Dry Skin

What Is It?

Normal skin has a soft, supple texture because of its water content. For skin to feel soft, pliable and "normal," its top layer must contain a minimum of 10% water and ideally between 20% and 35%. To help protect the outer layer of skin from losing water, the skin's sebaceous glands produce an oily substance called sebum. Sebum is a complex mixture of fatty acids, sugars, waxes and other natural chemicals that form a protective barrier against water evaporation. If the skin doesn't have enough sebum, it loses water and feels dry. If environmental factors cause more water evaporation and overwhelm the ability of sebum to prevent water loss, the skin will shrivel and crack.

Dry skin, also called xerosis, is a very common problem in modern societies, affecting people of all ages, even infants. In the United States, most cases of dry skin are related to one or more of the following factors:

• Decreased production of sebum This is often a factor in the elderly, since the number of sebaceous glands in the skin tends to decrease with age. Aging also may cause blood flow to the skin to decrease, causing a drop in sebum production.
• Loss of existing sebum This usually is caused by lifestyle factors, such as excessive bathing or showering, excessive scrubbing of the skin while washing, or harsh soaps that dissolve the protective layer of sebum. In some cases, the result is dry skin over the entire body, especially among school athletes who shower several times a day. In other cases, dry skin affects only the hands for example, in health care workers, food handlers, house cleaners, homemakers and others who frequently wash their hands.
• Environmental conditions that increase water loss Extreme environmental conditions can overwhelm the skin's natural protective barrier, causing water to evaporate. This is an important reason for dry skin among people who live in sun-baked desert climates, especially in parts of the southwestern United States. Excessively dry indoor air also can cause dry skin and "winter itch" in the northern United States, particularly in people who use forced-air heating systems. Among outdoor athletes, frequent exposure to wind and sun can evaporate water from the skin, making the surface feel itchy and dry. Even swimmers can get dry skin, since the chemical content of pool water actually draws moisture from the skin.

Dry skin is a common problem in people with diabetes or skin allergies (atopic dermatitis). Less often, it can also be a symptom of hypothyroidism, kidney failure or Sjögren's syndrome. In addition, dry skin sometimes develops as a side effect of medication, especially acne products that are applied to the skin.

Symptoms

Sometimes, the only symptom of dry skin is itching, although most people also will notice that their skin is flaky and slightly more wrinkled than normal. Symptoms of dry skin may worsen during the winter months, especially if you spend a lot of time indoors, where the heated air is dry.

Diagnosis

In most cases of uncomplicated dry skin, you can make the diagnosis yourself. Begin by examining your normal skin care routine. Do you often take long, hot baths or showers that may be washing away your skin's protective sebum? Do you shower several times a day or scrub your skin surface with harsh soaps? Do you have a job that requires frequent handwashing?

Next, examine your environmental risk factors, both indoors and outdoors. Do you live in a dry, desert climate? Do you usually spend your winter months indoors, in heated rooms without a humidifier? When you do go outdoors, do you protect your skin with appropriate clothing or with a sunscreen on exposed surfaces? When was the last time you used a moisturizer?

Expected Duration

Once you begin to take care of your skin properly, the flakiness and itch of dry skin should improve within one or two weeks. In many cases, a good moisturizer will begin to make your skin look softer and suppler within minutes.

Without proper care, dry skin can become a chronic problem that can lead to skin thickening, cracking and bleeding. This may increase your risk of skin infections.

Prevention

You can help to prevent dry skin by taking these steps:

• Take only one shower or bath daily. Wash with comfortably warm (not hot) water, using a soap that either has a high fat content or contains glycerin. Limit your bath time to 10 to 15 minutes, and avoid scrubbing.
• If you are an athlete, shower off quickly after a workout or game. Use warm water, and bring your own mild soap, since heavy-duty "gym" brands may be too strong.
• When you finish your bath or shower, apply moisturizer while your skin is still wet. Petroleum jelly or a thick cream is best for sealing skin moisture.
• Cover exposed skin when you play outdoors. If you can't wear protective clothing because of hot weather or game regulations, apply a sunscreen with a moisturizer. If you are a swimmer, apply a light layer of petroleum jelly before you enter the pool.
• If your indoor air is dry during winter months, use a humidifier to raise the humidity level.
• As necessary during the day, apply a moisturizer that contains at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts or alpha hydroxy acids.
• Avoid overusing antiperspirants and perfumes, since these products can dry the skin.

Treatment

If you have a simple case of dry skin, begin by trying the suggestions outlined in the Prevention section. If your dry skin persists, contact your doctor's office for advice.

When To Call A Professional

Call your primary care doctor or a dermatologist (a doctor who specializes in skin problems) if you have:

• Dry skin that doesn't respond to nonprescription treatments
• Severe itching that interferes with your ability to work or sleep
• Dry skin that cracks and bleeds, or becomes red, swollen and painful

Prognosis

Overall, the prognosis is excellent. You can often prevent dry skin by making a few simple changes in lifestyle. If dry skin develops, there are many soothing and effective treatments available. Most can be purchased without a prescription.

Additional Info

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse

National Insitutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: (301) 495-4484

Toll-Free: (877) 226-4267

Fax: (301) 718-6366

TTY: (301) 565-2966

E-Mail: niamsinfo@mail.nih.gov

http://www.niams.nih.gov/

National Institute on Aging

Building 31, Room 5C27

31 Center Drive, MSC 2292

Bethesda, MD 20892

Toll-Free: (800) 222-2225

http://www.nih.gov/nia/

American Academy of Dermatology

P.O. Box 4014

Schaumburg, IL 60168-4014

Phone: (847) 330-0230

Toll-Free: (888) 462-3376

Fax: (847) 330-0050

http://www.aad.org/