Dry Skin 101: The Dos and Don’ts
Do you have scaling, itching, cracking, or other dry skin symptoms? Nearly all of us have experienced dry skin, also called xerosis or xerosis cutis, at some point. Learn more about causes, prevention, and treatments to keep you comfortable.
Understanding the skin barrier
The skin is the largest organ of the body. One of its chief functions is to act as a barrier between ourselves and the outside world. This barrier is composed of highly structured layers of proteins, cellular material, and, importantly, lipids, which are fat molecules that impede the flow of water across the skin. The lipid composition varies during development and normal aging, and from one body part to another. Alterations in skin lipids are believed to play an important role in causing skin conditions such as dry skin and eczema.
What causes dry skin?
Dry skin can be caused by external factors, genetic or inflammatory conditions, or, most frequently, a combination of both.
External factors
Common external irritants include:
Detergents and soaps
Changes in weather, particularly low humidity and indoor heating during winter months
Exposure to skin irritants, especially dyes and fragrances in household products and cosmetics
Genetics
Genetic conditions can contribute to dry skin and are very common in all populations around the world. In particular, mutations in the gene encoding the skin protein filaggrin impair the barrier function of the skin. This is found in Keratosis Pilaris, Ichthyosis Vulgaris, and Atopic Dermatitis, at frequencies up to 30-40% of the population examined. This is more of a dominant trait than a disease but does indicate a need to take extra precautions for gentle skincare.
Inflammation related to skin diseases
The inflammation occurring in skin diseases, especially eczema and skin allergies (contact dermatitis), causes decreased production of skin barrier molecules and can cause dry and sensitive skin. This feeds into a cycle where the inflamed skin more easily reacts to external triggers, which then contribute to worsening inflammation and symptoms.
Aging
Normal aging can trigger bouts of dry skin, as lipid production decreases later in life. I commonly hear from patients that they “never had dry skin before.” Gradual changes occur for everyone and may not be noticeable until they cause symptoms or are magnified by external or seasonal factors.
Other causes
Other medical conditions can also contribute to dry skin, including diabetes. In addition, it can be a side effect of medications used to control blood pressure and high cholesterol.
How do you prevent and treat dry skin?
Avoid external triggers.
External triggers can be difficult to avoid, but options are available for many products:
Laundry detergent, such as All Free Clear
Bath soap, such as Dove Sensitive Skin Bar Soap
Moisturizer, such as CeraVe® lotion or cream
Sunscreen, such as Elta MD sunscreens
Keep in mind: Many products labeled as natural, organic, or plant-based can still contain strong and irritating dyes or fragrances. Even products labeled unscented are not necessarily free of perfumes and fragrances—these products often contain additives to mask the odor of the active ingredients and can still irritate the skin. Instead of unscented, look for fragrance-free products.
Treat with moisturizer.
What’s the mainstay of dry skin treatment and prevention? It’s the frequent application of moisturizer to all affected and vulnerable skin. Although there is a huge variety of products available, they can be broken down into lotions, creams, and ointments.
Lotions:
Lotions are mostly water-based, frequently found in pump bottles, and have a liquid consistency.
They are quickly absorbed into the skin without much residue, which makes them easy to apply.
However, they contain few lipids and therefore offer only a small benefit in terms of skin protection and repair of dry skin. Many patients experience worsening of eczema with applications of lotions since the water content evaporates quickly and can leave the skin drier than it started!
Examples: CeraVe® Daily Moisturizing Lotion, Cetaphil® Moisturizing Lotion, Aveeno® Moisturizing Body Lotion
Creams:
Creams, with a thick consistency and usually found in jars, are generally much more effective than lotions.
Although they can seem greasier, this grease is the lipid content, which is the most important factor to protect against dry skin!
Creams contain a mixture of lipid oils and water in an emulsion, which results in an excellent balance between skin protection and ease of use.
Examples: Eucerin® Original Healing Cream, CeraVe® Moisturizing Cream, La Roche-Posay® Lipikar Balm AP+
Ointments:
Ointments are typically fully oil-based, have a jelly-like consistency, and offer the most protection.
Ointments can be effective when the skin remains dry despite treatment with other types of moisturizer.
Examples: The prototypical ointment is petrolatum, known by the brand name Vaseline, as well as Aquaphor® Healing Ointment and Vaniply™ Ointment
Whatever type you use, apply moisturizer regularly, consistently, and often—sometimes three to four times daily.
My tips to stay on track:
Make moisturizing a habit like brushing your teeth.
Keep multiple containers of moisturizer in easily accessible locations—home, work, car, jacket pockets, etc.
Be shower and bath savvy.
Shorten showers and baths to help decrease the amount of natural lipids removed from the skin.
Use warm but not hot water.
Use mild, fragrance-free moisturizing cleansers.
Apply moisturizer right after a shower or bath to slightly damp skin—this can lock in the moisture.
Is it time to see your SSDP board-certified dermatologist?
Of course, in some cases, home care isn’t enough. As board-certified dermatologists, we have additional options available to help—and can ensure your skin condition is diagnosed and treated correctly.
Any questions? Consult one of our board-certified dermatologists. Please contact SSDP to schedule an appointment with any of our physicians.
