Dry skin – sometimes called xerosis by doctors - is a condition (not necessarily a disease) where the skin is red, scaly and itchy. The problem is usually worse in autumn and winter, and dry skin is most common on the face, hands, arms and legs. As we age, dry skin becomes more likely. It is not a serious problem usually, but can be uncomfortable and unsightly. Ageing, living in dry, cold or low-humidity climates and bathing or showering frequently make it more likely to occur. It affects both sexes, and is more common in Caucasian skin than those whose skin has a higher oil content, such as with Afro-Caribbean or Mediterranean skin.
Dry skin can be intensely itchy. It feels rough and flakes easily. Cracks and redness can form in more severe cases. Children can be particularly at risk, and this may take the form of eczema - where inflammation of the uppermost layer of skin causes dryness, and this is most likely to appear on the insides of elbows or the backs of knees. Eczema may run in families or run alongside asthma or hay fever.
Dry skin is a variant of normal skin and is not contagious
These depend on your age, your general health, the amount of time you spend outdoors and the cause of the problem. If you have dry skin, you're likely to experience a feeling of skin tightness, especially after showering, bathing or swimming and the skin will look shrunken or dehydrated in the affected area. It will often feel and looks rough, and be very itchy, with flaking, scaling or peeling. There may be fine lines or cracks in the skin along with redness and occasionally some bleeding.
Fortunately, most cases of dry skin respond well to simple lifestyle changes but see your doctor if there is significant skin redness (this may be a sign of infection), if the dryness and itching interfere with sleeping, if you have open sores or infections from scratching or if there are large areas of scaling or peeling skin.
Potential causes of dry skin include:
Harsh soaps and detergents. Many popular soaps and detergents strip lipids and water from your skin. Deodorant and antibacterial soaps are usually the most damaging, as are many shampoos that dry out your scalp.
Weather. In general, your skin is driest in winter, when temperatures and humidity levels plummet. Winter conditions also tend to make many existing skin conditions worse. But the reverse may be true if you live in desert regions, where temperatures can soar, but humidity levels remain low.
Central heating and air conditioning. Central air and heating, wood-burning stoves, space heaters, and fireplaces all reduce humidity and dry your skin.
Hot baths and showers. Frequent showering or bathing, especially if you like the water hot and your baths long, breaks down the lipid barriers in your skin. So does frequent swimming, particularly in heavily chlorinated pools.
Sunlight. Like all types of heat, the sun dries the skin and so sun-damaged skin may have the appearance of dry skin.
Atopic dermatitis. This is one of the more common types of eczema, and those affected have more sensitive and drier skin. Many people with mild eczema confuse this skin condition with excessive dryness. Areas commonly affected include the face, sides of the neck, and fold areas around the elbows, wrists, knees and ankles.
Psoriasis. This skin condition is marked by a rapid build-up of rough, dry, dead skin cells that form thick scales.
Thyroid disorders. Hypothyroidism, a condition that occurs when your thyroid produces too little thyroid hormones, reduces the activity of your sweat and oil glands, leading to rough, dry skin.
Dry skin is very common in the elderly, owing to loss of elasticity, collagen and fat (asteatosis). This commonly occurs on the lower legs. A lack of oestrogen can cause the same effect in menopausal women. The key to treating dry skin is to moisturise, moisturise, moisturise!
There are a great many emollients (moisturisers) that can be used to treat dry skin conditions and help retain moisture in the skin so it’s often a case of trying them and finding the right one (or combination) that works best for your skin type or condition.
Emollients can come in a variety of formulations such as creams, ointments, oils, as well as soap substitutes and bath additives. They all serve the same purpose of aiming to moisturise the skin.
Creams generally absorb quite well into the skin, providing a good moisture barrier and hydrating the top layer of the skin known as the epidermis. This can help treat dry and dehydrated skin, and help to maintain elasticity and prevent cracks in the top skin layer.
Ointments generally do not absorb as well into the skin as creams, and are often greasier in consistency. They tend to sit on top of the skin and provide an additional barrier over the skin. This is particularly useful for very dry skin, or in harsh weather conditions.
Ointments can be used alone or in combination with creams, but you should put creams on first, so the skin can absorb them. This is important if you are prescribed a steroid cream alongside an emollient: leave the steroid cream to absorb for at least 30 minutes before applying any other cream or ointment is used. It provides a greasy barrier over the skin to help repair and protect.
Lotions and oils can be used instead of creams and ointments if a large area needs to be covered, or over particularly hairy areas, since these formulations are finer in consistency and easier to apply.
Many emollients are designed to moisturise the skin, and also be used as soap substitutes, or as bath additives. For particularly sensitive skin or children's skin, try to find mild skin products that are either hypoallergenic, fragrance-free or colour-free.
The most important thing is to moisturize your skin – as mentioned above, moisturizers provide a seal over your skin to keep water from escaping and thicker moisturizers work best. Use warm water and limit your bath time as hot water and long showers or baths remove oils from your skin. Limit your bath or shower time to about 15 minutes or less, and use warm, rather than hot, water. Apply moisturizers immediately after bathing. Don’t use bubble baths as these dry out the skin.
Try to avoid harsh, drying soaps and instead use cleansing creams or gentle skin cleansers and bath or shower gels with added moisturizers. Experiment with several brands until you find one that works particularly well for you. A good rule of thumb is that your skin should feel soft and smooth after cleansing, never tight or dry.
If your dry skin is not responding to over-the-counter remedies, it's widespread or you develop a red or bumpy rash, you should book an appointment with your doctor, who will discuss your symptoms and examine you. They may decide to send you for further tests and refer you on if necessary to a specialist.
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