common complication of dry skin and itching is secondary bacterial infection. Infections may be mild and resolve spontaneously, or may be more severe and necessitate antibiotic treatment. Severe itching leads to repeat scratching of lesions – hence the “itch-scratch-rash-itch cycle.” Because of the persistence of this itch-scratch cycle, the skin may become much thickened in these areas from rubbing. Repeat skin rubbing in the same area may lead to two localized chronic skin conditions called lichen simplex chronicus (LSC) and prurigo nodule.

What are some home remedies for dry skin?

Home remedies for dry skin include twice or three times daily applications of Crisco vegetable shortening or Vaseline.

Dry skin may be improved by taking lukewarm showers or baths and avoiding excess skin scrubbing. Hot water and harsh scrubbing can take away the natural oils that protect skin and make the skin even drier.

Dry skin may be prevented by use of gentle cleansers. Non-scented, mild cleansers or soap-free products like Aveeno, Cetaphil, Dove, or Neutrogena are recommended for dry and sensitive skin. Many scented, deodorant, and anti-bacterial soaps can be too harsh and wash off natural skin-protecting oils.

Gentle exfoliation and hydration may help improve the appearance of non-facial dry skin. Special moisturizers containing lactic acid (Amlactin, Lac-Hydrin), salicylic acid (Salex), or urea ( Urix or Carmol) are very effective in gently exfoliating the skin and helping other moisturizers penetrate into the skin more deeply.

Mild soaps and cleansers include

  • Dove Soapless cleanser
  • Aveeno cleanser
  • Cetaphil cleanser

Mild moisturizers without perfumes are good for dry skin. Thick and greasy emollients also work best. Typically, moisturizers should be applied within 3-5 minutes of bathing when the skin is just patted dry and still damp.

Sunscreens with a sun protection factor (SPF) of at least 15 or higher help protect the skin from possible sunburns and damage caused by UVA and UVB rays.

Proper nutrition and essential factors in the diet may help improve dry skin. For instance, essential fatty acids such as omega-3s can be metabolized in the body to produce natural, moisture-retaining oil barriers of the skin. Omega-3-rich foods include flax, walnuts, safflower oil, and cold-water fish such as tuna, herring, halibut, salmon, sardines, and mackerel.

The general skin and environment moisture is very important in improving dry skin. Maintaining the skin at optimal hydration and using an indoor humidifier may help improve dry skin.

How can dry skin be prevented?

To prevent skin from drying out, it may be helpful to humidify the indoor environment especially during the drier, winter months. Sometimes decreasing bathing frequency, avoiding strong soaps, and decreasing exposure to detergents also may help improve dry skin. Harsh cleansers can strip away the natural oils and sebum from the skin. Limiting exposure to irritants such as solvents and wool clothing can prevent the dry skin condition from worsening.

  • Avoid strong soaps and detergents
  • Use indoor room humidifiers
  • Limit exposure to irritants such as solvents
  •  Avoid wool clothing
  • Use cotton and natural fiber clothing

What are the best products for dry skin?

Top products for dry skin include mild cleansers and rich moisturizers. Non-scented, mild cleansers or soap-free products include Dove, Cetaphil, and Purpose soap. Thick, greasy, perfume-free moisturizers include Aquaphor, Vaseline, Crisco, and SBR lipocream.

Dry skin at a glance

  • ·         Dry skin is a very common condition causing small fine flakes and dry patches.
  • ·         Itching is one of the most common symptoms of dry skin.
  • ·         Scratching may be hard to resist
  • ·         Dry skin is more common in colder, winter months and drier climates.
  • ·         The elderly are more prone to dry skin than younger people.
  • ·         Dry skin is more common in individuals with a history of eczema, atopic dermatitis, allergies, or asthma.
  • ·         Dry skin may rarely be a side effect of medications.
  • ·         Dry skin is more common in hypothyroidism and hyperthyroidism.
  • ·         Repeat itch scratch cycles may lead to skin thickening and darkening.
  • ·         Possible complications include rashes, eczema, and bacterial infections.
  • ·         Extremely dry skin can cause cracks and breaks on the skin.
  • ·         Medications including topical corticosteroids and oral antihistamines can help ease itching.
  • ·         Secondary infections may result from scratches and skin breakdown.
  • ·          Topical or oral antibiotics may be necessary for secondarily infected dry skin.
  • ·         Several home remedies, such as decreasing bathing frequency and lubricating the skin with thick moisturizers after showers, can help control and prevent dry skin.

Reference List

  1. 1.      Fitzpatrick, Thomas B, et al. Dermatology in General Medicine. New York: McGraw-Hill, 1993. P.1551.
  2. 2.       Goroll, A. H. and Mulley, A. G. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. Lippincott Williams & Wilkins, 2009. P. 1266.
  3. 3.       Itching. Reviewed by Schalock, P. C. Merck Manual. Merck. Dec., 2006.
  4. 4.       Marieb, E. N., Mallatt, J., and Wilhelm, P. B. Human Anatomy. 4th Ed. 2004. P.106 – 119.
  5. 5.       Resnick, B. Dermatologic Problems in the Elderly. Lippincotts Primary Care Practice. Lippincott Williams & Wilkins. 1997. Mar-Apr; (1): 14-30.

 

 

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For more information, please call (949) 582-7699 or visit the practice website at
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