Dry skin is a common condition that results from a loss of moisture in the skin. It may be accompanied by itching, flaking or the appearance of fine lines.
The skin can lose moisture as a result of:
Environmental factors (e.g., weather)
Aging
Chronic illness (e.g., diabetes)
Generally, dry skin can be remedied by returning moisture to the skin. This can be achieved by applying plenty of moisturizer, avoiding sun exposure and drinking lots of water (at least eight 8-ounce glasses daily), among other preventive methods. However, people with chronic or severe dry skin are advised to seek the care of a physician (typically a dermatologist) to rule out any underlying health problems.
About dry skin
Dry skin is a common condition that can affect people of all ages, even infants. The medical term for dry skin is xerosis. Dry skin has a parched look, resulting from its inability to retain moisture, and usually feels "tight" and uncomfortable, especially right after cleansing.
Skin is composed of three layers: the epidermis, dermis and subcutaneous tissue. The outer protective layer of skin is the epidermis. The middle layer is the dermis, which contains blood vessels, glands and nerve endings. The bottom layer is the subcutaneous tissue, which contains fat, nerves and blood vessels.
Dry skin results from a lack of water in the stratum corneum, the outer, compacted layer of cells in the epidermis. Part of the stratum corneum between the cells is composed mainly of lipids (fats), such as cholesterol and fatty acids. These lipids form a strong, protective barrier that preserves moisture in the skin. A film of natural oil (sebum) excreted by glands in the subcutaneous tissue also helps retain moisture. When this protective barrier is stripped away, the skin cells lose water, which they need to stay healthy and supple. Scientists define dry skin based on measurable changes in water and lipids in the stratum corneum.
A healthy stratum corneum consists of about 30 percent water, which gives skin its resilience and elasticity. Most of the water is in the interior of the stratum corneum. In the outer layers, the amount of water depends on the environment. For instance, the drier the air, the drier the outermost layer of skin.
If a person experiences chronic or severe dry skin, they are advised to seek the care of a dermatologist. If dry skin is left untreated, it can lead to premature fine lines and wrinkles. Rarely, it may lead to more serious complications such as:
Cellulitis. A potentially serious bacterial infection affecting the skin’s underlying tissues.
Folliculitis. Inflammation of the hair follicles on the skin or scalp caused by infection.
These complications usually occur when the skin’s normal protective layer is compromised, such as with excessive scratching and/or bleeding, which can provide a way for bacteria to invade the body.
Other symptoms related to dry skin
Dry, rough skin may be accompanied by many other symptoms, such as:
Skin tightness or tautness
Loss of skin turgor
Itching (pruritus)
Flaking, peeling or scaling
Fine lines or cracks
Redness and inflammation
Deep fissures that may bleed
Increased thirst
Dry hair
Patients should consult their physician if over-the-counter moisturizers fail to relieve these symptoms.
Redness, swelling, pain or warmth may indicate that a patient has developed a secondary infection from scratching their dry skin. Fluid may also ooze from infected skin. Individuals who suspect an infection should contact their physician immediately. They may require topical and/or oral antibiotics to treat the infection.
Risk factors and causes of dry skin
Various environmental factors can lead to a loss of moisture in the skin, resulting in dryness and/or coarseness. These may include:
Weather. Skin tends to become dry during winter or when temperatures and humidity levels drop. Winter and colder climates tend to make other existing skin conditions (e.g., psoriasis, eczema) worse, which may exacerbate dryness.
Excessive sun exposure. Like all types of heat, the sun has a drying effect on the skin. Plus, the sun’s ultraviolet rays penetrate deep within the epidermis causing long-term damage, which can lead to the formation of deep wrinkles and loose, sagging skin.
Air conditioning and/or central heating units. These appliances tend to draw moisture out of the air and out of the skin. Other moisture-depleting devices include wood burning ovens, space heaters and fireplaces.
Other factors leading to dry skin include:
Over-cleansing. Frequent showering or bathing, especially using hot water, tends to break down the lipid barriers in the skin, resulting in dryness. Also, frequent swimming, especially in heavily chlorinated pools, can lead to dry skin.
Harsh soaps and detergents (e.g., deodorant and anti-bacterial soaps). Products containing fragrances and lauryl sulfates are harsher and more irritating to the skin. Therefore, excessive use of these products can lead to a loss of moisture.
Alcohol, caffeine and drugs. Excessive alcohol and caffeine intake can deplete the body of water and lead to dry skin. Certain prescription drugs (e.g., diuretics to increase urine production) also have a drying effect.
Smoking cigarettes. Tobacco does not cause the skin to dry, but it does deprive it of oxygen, thereby leading to the formation of premature fine lines and wrinkles, which can give the skin a coarse, dry appearance.
Age. As people get older, the skin tends to become drier because the oil-producing glands (sebaceous glands) are less active. In addition, the shedding and renewal of cells in the skin’s stratum corneum – the top sublayer of the epidermis – slows down with age, resulting in a rough, dull complexion.
Gender. Even though everyone’s skin dries with age, in general men’s skin tends to retain moisture longer than women’s. Men experience a relatively small decrease in oil production until well into their 80s, whereas women’s skin tends to become much drier after menopause.
Not drinking enough water. Not drinking enough liquids can lead to dehydration, which can cause the body to lose more fluid than what is taken in. Dry skin is one of the first signs of dehydration.
Nutritional deficiencies. Deficiencies in certain fatty acids (e.g., omega-3), zinc and vitamin A can affect the moisture levels of the skin.
In addition, some underlying health conditions and skin disorders may lead to or exacerbate dry skin. These may include:
Diabetes (excessive blood sugar levels). Diabetes can damage small blood vessels and nerves, making the skin prone to dryness as well as serious complications, such as infection (e.g., cellulitis).
Hypothyroidism (underactive thyroid gland). When the thyroid produces too few hormones, it reduces the activity of the sweat and oil glands, leading to dry skin.
Ichthyosis. A group of skin disorders that result in excessively dry skin that is extremely rough and scaly in appearance. These conditions may be inherited or caused by environmental factors.
Eczema. Inflammatory skin condition characterized by lesions that appear dry, thick and scaly.
Psoriasis. A chronic skin condition resulting in the rapid buildup of rough, dry, dead skin cells that form thick scales.
Keratosis pilaris. A genetic (inherited) condition in which the hair follicle is plugged with dry skin. This results in redness and the appearance of tiny bumps on the skin, which often resemble small pimples. It typically affects the back of the upper arms, buttocks and thighs. In children, it is commonly found on the face.
Diagnosis methods for dry skin
In many cases people with dry skin do not require a formal medical diagnosis. Topical moisturizers may treat the condition. When dry skin is not relieved by home care methods, consulting a physician (often a dermatologist) may be necessary.
To determine the cause of dry skin, a physician will obtain a medical history and perform a thorough physical examination, paying careful attention to all parts of the skin. To further understand the cause of the dry skin, a physician may ask questions such as:
When did the skin become dry, or has it always been dry?
Are all parts of the body affected? If not, which areas are involved?
What seems to make the dryness worse?
Are any methods successful in alleviating the dryness?
Are there any other symptoms?
In addition, a physician may order blood tests to rule out underlying health conditions (e.g., diabetes, hypothyroidism) that may be responsible for the dry skin. A biopsy to remove a sample from any lesions may also be performed to check for the presence of bacteria or infection (e.g., cellulitis).
Treatment and prevention methods for dry skin
If a chronic health condition, such as diabetes, is causing the dry skin, the underlying condition must be treated in order to improve the appearance of the skin. In cases where dryness results from a skin disease, such as eczema, a physician may refer the patient to a dermatologist for treatment.
In most cases, though, treatment of dry skin is simple and requires returning moisture to the skin. This can be achieved by using moisturizers and emollients, which help nourish and hydrate the skin, on a regular basis. The most effective moisturizers are ointments, followed by creams. Lotions are the least lubricating form of moisturizer.
Many moisturizers contain sunscreen, which helps protect the skin against the sun’s harmful rays. Moisturizers with a sun protection factor (SPF) of 15 or more should be applied daily to areas of the skin that are frequently exposed to the sun, including the face, ears, hands and neck.
Patients experiencing dry skin are advised to apply moisturizers as often as necessary, especially after bathing, showering or washing the face when the skin is moist. It also should be applied before exercising outdoors, in cold climates and every time the hands are washed. Individuals with severely dry skin should also apply a moisturizer before bed. Those with dry hands may benefit from applying a moisturizer to the skin at bedtime and wearing cotton gloves overnight.
In addition, people can help keep their skin hydrated and prevent dry skin by:
Limiting bathing time. Showers and baths should be limited to 10 minutes or less, and only once a day.
Using warm water instead of hot water.
Avoiding harsh, drying soaps and powders. Non-deodorant soaps and nonsoap cleansers are best.
Not scrubbing, rubbing or scratching the skin. This can lead to inflammation and in some cases infection. Skin should be gently patted dry with a towel after a shower or bath.
Moisturizing the home if the air is dry. This can be done by using a humidifier, which helps maintain moisture in the air. Humidifiers are particularly useful during the winter months. They can be placed throughout the home, or at least in the bedroom.
Keeping the temperature of the home low. Heat is drying to the skin. As a result, patients may benefit from keeping the temperature below 70 degrees Fahrenheit (21 degrees Celsius).
Choosing natural fabrics (e.g., cotton, silk) that do not irritate the skin. Clothing made of rough fabrics such as wool should be avoided.
Using detergents that do not contain fragrances or dyes and avoiding fabric softeners.
Incorporating a well-balanced diet.
Limiting alcohol and caffeine consumption.
Avoiding or limiting cigarette smoking.
Drinking plenty of water (at least eight 8-ounce glasses) every day.
Wearing gloves when doing chores, such as washing dishes and gardening. They should also be worn in cold temperatures to minimize exposure to the elements.
Bathing as soon as possible after spending time in a chlorinated pool or hot tub.
Patients with dry skin that is severely inflamed may require topical corticosteroids. Individuals who develop secondary infections from scratching may require topical and/or oral antibiotics to treat the infection.
Questions for your doctor regarding dry skin
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding dry skin:
Should I be worried about my dry skin?
What may be causing me to have dry skin?
What are my treatment options?
Can I treat dry skin at home?
Are any of my current medications causing the dry skin?
How can I prevent dry skin?
How often should I moisturize my skin?
Can you recommend soaps and lotions for my skin type?
What changes can I make in my diet to improve the condition of my skin?
Are my children more likely to have dry skin because I have the condition?
