Dry Skin

Symptoms Of 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, living environment and can include:

1. Dryness

As the name itself suggests, the typical sign of dry skin is dryness of skin because of lack of moisture and natural oils. It also causes fine lines on the skin that sometimes itches. 

2. Flaking 

Excessive loss of moisture also causes flaking of skin that gives a rough texture to the skin.

3. Cracking 

Dry skin can also cause cracks to form due to shrinking of the skin. These cracks can become deep and may bleed also. 

4. Itching

Dry skin also causes itching. Some people experience itching all the time that interferes with routine chores such as driving, sleeping, etc. 

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5. Pain

The already cracked and flaked skin often feels painful as well. The exposure to even water causes burning sensation to the skin of people affected with dry skin. 

6. Wrinkles 

The skin of people with dry skin loses its strength due to loss of water and develops a rough texture. This is most common at old age. 

7. Peeling

Peeling refers to the renewal of the uppermost layer of skin – epidermis. It is a natural process to shed dead skin cells. Dry skin increases the shedding process which causes skin to peel off easily. 

8. Skin infections

The people affected with dry skin are more prone to skin infections due to the breaks and cracks in the skin. The cracks allow the penetration of microbes inside the skin that can lead to infections such as fungal skin infections. 

Read in detail about fungal skin infections. 
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Causes Of Dry Skin

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. The 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. The changes in water holding capacity, both too high and too low also affects the skin barrier. 

• The composition of lipids in the uppermost layer is also affected by various factors like age, genetic disposition, diet (e.g., percentage of essential fatty acids) as well as drugs (e.g., cholesterol-lowering agents).

Dry skin is caused due to disturbance in this natural barrier function and/or lack of moisturizing factors in the skin. The various causes that can either alter the lipid composition or can 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 cause it: 

• Frequently taking long hot showers 

• Excessive scrubbing of the skin

• Frequent washing of the hands 

• 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 system 

3. Occupational factors: Some people have constant exposure to the agents that remove moisture from the skin and cause dry skin. This includes people working in hairdressings, housekeeping, catering, metal workers, construction, agriculture etc. Healthcare professionals are also at increased risk of dry skin because they have to wash their hands frequently.

B. Internal causes

These are the uncontrollable factors and include various disorders that can cause dry skin. This can be: 

1. Dermatological causes

Inflammatory skin disorders: There are various skin disorders that can cause dry skin such as : 

• 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: It refers to rare inherited skin diseases that can influence the texture, color and structure of skin depending upon the type. Common example include ichthyosis in which the skin becomes severely dry. 

Infectious dermatose: These are the skin conditions that are caused by bacteria, virus, fungi, or parasites. In the chronic stage, they also cause dry skin. The disease includes pediculosis and scabies. 

Neoplasms: Some forms of cancers such as cutaneous lymphoma (cancer of white blood cells) can also cause dry skin. 

2. Psychiatric causes

Obsessive compulsive disorder (OCD): Some patients of OCD have the addiction of excessive cleaning and washing which can be the cause of dry skin. 

Eating disorders: It includes anorexia nervosa which is characterized by self starvation that can lead to lack of essential nutrients and vitamins required to keep the skin healthy.

Alcohol addiction: The excessive consumption of alcohol causes dehydration which can eventually lead to dry skin. It can also worsen underlying skin conditions. Heavy drinking can cause alcohol use disorder (AUD) which increases the chances of several skin disorders such as dry skin, skin infections and skin cancers. According to The National Institute on Alcohol Abuse and Alcoholism, heavy  drinking refers to :

• 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: Dietary causes such as deficiencies of Vitamin A, Vitamin D, zinc and iron can also cause dry skin. 

Dehydration: Insufficient fluid intake and excessive perspiration can also cause dry skin. 

4. Drug-related causes

Retinoids, topical corticosteroids (prolonged use), diuretics, lipid-lowering agents, calcium antagonists, beta blockers, antirheumatic drugs, contraceptives/antiandrogens, cytostatic agents, radiation dermatitis (following radiation therapy), immunomodulators can also make the skin dry. 

5. Internal diseases/conditions

1. Endocrine and metabolic disorders: There are various diseases that can cause dry, cracked and flaky skin. These disorders include:

• Chronic kidney disease
• Diabetes mellitus
• Liver disorders (primary biliary cholangitis, primary sclerotic cholangitis, drug-induced cholestasis, extrahepatic cholestasis)
• Hyperparathyroidism
• Hypothyroidism
• Malabsorption

2. Inflammatory causes: The diseases that cause inflammation can also cause dry skin. They include chronic inflammatory bowel disease (gluten sensitivity) and rheumatic disease.

3. Infections: Some infections can also make the skin dry. It includes diarrheal diseases, helminths, Hepatitis B and C infections, and HIV infection. 

4. Hormonal changes: The hormonal changes in the conditions such as menopause, andropause, and pregnancy causes the skin to lose its elasticity and mositure leading to dry skin. 

5. Other medical conditions: Conditions such as polycythemia vera, essential thrombocytosis, Hodgkin’s disease, non-Hodgkin’s lymphoma, and multiple myeloma can also be a cause of dry skin. 

Diagnosis Of Dry Skin

1. Physical examination and medical history

Dry skin is usually diagnosed through visually examining the skin. The doctor will gather complete information about your medical history. The doctor also discusses medications you are taking, your bathing habits, occupation, family history etc. This will help the health care provider in guiding the treatment plan.

2. Blood tests

Based on the medical information, some tests such as thyroid test, blood glucose tests can also be suggested to find the exact cause. 

3. Biopsy

In severe cases, skin biopsy is also used to confirm the diagnosis and decide the treatment. It also helps in distinguishing the similar appearing conditions. In this, a piece of skin tissue is removed and examined under the microscope. It can be of following types: 

• Shave biopsy: This technique uses a thin slice removed from the top of the skin. 

• Punch biopsy: It is generally used to diagnose rashes and uses a small cylindrical piece of tissue from the affected skin. 

• Excisions: It uses larger and deeper tissues for examination. It is mostly utilized for detecting skin cancers. 

Specialist To Visit 

In most of the cases, dry skin resolves with lifestyle modifications and home remedies. Consult your healthcare provider if: 

• Dry skin persists even after OTC medications and self-care tips

• Skin becomes inflamed or painful

• Dry skin develops as a result of side effects of cancer treatment

• You are unable to do your regular activities as a result of itching 

• You have open sores

The specialist doctors that can help in this condition include: 

• Dermatologist 

• General physician

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Prevention Of Dry Skin

The following measures can prevent the skin from drying. 

Skin cleansing and moisturizing

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

• Use lukewarm water for bathing instead of warm/hot water

• Take full-body bath for a maximum of 5 min only

• Avoid bubble bath 

• Use mild, non-alkaline soap, lipid-replenishing syndets/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 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 the skin conditions as the skin is in direct contact with the clothes. For keeping the skin healthy, avoid potential triggers that can lead to itching and dryness of skin. 

• Prefer cotton clothes over synthetic fabrics

• Avoid wool based clothing, if possible

• Avoid tight clothes

• Use gloves for hands and feets  

Eat wisely

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

Lifestyle modifications

Stress, anxiety, and lack of water can also modulate the skin conditions and make it more prone to acne and dry skin. The basic lifestyle changes can help prevent dry skin. 

• Consume sufficient amount of water

• Take proper rest 

• Do regular moderate exercise

• Avoid excessive smoking and alcohol consumption 

• Avoid direct exposure to sun especially during afternoons

• Use sunscreens which give appropriate protection

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

Treatment Of Dry Skin

The treatment of dry skin focuses on the following motives:

• Repair the natural lipid barrier of the skin

• Supply water in the uppermost layer of the skin

• Increase the water holding holding capacity of the skin

• Reduce itching

• Repair stratum corneum (uppermost layer of the skin)

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

• Humectants: They promote water transfer from dermis to epidermis. Examples include glycerin, urea, ammonium lactate, hyaluronic acid, and gelatin. Silicone preparations are also available as humectants. They are not greasy and have good tolerance. 

• Occlusives: These are the preparations that prevent water loss from the skin by creating a hydrophobic layer over it. The common examples include lanolin, paraffin, petroleum jelly, cholesterol, and stearyl alcohol. 

• Emollients: These agents fill gaps and fissures in the skin. Dimethicone and propylene glycol are common examples.

• Relipidating agents: The topical formulations also contain relipidating ingredients that ensures the availability of lipid in the uppermost layer of the skin. The common examples are cholesterol and fatty acids such as evening primrose, shea, jojoba, borage, olive, wheat germ, and sunflower.

• Other ingredients: The preparations also contain several other ingredients that serve different purposes. 

1. Oats: It is rich in water, proteins, lipids, mineral salts, and vitamins. It keeps the skin hydrated and also prevents deprivation of essential vitamins and minerals. It is also used to increase the compatibility between the components in the preparation.  

2. Allantoin: It possesses hydrating properties which keeps the skin moist. 

3.  A-bisabolol: It has anti-inflammatory and bactericidal properties. It helps in repairing the damaged skin and also prevents bacterial skin infections. 

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

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

The common examples include: 

• Clobetasone

• Hydrocortisone

• Beclomethasone

• Betamethasone

• Clobetasol

• Fluticasone

• Mometasone

In severe cases, oral or injectable medications are also given.

Home-care For Dry Skin

Eat a healthy diet

Foods to include

The type of food we eat plays a very important role in keeping the skin healthy. Dry skin can also be a sign of deficiency of certain nutrients such as Vitamin A, Vitamin C, Vitamin D, zinc, and selenium. Hence, it is advised to take 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, and green tea. 

Foods to avoid

Certain food items can hamper the skin care treatment by dehydrating the skin. Excessive consumption of coffee, sugar, salty foods, and refined carbs should be avoided as it restricts the blood flow to the skin or extracts water from it. 

Manage stress

Stress can also promote skin breakouts and acne which can also result in dry skin. The following measures can be taken to manage the stress effectively.

• Get enough sleep

• Do things you enjoy such as painting, playing, singing, crafting etc

• Go for a walk

• Perform yoga

Shave carefully 

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

Say no to smoking

Smoking can damage the skin through restricting the blood supply. Excessive smoking destroys collagen and elastin that gives the skin strength and elasticity. Thus, it is important to quit smoking to keep the skin healthy. 

Read about the various practical ways to quit smoking.
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Complications Of Dry Skin

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 of time, it creates cracks in the skin. The damaged skin is more prone to the exposure of various microbes such as  fungi and bacteria. It can eventually lead to several infections. 

Permanent changes to the skin

Dry skin causes itching and frequent scratching can transform the skin permanently. It can cause changes such as thickened patches on the skin and discolouration of the skin. 

Allergic contact dermatitis

Dry skin can also lead to allergic contact dermatitis due to compromised skin barrier. 

Atopic eczema (atopic dermatitis) 

The excessively dry skin can lead to atopic eczema. It is an inflammatory condition that is characterized by a rash along with itching and dry skin. 

Eczema craquele

Also known as asteatotic eczema. The disease gets its name due to the cracked skin which is the characteristic of this condition. It is most commonly seen in old people. People having dry skin with other systemic diseases such as hypothyroidism, zinc deficiency, and lymphoma have the high chances of developing it. 

Nummular dermatitis/discoid eczema

The disease is characterized by scattered, well-defined, coin-shaped and coin-sized plaques. It is mostly seen in people who wash their hands excessively. 

Pruritus/Itching 

Dry skin can also lead to consistent itching which can cause discomfort and frustration. In severe cases, it can also lead to anxiety and depression as it hampers daily chores and activity. 

Overheating 

Prolonged dryness impairs the skin barrier and can lead to overheating in the body. It is most commonly seen in some forms of ichthyosis. 

Alternative Therapies Of Dry Skin

Home remedies

Sunflower seed oil: Studies have shown that sunflower seed oil acts as a moisturizer when applied on the skin. 

Coconut oil (Nariyal tel): It is a natural oil that is also widely used to moist dry skin. It acts as an emollient due to the presence of saturated fatty acids in it. Some studies suggest that its safety and efficacy is similar to that of petroleum jelly. It improves skin hydration and increases natural lipids in the skin. It can also be safely applied to the sensitive parts of the body such as under the eyes and around the mouth.

Oatmeal bath: Oatmeal has antioxidant and antiinflammatory properties which helps to relieve symptoms of dry skin such as redness and itching.  The powdered oatmeal  added to the bath helps to reduce dry skin. It is also available in the form of creams. 

Milk: Milk contains fat that improves skin barrier. A diet including milk could improve dry skin. However more research is needed to confirm this. 

Honey: It also possesses moisturizing, healing and anti-inflammatory properties. It can be applied directly on the skin.

Petroleum jelly: It is also known as mineral oil and has been known from years for its moisturizing properties. Studies have found that it improves skin barrier in older people. This study supports the use of mineral oil in dry skin. 

Aloe vera gel: It also provides relief from dry skin. It can be applied directly over the affected area before going to bed at night. 

Antioxidants: Dry skin causes cracking and flaking of the skin which exposes it to certain toxic elements of the atmosphere. Diet rich in antioxidants makes the skin healthier. Some of the common foods that can improve skin health include: 

• Tomatoes

• Carrots

• Beans

• Peas

• Lentils

• Berries

Living With Dry Skin

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/tight clothing, excess alcohol, spicy foods, citrus fruits, and stress also helps in relieving symptoms and prevents complications. The following measures that can be included in the lifestyle to reduce the symptoms of dry skin: 

Consult dermatologist

Sometimes, dry skin can be a result of an underlying disease. It is very important to consult a dermatologist for the right diagnosis. It also helps the doctor in making the right treatment plan that suits your skin.  

Frequent moisturization

Moisturization plays a very integral role in healing the skin damaged by dry skin. Make sure to apply the moisturizer after taking a bath, washing hands and whenever you feel the skin has become dry. Moisturizer should be gently massaged into the skin. You can also discuss with your doctor about the dose and method of application.  

Use of mild cleansers

Cleansers play a key role in changing the skin texture. Soaps and detergents should be wisely chosen. Syndet cleansers are shown to reduce itching as they are less irritating than traditional soaps. The people having dry skin should avoid traditional soaps as they can worsen the skin conditions. Medicated soaps prescribed by the doctor should be used in case of severely damaged skin.

Use humidifier

Dry skin causes the skin to lose its moisture, especially in the cold atmosphere. The humidity level can be artificially increased with the help of humidifiers. Portable humidifiers are also available that can be placed near you while you sleep. 

Wear gloves

The over exposure of the skin to the water removes the natural oil from the skin and makes it dry. It also reduces the effect of moisturizer. It is wise to wear gloves while doing activities such as washing dishes, gardening, cooking etc. 

Wearing gloves in the winter also keeps the skin warm and prevents the skin from drying. 

Explore some interesting and simple skin care tips for dry skin in winter.
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Use sunscreens

Sun emits UV rays which can worsen the damaged skin affected by dry skin. Clothing such as long sleeves, pants and hats also reduces the exposure of the skin from the sunrays. Always apply sunscreens that offer wide spectrum protection. Sunscreen with SPF 30 or higher provides good protection to the skin.  

Wear proper clothing 

Loose and cotton clothes over synthetic and tight ones should be used as it relieves irritation. Tight and synthetic clothing rub against the skin that makes the skin more cracked and inflamed. 

Do not self medicate

The application of several drugs such as anti-acne medications can cause dry skin. It is always advisable to consult your dermatologist before applying medicated cream over the skin.