Dry Skin

Dry skin is mostly seasonal, typically occurring during winters. The symptoms may vary based on a person's age, skin tone, health conditions, and living environment and can include:

• Dryness: The primary sign of dry skin is a lack of moisture and natural oils, leading to dryness. This condition may also cause fine lines and occasional itching.
• Flaking: Excessive moisture loss can lead to skin flaking, resulting in a rough texture.
• Cracking: Dry skin may cause cracks due to skin shrinkage. These cracks can become deep and may bleed.
• Itching: Itching is common with dry skin, and some individuals may find it persistent, interfering with daily activities such as driving and sleeping. Explore home remedies to alleviate this issue.
• Pain: Cracked and flaked skin can be painful, with exposure to water often causing a burning sensation.
• Wrinkles: Dry skin can lead to a loss of skin strength and a rough texture, particularly common in older adults.
• Peeling: Peeling refers to the natural shedding of dead skin cells from the epidermis. Dry skin accelerates this process, making the skin peel more easily.
• Skin infections: Individuals with dry skin are at a higher risk of skin infections due to breaks and cracks, which allow microbes to penetrate the skin, potentially leading to fungal infections.

Before understanding the causes of dry skin, it is important to know the structure and composition of skin:

The natural skin barrier consists of specialized cells known as corneocytes. These corneocytes are fixed in the lipid-rich layer of the skin. A disturbance in the size, number, and arrangement of corneocytes impairs the skin barrier.

The normal skin should be able to store 10-20% of water content. Changes in water-holding capacity, both too high and too low, also affect the skin barrier.

The composition of lipids in the uppermost layer is influenced by various factors, including age, genetic predisposition, diet (e.g., percentage of essential fatty acids), and medications (e.g., cholesterol-lowering agents).

Dry skin is caused by a disturbance in this natural barrier function and/or a lack of moisturizing factors in the skin. The various causes that can either alter the lipid composition or decrease the content of moisturizing factors can be grouped as:

A. External causes

1. Skin cleansing: Excessive exposure to water can remove natural oils from the skin, making it dry. The following daily activities can contribute to this:
• Frequently taking long hot showers
• Excessive scrubbing of the skin
• Frequent handwashing
• Using harsh soaps
• Using alkaline soaps and detergents
• Excessive use of sanitizers
2. Environmental factors: Some environmental factors can also cause dry skin. These include:
• Living in cold weather where humidity is low
• Intense exposure to sunlight
• Using air conditioning systems
3. Occupational factors: Some individuals have constant exposure to agents that remove moisture from the skin and cause dryness. This includes people working in hairdressing, housekeeping, catering, metalworking, construction, agriculture, etc. Healthcare professionals are also at increased risk of dry skin due to frequent handwashing.

B. Internal causes

These are uncontrollable factors and include various disorders that can cause dry skin:

1. Dermatological causes: Inflammatory skin disorders that can cause dry skin include:
• Atopic dermatitis
• Allergic contact dermatitis
• Irritant contact dermatitis
• Seborrheic dermatitis
• Perioral dermatitis
• Dyshidrotic eczema
• Nummular eczema
• Psoriasis
• Scabies
• Skin infections
• Xeroderma pigmentosum
• Cutaneous T-cell lymphoma
• Lichen planus
• Urticaria
• Drug eruptions
• Genodermatoses: Rare inherited skin diseases that can influence the texture, color, and structure of the skin. A common example is ichthyosis, where the skin becomes severely dry.
2. Infectious dermatose: Skin conditions caused by bacteria, viruses, fungi, or parasites can also lead to dry skin in the chronic stage. Examples include pediculosis and scabies.
3. Neoplasms: Certain cancers, such as cutaneous lymphoma (cancer of white blood cells), can cause dry skin.

2. Psychiatric causes:

• Obsessive-compulsive disorder (OCD): Some patients with OCD may have an addiction to excessive cleaning and washing, leading to dry skin.
• Eating disorders: Anorexia nervosa, characterized by self-starvation, can lead to a lack of essential nutrients and vitamins required to maintain healthy skin.
• Alcohol addiction: Excessive alcohol consumption causes dehydration, which can lead to dry skin and worsen underlying skin conditions. Heavy drinking can lead to alcohol use disorder (AUD), increasing the risk of several skin disorders, including dry skin, skin infections, and skin cancers. According to the National Institute on Alcohol Abuse and Alcoholism, heavy drinking is defined as:
• Females: More than 3 drinks per day or more than 7 drinks per week.
• Males: More than 4 drinks per day or more than 14 drinks per week.

3. Dietary causes:

• Malnutrition: Deficiencies in Vitamin A, Vitamin D, zinc, and iron can cause dry skin.
• Dehydration: Insufficient fluid intake and excessive perspiration can also lead to dry skin.

4. Drug-related causes:

Medications such as retinoids, prolonged use of topical corticosteroids, diuretics, lipid-lowering agents, calcium antagonists, beta-blockers, antirheumatic drugs, contraceptives/antiandrogens, cytostatic agents, and immunomodulators can contribute to dry skin.

5. Internal diseases/conditions:

1. Endocrine and metabolic disorders: Various diseases can cause dry, cracked, and flaky skin, including:
• Chronic kidney disease
• Diabetes mellitus
• Liver disorders (primary biliary cholangitis, primary sclerotic cholangitis, drug-induced cholestasis, extrahepatic cholestasis)
• Hyperparathyroidism
• Hypothyroidism
• Malabsorption
2. Inflammatory causes: Diseases causing inflammation can also lead to dry skin, including chronic inflammatory bowel disease (gluten sensitivity) and rheumatic disease.
3. Infections: Certain infections can contribute to dry skin, including diarrheal diseases, helminths, Hepatitis B and C infections, and HIV infection.
4. Hormonal changes: Hormonal changes during menopause, andropause, and pregnancy can cause the skin to lose elasticity and moisture, leading to dryness.
5. Other medical conditions: Conditions such as polycythemia vera, essential thrombocytosis, Hodgkin’s disease, non-Hodgkin’s lymphoma, and multiple myeloma can also cause dry skin.

1. Physical examination and medical history
   Dry skin is typically diagnosed through a visual examination of the skin. The doctor will gather comprehensive information about your medical history, including medications you are taking, bathing habits, occupation, and family history. This information assists the healthcare provider in developing an appropriate treatment plan.
2. Blood tests
   Based on the medical information obtained, tests such as thyroid tests and blood glucose tests may be suggested to identify the underlying cause.
3. Biopsy
   In severe cases, a skin biopsy may be performed to confirm the diagnosis and determine the treatment. This procedure helps distinguish between similar-appearing conditions. A piece of skin tissue is removed and examined under a microscope. The types of biopsies include:
   • Shave biopsy: A thin slice is removed from the top of the skin.
   • Punch biopsy: Typically used to diagnose rashes, this technique involves removing a small cylindrical piece of tissue from the affected skin.
   • Excision: This method involves removing larger and deeper tissues for examination, primarily for detecting skin cancers.

The following measures can prevent the skin from drying.

Skin Cleansing and Moisturizing

Cleansing of the skin followed by moisturizing plays a crucial role in maintaining skin texture and overall health. The following measures should be taken to prevent dry skin:

• Use lukewarm water for bathing instead of warm or hot water.
• Take full-body baths for a maximum of 5 minutes only.
• Avoid bubble baths.
• Use mild, non-alkaline soap, lipid-replenishing syndets, or shower and bath oils.
• Use soaps that contain humectants.
• Avoid friction caused by rubbing with sponges.
• Use gentle and fragrance-free skin care products for the face.
• Avoid cleaning your face more than twice daily.
• Apply moisturizer regularly after bathing and washing hands.
• Avoid skin contact with alcohol-containing lotions, perfumes, and other products.

Wear Proper Clothing

Clothes also affect skin conditions as the skin is in direct contact with them. To keep the skin healthy, avoid potential triggers that can lead to itching and dryness:

• Prefer cotton clothes over synthetic fabrics.
• Avoid wool-based clothing, if possible.
• Avoid tight clothes.
• Use gloves for hands and feet.

Eat Wisely

The type of food we eat plays a significant role in keeping the skin healthy. A balanced diet that includes sufficient fruits and vegetables nourishes the skin and keeps it moist. Avoid citrus fruits, very hot and spicy foods, excessive hot drinks, and alcohol as they can dehydrate the skin.

Lifestyle Modifications

Stress, anxiety, and lack of water can also affect skin conditions, making it more prone to acne and dryness. Basic lifestyle changes can help prevent dry skin:

• Consume a sufficient amount of water.
• Take proper rest.
• Engage in regular moderate exercise.
• Avoid excessive smoking and alcohol consumption.
• Avoid direct sun exposure, especially during afternoons.
• Use sunscreens that provide appropriate protection.

Watch the video by our expert to learn about the right sunscreen.

The treatment of dry skin focuses on the following objectives:

• Repair the natural lipid barrier of the skin
• Supply water in the uppermost layer of the skin
• Increase the water holding capacity of the skin
• Reduce itching
• Repair the stratum corneum (uppermost layer of the skin)

Most cases of dry skin can be managed by topical applications that are used directly on the skin. Various types of topical preparations include:

• Humectants: Promote water transfer from the dermis to the epidermis. Examples include glycerin, urea, ammonium lactate, hyaluronic acid, and gelatin. Silicone preparations are also available as humectants; they are non-greasy and well-tolerated.
• Occlusives: Prevent water loss from the skin by creating a hydrophobic layer over it. Common examples include lanolin, paraffin, petroleum jelly, cholesterol, and stearyl alcohol.
• Emollients: Fill gaps and fissures in the skin. Common examples are dimethicone and propylene glycol.
• Relipidating agents: Contain ingredients that ensure the availability of lipids in the uppermost layer of the skin. Common examples include cholesterol and fatty acids such as evening primrose, shea, jojoba, borage, olive, wheat germ, and sunflower.
• Other ingredients: Various other ingredients serve different purposes.
• Oats: Rich in water, proteins, lipids, mineral salts, and vitamins. They keep the skin hydrated and prevent the deprivation of essential vitamins and minerals. Oats also increase compatibility between the components in the preparation.
• Allantoin: Possesses hydrating properties that keep the skin moist.
• A-bisabolol: Has anti-inflammatory and bactericidal properties. It helps repair damaged skin and prevents bacterial skin infections.

Topical steroids and calcineurin inhibitors are also prescribed in cases of itching and dermatitis. They reduce inflammation and irritation and are available in different forms such as:

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

Common examples include:

• Clobetasone
• Hydrocortisone
• Beclomethasone
• Betamethasone
• Clobetasol
• Fluticasone
• Mometasone

In severe cases, oral or injectable medications may also be prescribed.

Eat a healthy diet

Foods to include

The type of food we eat plays a crucial role in maintaining healthy skin. Dry skin can signify a deficiency in certain nutrients such as Vitamin A, Vitamin C, Vitamin D, zinc, and selenium. It is advised to consume a nutrient-rich diet to keep the skin moist and healthy. This should include:

• Sweet potato
• Kiwi
• Cod liver oil
• Almond oat milk
• Baked beans
• Avocado
• Green tea

Foods to avoid

Certain food items can hinder skin care treatment by dehydrating the skin. Excessive consumption of coffee, sugar, salty foods, and refined carbohydrates should be avoided as they restrict blood flow to the skin or extract moisture from it.

Manage stress

Stress can lead to skin breakouts and acne, which may contribute to dry skin. The following measures can help manage stress effectively:

• Get enough sleep
• Engage in enjoyable activities such as painting, playing, singing, or crafting
• Go for a walk
• Practice yoga

Shave carefully

It is advisable to apply moisturizer gel or cream before shaving. For soft and smooth skin, use a clean, sharp razor and shave in the direction of hair growth, not against it.

Say no to smoking

Smoking can damage the skin by restricting blood supply. Excessive smoking destroys collagen and elastin, which provide the skin with strength and elasticity. Therefore, it is important to quit smoking to maintain healthy skin.

Read about various practical ways to quit smoking.

Dry skin can be mostly treated with self-care and medications. However, if left untreated or ignored, it can lead to the following complications:

• Infections: If dry skin persists for a long period, it creates cracks in the skin. The damaged skin is more prone to exposure to various microbes such as fungi and bacteria, which can eventually lead to several infections.
• Permanent changes to the skin: Dry skin causes itching, and frequent scratching can result in permanent transformations. This may include thickened patches and discoloration of the skin.
• Allergic contact dermatitis: Dry skin can lead to allergic contact dermatitis due to a compromised skin barrier.
• Atopic eczema (atopic dermatitis): Excessively dry skin can lead to atopic eczema, an inflammatory condition characterized by a rash along with itching and dry skin.
• Eczema craquele: Also known as asteatotic eczema, this condition is characterized by cracked skin and is most commonly seen in older adults. Individuals with dry skin and other systemic diseases such as hypothyroidism, zinc deficiency, and lymphoma are at higher risk of developing it.
• Nummular dermatitis/discoid eczema: This condition is characterized by scattered, well-defined, coin-shaped plaques and is often seen in individuals who wash their hands excessively.
• Pruritus/Itching: Dry skin can lead to persistent itching, causing discomfort and frustration. In severe cases, it may also result in anxiety and depression, as it hampers daily activities.
• Overheating: Prolonged dryness impairs the skin barrier and can lead to overheating in the body, commonly observed in certain forms of ichthyosis.

Home Remedies

• Sunflower Seed Oil: Studies have shown that sunflower seed oil acts as a moisturizer when applied to the skin.
• Coconut Oil (Nariyal Tel): This natural oil is widely used to moisturize dry skin. It acts as an emollient due to its saturated fatty acids. Some studies suggest that its safety and efficacy are similar to petroleum jelly. It improves skin hydration and increases natural lipids in the skin. It can also be safely applied to sensitive areas, such as under the eyes and around the mouth.
• Oatmeal Bath: Oatmeal has antioxidant and anti-inflammatory properties that help relieve symptoms of dry skin, such as redness and itching. Powdered oatmeal added to the bath can reduce dry skin and is also available in cream form.
• Milk: Milk contains fats that improve the skin barrier. A diet that includes milk may enhance dry skin, although more research is needed to confirm this.
• Honey: Honey possesses moisturizing, healing, and anti-inflammatory properties and can be applied directly to the skin.
• Petroleum Jelly: Also known as mineral oil, it has been recognized for its moisturizing properties for years. Studies have found that it improves the skin barrier in older individuals, supporting the use of mineral oil for dry skin.
• Aloe Vera Gel: Aloe vera provides relief from dry skin and can be applied directly to the affected area before bedtime.
• Antioxidants: Dry skin can lead to cracking and flaking, exposing it to toxic elements in the atmosphere. A diet rich in antioxidants promotes healthier skin. Common foods that can improve skin health include:
  • Tomatoes
  • Carrots
  • Beans
  • Peas
  • Lentils
  • Berries

Dry skin can be acute or chronic. Many people might experience it throughout their lives. Most cases can be managed with gentle cleansing and adequate moisturization. Recognizing and avoiding triggers, including harsh soaps, detergents, extreme climate, rough or tight clothing, excess alcohol, spicy foods, citrus fruits, and stress, also helps in relieving symptoms and preventing complications. The following measures can be included in the lifestyle to reduce the symptoms of dry skin:

• Consult a dermatologist: Sometimes, dry skin can be a result of an underlying disease. It is very important to consult a dermatologist for the right diagnosis. This also helps the doctor in making the appropriate treatment plan that suits your skin.
• Frequent moisturization: Moisturization plays a crucial role in healing skin damaged by dryness. Apply the moisturizer after bathing, washing hands, and whenever you feel your skin has become dry. The moisturizer should be gently massaged into the skin. You can also discuss the dosage and method of application with your doctor.
• Use of mild cleansers: Cleansers play a key role in changing skin texture. Soaps and detergents should be chosen wisely. Syndet cleansers are shown to reduce itching as they are less irritating than traditional soaps. People with dry skin should avoid traditional soaps, as they can worsen skin conditions. Medicated soaps prescribed by the doctor should be used in cases of severely damaged skin.
• Use a humidifier: Dry skin causes moisture loss, especially in cold environments. The humidity level can be artificially increased with the help of humidifiers. Portable humidifiers are also available for use while you sleep.
• Wear gloves: Overexposure of the skin to water removes natural oils, making the skin dry and reducing the effectiveness of moisturizers. It is advisable to wear gloves while engaging in activities such as washing dishes, gardening, and cooking. Wearing gloves in winter also keeps the skin warm and prevents dryness.
• Use sunscreens: Sun exposure emits UV rays that can worsen skin damaged by dryness. Clothing such as long sleeves, pants, and hats can reduce exposure to sunlight. Always apply sunscreens that offer broad-spectrum protection. Sunscreen with SPF 30 or higher provides good protection for the skin.
• Wear proper clothing: Loose cotton clothes should be preferred over synthetic and tight clothing, as they relieve irritation. Tight and synthetic clothing can rub against the skin, leading to cracks and inflammation.
• Do not self-medicate: The application of various medications, such as anti-acne treatments, can cause dry skin. It is always advisable to consult your dermatologist before applying any medicated cream to the skin.