Dry Skin

Skin is the largest organ of the body assigned the task of protection, regulation and sensation.  It is made up of multiple layers to protect the underlying muscles, bones and vital internal organs. It is the first line of defense for your body against the pathogens in the environment. It also protects against water and heat loss and is in constant communication with the environment to maintain our bodies at a constant state. It is also important for insulation and vitamin D production. Structure and function of skin varies depending on location on body. Hence it is important to protect the skin from damage so it can continue to perform its many functions. 

What causes dry skin?

One of the most common complaints received in dermatology offices is that of dry skin.  Use of harsh cleansers, lack of aggressive moisturization routine, certain medications and medical conditions can also cause dry skin. Elderly are even more prone to excessive dry skin because skin thins with age and loses its ability to retain moisture. Skin makes its own lubricants consisting of free fatty acids, cholesterol and ceramides. These lubricants help skin moisturize itself and help regulate water and heat loss.  Cholesterol medications that are common prescribed to older patients, also cause dry skin by reducing production of cholesterol, which is one of the lubricants of skin.


What are the treatment options for dry skin?

Treatment of dry skin is aimed at restoring healthy and hydrated skin and maintaining it so skin can continue to insulate, protect, sense, regulate, and produce.  

  • Avoid harsh cleansers and antibacterial soaps that strip natural lubricants from your skin.  Use gentle soap-free unscented cleansers without mechanical cleansers like loofa.

  • Keep water temperature warm, not hot and keep showers short and sweet, especially in winter months when it is tempting to stay under hot water for prolonged periods of time.

  • Avoid soaking in hot tub for prolonged periods of time. The longer the time spent, the dryer the skin becomes.

  • Moisturize skin immediately after baths and showers while skin is supple.

  • Make moisturization a part of your daily routine, at least twice a day for the body, and after each hand wash for your hands. 

  • There are several types of moisturizers including humectants, emollients and occlusives.  Depending on your symptoms and clinical presentation, your dermatologist might recommend one or a combination of any of these.  Generally, humectants like alpha hydroxy acids, glycerin, lactic acid, urea and hyaluronic acid work by exfoliating the top dead layer of your skin and drawing water into it.  They have more water content compared to oil content.  Emollients contain less water compared to oil and help seal the tiny cracks in your skin. Occlusives like lanolin, mineral oil and petrolatum contain the most oil and provide a thick protective covering on skin to help prevent water loss. For dry skin that has cracks and fissures, barrier creams that contain dimethicone can be extremely helpful. It is important to not use very occlusive moisturizers on face because they can clog your pores and cause acne like breakouts. Ceramides are natural fats made by skin and are damaged or missing in dry damaged skin and in patients with atopic dermatitis or eczema. It is important to pick moisturizers that contain ceramides especially with history of eczema. Studies have shown reduction in number and severity of eczema flares with ceramide replacement regimen.

Severely dry skin, that presents as fish scales and runs in family members can be a sign of inherited skin condition called ichthyosis. Acquired ichthyosis, which pesents as severely dry and rough skin with scaling for the first time in adulthood, can be a sign of internal conditions like kidney failure, chronic liver disease, some cancers (Hodgkin's lymphoma), malnutrition and human immunodeficiency virus (HIV). It is important to talk to your dermatologist for dry skin that does not respond to traditional skin care regimens.