Dry Skin

What is dry skin?

Dry skin is skin that feels rough and flaky to the touch due to a lack of moisture content.^2,4 Of course, this is only scratching the surface of what dry skin actually is, so let’s dive a bit deeper.

Dry skin occurs when the skin barrier (stratum corneum) is impaired.^6–8 Your stratum corneum is the outermost layer of your epidermis (outermost skin layer) and is made up of many layers, called corneocytes, embedded in a lipid (fatty) substance.^4,6,8

For optimum skin health, the moisture level in the stratum corneum should range from 10% to 30%.⁶ However, environmental and other factors can cause this layer of skin to lose water.⁶ Water loss impairs the stratum corneum’s ability to shed dead skin cells (corneocyte desquamation), which is a normal process required to maintain your skin barrier function.⁶ Abnormal corneocyte desquamation damages the skin barrier and exacerbates water loss.^6,7

This process can occur anywhere on your body, but commonly causes:²

• Dry hands and peeling fingertips
• Dry skin on your feet
• Skin dryness on your face
• Dry elbows
• Lip dryness
• Dry skin around your genitals
• Dry patches on your legs

Dry skin symptoms

The symptoms of dry skin patches include:^2,5

• Cracked, rough, itchy skin
• A feeling of tight skin
• Flaky skin, which can appear ashy on brown and black skin
• Scaling or peeling skin
• Deep cracks that may bleed
• Skin that looks red on white skin and grey on brown and black skin
• A rash (dermatitis), only on severely dry skin

Causes of dry skin

Certain factors can trigger a loss of water in the stratum corneum, including:^2,4,5,9–11

• Age – as you age, your skin naturally thins and produces less sebum (the oil in your skin that’s needed for water retention)
• Environmental conditions –dry skin can occur year-round but often gets worse in the winter as low humidity environments can increase water loss. As a result, cold and windy climates cause dry skin. Inversely, so do hot and dry climates
• Genetics – dry skin tends to run in families, meaning you may be born with genes that predispose you to it
• Skin conditions – atopic dermatitis (eczema), contact dermatitis, asteatotic eczema, discoid eczema, seborrheic dermatitis and psoriasis all cause dry skin
• Health conditions – diabetes can lead to decreased blood flow to the skin and kidney disease can cause changes in your sweat and oil glands, leading to dry skin
• Occupations – if you work outdoors, with chemicals or need to wash your hands a lot during work, you can develop dry skin. For example, if you work in healthcare or in farming
• Too much bathing or scrubbing – taking long, hot showers or baths or scrubbing your skin too much can dissolve the sebum in your skin, causing dry skin
• Harsh soaps and detergents – many popular soaps, detergents and shampoos contain chemicals that remove oil, causing them to strip the moisture from your skin

How to treat dry skin

Lifestyle measures

The following measures can’t cure your dry skin, but they can help you to manage the condition and prevent it from getting worse:

• Use good alcohol-free cleansers for dry skin, as alcohol can dry your skin
• Use fragrance-free (hypoallergenic) skincare products
• Use dry skin creams or face creams for dry skin that contain urea, petroleum jelly, jojoba oil, shea butter, ceramides, glycerine, mineral oil, or lanolin, as these can help to repair your skin
• Use a good face wash for dry skin that does not contain sodium lauryl sulfate, as this can dry your skin
• Use sun cream with an spf of at least 30, even on cloudy days, to protect your skin from the sun
• Use warm water when you bathe or shower and limit bathing to no more than once per day and no longer than 5-10 minutes
• Use a humidifier to add moisture to the air inside your home
• Wear fabrics made from natural fibres, such as cotton, to allow your skin to breathe. Wool, however, can be irritating
• Use detergents without dyes or perfumes, both of which can irritate your skin
• Apply a clean, cool, damp cloth to itchy areas to relieve itchiness

Moisturisers and emollients

The main form of treatment for dry skin focuses on rehydrating your skin using moisturisers and face lotions for dry skin. The best moisturisers for dry skin contain emollients.

Emollients work by producing an oily layer on the surface of the skin, which traps moisture beneath it and restores the stratum corneum. They should be used liberally and often throughout the day.

Emollients are available as:

• Lotions
• Creams
• Hydrating gels
• Sprays
• Ointments

Different emollients contain different formulations, so you may need to try a few brands until you find one that works well for you.

You can get:

• Occlusive effect emollients – sometimes called ‘leave-on’ emollients, as they’re designed to keep the skin moisturised for several hours by covering the skin with a thin layer to prevent water loss
• Light occlusive effect emollients – these keep the skin moisturised for 1–4 hours, so need to be used several times a day
• Heavy occlusive effect emollients – these leave a thick film on top of the skin and can work for up to eight hours
• Humectant emollients – these contain additional ingredients, such as glycerine or urea, which are naturally moisturising. They have the largest occlusive effect and can last for between 6–24 hours. But they should still be applied at least twice a day for the best results

Other additional ingredients that are sometimes used in emollients include:

• Antimicrobials (antiseptics)– to destroy bacteria
• Humectants (glycerine, propylene glycol and urea) – which draw water into the epidermis from the dermis (the second layer of skin)
• Lauromacrogols – to help relieve itching
• Ceramides – which aim to restore the appropriate balance of fats needed for the stratum corneum to function properly
• Oatmeal– which has antioxidant properties

Emollients are recommended by the NHS to treat newborn dry skin and infant dry skin.

Medications

If you have severe dry skin, your GP may prescribe a topical corticosteroid, which works by reducing inflammation and irritation. These are available in different forms, such as:

• Creams
• Lotions
• Gels
• Mousses
• Ointments
• Tapes and bandages
• Solutions

Over the counter corticosteroids include clobetasone and hydrocortisone. Prescription only corticosteroids include beclometasone, betamethasone, clobetasol, fluticasone and mometasone furoate.

Sources

1. https://onlinelibrary.wiley.com/doi/10.1111/jdv.15157
2. https://my.clevelandclinic.org/health/diseases/16940-dry-skin
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8163918/
4. https://www.shropshiretelfordandwrekin.nhs.uk/self-care/mild-dry-skin/
5. https://www.mayoclinic.org/diseases-conditions/dry-skin/symptoms-causes/syc-20353885
6. https://www.ncbi.nlm.nih.gov/books/NBK565884/
7. https://dermnetnz.org/topics/dry-skin
8. https://www.sciencedirect.com/science/article/pii/S0009308421000086#:~:text=The%20skin%20is%20a%20large,diseased%20states%20in%20human%20skin.
9. https://www.hopkinsmedicine.org/health/conditions-and-diseases/dry-skin
10. https://www.cerave.com/skin-smarts/skin-concerns/diabetic-skin/is-diabetes-causing-your-skin-problems#:~:text=Itchy%2C%20dry%20skin%20and%20rashes,skin%20is%20broken%20or%20inflamed.&text=Stabilizing%20diabetes%20and%20glucose%20levels%20can%20also%20help%20reduce%20dryness%20and%20itching.
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC3891143/
12. https://www.mayoclinic.org/diseases-conditions/dry-skin/diagnosis-treatment/drc-20353891
13. https://eczema.org/information-and-advice/treatments-for-eczema/emollients/
14. https://www.nhs.uk/conditions/topical-steroids/
15. https://derbyshirefamilyhealthservice.nhs.uk/our-services/0-5-years/babies-health-and-wellbeing/dry-skin-and-atopic-eczema