In this article:
- Xerosis is the medical name for dry skin, which can weaken/compromise the skin’s barrier function.
- Xerosis is especially severe and recurrent during winters when the air is very dry.
- Prolonged exposure to water, especially hot water, is counterproductive as it depletes the moisture in your skin.
- Dry skin can result from multiple different factors, but most cases can easily be managed through proper self-care or, if need be, medication.
- Xerosis can stem from underlying systemic conditions, which require medical intervention.
What Is Xerosis?
Xerosis is commonly known as dry skin. The skin is the largest organ of the body. It acts as the first line of defense between the internal organs and the outside world.
Your skin gets its softness and suppleness from its intrinsic water and oil content. The humidity in the surrounding atmosphere also adds to the moisture of the skin. Dry skin occurs when the topmost layer of the skin, the epidermis, does not retain this moisture.
People of all ages, from infants to the elderly, can suffer from dry skin. The dryness can vary in its seriousness and extent. Although it is usually not a severe issue, there are times when dry skin becomes a challenge.
Causes of Dry Skin
People who do not moisturize their skin with a suitable emollient regularly are more likely to develop xerosis, for obvious reasons.
Additionally, excessive skin cleanliness can strip away the natural moisture from your skin, making it dry and irritated. A lot of people over scrub and overuse soaps and detergents to purify their skin. These practices damage the skin barrier and further add to the dryness.
Other factors that can make the condition worse despite proper fluid intake and skin moisturization include:
- Age: There is an age-related decline in the production of collagen, a structural protein responsible for keeping your skin elastic. Thus, skin integrity is increasingly compromised as you grow older, resulting in dry, saggy, and thin skin over time.
Moreover, older adults experience metabolic alterations and decreased liquid consumption, which can cause dryness, thinning, and loosening of the skin. (2)
- Hormones and metabolic diseases: Diabetes, malnutrition, hyperthyroidism, hypothyroidism, and Sjogren’s syndrome (a disorder of the autoimmune system characterized by dry eyes and dry mouth) can contribute to dry skin.
Moreover, menopausal women may produce abnormally low amounts of certain hormones that are responsible for stimulating the oil glands that underlie and lubricate the skin. (3)
- Climate: The problem of dry and flaky skin is particularly prevalent during the cold and dry winter months. The drier the weather, the drier the skin. This is only compounded by the overuse of indoor heaters and air ventilation, which make your living environment and thereby your skin even drier. (1)
- Certain skin conditions: Those who suffer from eczema, ichthyosis, contact dermatitis, or psoriasis often have dry, flaky, dehydrated skin.
- Occupation: People whose jobs require them to stay in constant contact with water and those who need to frequently wash their hands, such as nurses, hairstylists, and professional swimmers, often suffer from the problem of dry, wrinkled skin.
Prolonged exposure to water and the repeated use of soap can remove the natural moisture from your skin.
- Swimming in pools: The chlorine added to swimming pools to keep the water clean can cause dryness.
- Certain medicines: Dry skin can also result from the use of certain topical and oral drugs, which include diuretics and retinoids. Diuretics can dehydrate your body by increasing urine flow, and systemic retinoids can interfere with the structural integrity of the skin.
The skin dryness triggered by these medications is mainly temporary and can be reversed when the treatment is stopped.
- Nutritional deficiencies: What you eat reflects on your skin, which is why an unhealthy diet that lacks key nutrients is bound to make your skin increasingly dry and pale.
- Genetic predisposition: Some people are born with structural abnormalities in their skin cells that compromise the integrity of their skin barrier. Thus, they have an inherited tendency to develop dry skin.
Symptoms of Dry Skin
Xerosis, or dry skin, can manifest differently in different people, but it usually exhibits the following symptoms in varying degrees:
- Dry skin that is rough and scaly to touch
- Dull and flaky skin
- Fine lines that are more accentuated than before
- Intense, localized dryness, which can extend to the deeper layers of the skin, causing skin rupture and bleeding
- Chapped or cracked lips, which can sometimes bleed
- Fishnet-like cracks on the hands, feet, and lips
- Skin that feels unusually tight after exposure to water
- Greyish skin in dark-complexioned people
- Severe itching, which is particularly worst around the waist, lower legs, back, and abdomen
Diagnosing Dry Skin
To determine the reason behind the dryness, the doctor will carefully examine your skin and inquire about your habits, skincare routine, and medical history to get further insights into the condition.
You may have to undergo specific tests if the doctor suspects that an underlying health problem is causing the dryness. A biopsy may be conducted when there is a rash, wherein a small portion of the affected skin tissue is analyzed to reach a conclusive diagnosis.
Treatment for Dry Skin
Skin dryness can result from a variety of factors, and the proper treatment can only be determined once the root cause has been identified. To that end, you must visit a dermatologist to get a conclusive diagnosis and the necessary treatment.
Some of the most commonly recommended measures to treat dry skin include:
- Moisturizers: If you have extremely dry skin, the doctor may recommend a moisturizer that contains hyaluronic acid. This substance has a high viscosity and can hold and lockdown moisture in the skin.
It moisturizes the skin, promoting good skin health. Thus, hyaluronic acid is an essential substance in maintaining the water balance and supporting the structure of skin cells.
- Medicines: If your skin becomes severely dry or inflamed or the condition spreads to large areas of the body, your doctor may prescribe a topical corticosteroid or an immune modulator, such as tacrolimus and pimecrolimus, to bring down the inflammation and relieve the itch.
Ways to Manage Dry Skin
1. Follow these preventive self-care tips
- Consume ample fluids: An estimated 20% of your body’s total water content is stored in the skin, and 60%-70% of this reserve accumulates in the topmost layer.
Because a large part of the skin is mainly made up of water, it is important to maintain a steady supply of fluids in your body to keep the skin moisturized from within.
A well-hydrated body is an important prerequisite for a well-hydrated skin, whereas dry skin is one of the foremost signs of dehydration.
Older adults are advised to consume 1500 mL of water a day, which amounts to about nine 8-ounce cups per day. You can also supplement your fluid intake through water-rich fruits and foods.
- Prolonged exposure to water, especially hot water, can strip away the natural lipids of your skin and leave it utterly dry and crinkled. Keeping that in mind, you should avoid long baths or showers and always use lukewarm water.
- Consume a well-balanced diet, with a special focus on foods that are rich in omega-3 fatty acids as they help in maintaining and repairing the structural integrity of skin cells.
- Be mindful of the bathing products you use. Go through the list of ingredients before buying soap or skin cleanser to see if it contains any harsh chemicals, alcohol, or dyes, which can further dry out your skin.
Always choose gentle, unscented skin cleansers that come with added moisturizers. The same applies to your other skincare products.
- When you shave, do it right after bathing when the hair is still soft and pliable.
- Wear soft, comfortable clothing next to your skin. Avoid rough fabrics like wool.
- If your home environment is arid, consider using a humidifier to impart moisture to the air.
- Dry skin can be extremely itchy, but you must resist the urge to scratch to avoid further damage. Scratching the itch will only make your skin itch more, and the constant rubbing can rupture the skin barrier.
- One easy way to relieve the discomfort is by applying a cool compress to the irritated areas. This will help numb the nerve endings in that area temporarily and provide short-term relief.
- The skin does not respond well to sudden or drastic fluctuations in temperature, which can often trigger or aggravate skin dryness. Thus, maintain a stable temperature setting in your living space to avoid skin dryness.
- Prolonged exposure to the harmful ultraviolet radiation of the sun can alter the structure of the tissues and the DNA of the cells in the skin.
On exposure to sunlight, the skin cells absorb the radiation and then generate ROS (reactive oxygen species). ROS are detrimental to the skin and can make it dry, sallow, leathery, and rough.
- Avoid exposure during the peak hours, that is, between 10:00 AM and 4:00 PM, particularly during summer and spring, when the UV radiation is intense.
If you have to go out during these times, the least you can do is to apply a sunscreen of SPF 30 to protect your skin.
- Use detergents that do not contain any added color or fragrance to wash your clothes.
- Once you step out of the shower or bath, pat your skin dry instead of rubbing it with a towel.
- Limit your alcohol intake as it works as a diuretic that can drain your body of its water content and make your skin dry.
- Tobacco use in any form is to be avoided, as it can dry out your skin.
2. Use emollients and keep your skin hydrated
Topical therapy for dry skin involves the regular application of an emollient at least twice a day, ideally after bathing, shaving, or exfoliating when the skin is still damp.
The need for daily moisturizing becomes all the more necessary during winters when xerosis is at its worse, as topical emollients give your skin a much-needed dose of hydration.
Long, hot showers might seem like a good idea to beat the cold, but they are a great disservice to the overall health of your skin.
Hot water can further dry out your skin by stripping away its natural moisture and oils. Thus, people with xerosis must always bathe with tepid or lukewarm water no matter how cold the weather.
It is equally important to treat your skin with a generous application moisturizer within minutes of stepping out of the shower. Reapply the product every time you wash your skin or when you feel that its effect is wearing out.
Emollients come in a wide variety of formulations, such as creams, ointments, and lotions. They can be oil-based or waterbased. You may have to try several different products before you find the perfect fit for your particular skin type and condition. (4)
Ointments are usually a better fit for children and people with sensitive skin than creams as they stingless. This is mainly because ointments are devoid of added ingredients that can react harshly to your dry skin.
Emollients form a protective seal over the skin, which prevents the moisture from escaping into the atmosphere, a process that is known as transepidermal water loss (TEWL).
By keeping the skin hydrated, emollients help to repair and maintain the barrier function of the skin. They are also credited with anti-inflammatory properties.
Long-term adherence to emollient therapy is considered a safe and effective treatment choice for children with atopic dermatitis. (5)
Research also suggests that people with elevated blood sugar who are at a greater risk of having xerosis can benefit from using emollients for the management of diabetes-induced skin complications such as itchiness and dryness. (6)
You might want to try these natural oils and moisturizers for excessively dry skin:
a. Coconut oil
Coconut oil can help relieve mild to moderate xerosis, much the same way as a regular mineral oil would, without causing any adverse side effects. (7)
This easily available natural oil has been recognized as an effective agent for the treatment and prevention of atopic dermatitis. Not only does coconut oil moisturize and repair the skin, but it is also known to exhibit antibacterial properties. (8)
How to use :
- Apply warm coconut oil all over your body before going to sleep. Wash it off in the morning. Do this daily to make your skin soft and smooth.
- You may apply coconut oil to your dry skin right after taking a bath or shower as well. Do this while your skin is still warm and supple from the bath to facilitate better product absorption and to lock in the moisture. Repeat the application every day for silky smooth skin.
b. Colloidal oatmeal
Oatmeal helps moisturize and relieve dry skin. Oatmeal is high in protein, which leaves a protective barrier on the skin, preventing water loss and maintaining moisture. It has anti-inflammatory and antioxidant properties that are good for the overall health of your skin.
Whole oat extracts have such constituents that further their ability to heal dry skin. Among all the cereals, oats have the highest oil content (10% and up).
Additionally, oat triglycerides are loaded with omega-3 linoleic and omega-6 linoleic acids, as well as essential fatty acids, all of which are required for strengthening the skin barrier activity. (9)(10)(11)
There are numerous oatmeal-containing lotions and moisturizing products available on the market that can help soothe your dry skin.
c. Aloe vera
The skin-healing virtues of aloe vera are widely acknowledged and find considerable usage in the treatment of dry skin. This plant is credited with anti-inflammatory, moisturizing, antibacterial, antifungal, and antiviral properties, which make it a worthy candidate for combating xerosis. (12)
When applied topically over dry patches, aloe vera hydrates the irritated skin and forms a protective layer over it to prevent further damage by external irritants.
Multiple aloe-containing creams and gels can be used to moisturize dry skin, but the product should have a minimum of 10% aloe vera concentration to produce a noticeable effect. (13)
How to use:
You can apply raw aloe vera on the skin to relieve skin dryness:
- Cut open a fresh aloe vera leaf and squeeze the gel out of it.
- Apply the gel to your dry skin and let it sit for 10–15 minutes.
- Rinse it off with lukewarm water.
- Repeat this process two times every day.
Honey is known to exhibit anti-inflammatory, antimicrobial, antioxidant, antiseptic, blood-purifying, cleansing, healing, and moisturizing properties, which make it a sought-after remedy for multiple skin ailments, including xerosis.
Popularly termed as “nectar of the gods,” this viscous fluid imparts moisture to the skin and then seals it, thanks to its hygroscopic property.
This ability to lock down skin moisture makes honey a natural humectant and justifies its use in a wide variety of moisturizing products.
Dry Skin in Babies
It is completely normal for newborns to have dry patches on their bodies, which usually resolve without any additional moisturization in a matter of days. Some may have it worst and require a bit of topical emollient therapy to prevent skin cracks, especially around the ankles and hands.
For extreme skin dryness, you can apply a mild baby lotion that has no added dyes or fragrance to hydrate the parched areas of your baby’s skin.
Moreover, you should refrain from bathing your baby too often as excessive skin wetting, and the use of soaps can further dry out your little one’s sensitive skin.
A key distinction to be made is between dry skin and what is known as cradle cap. Many babies are born with a protruding, crusty rash on the scalp that is greasy to touch and yellow or white in color. The baby will naturally shed these rough-looking patches overtime.
Xerosis vs. Ichthyosis
Unlike xerosis, which generally refers to dry skin, ichthyosis is a collection of rare skin conditions that lead to the development of parched, thick, and scaly patches of skin all over the body.
Ichthyosis is largely incurable, and most of the skin conditions that fall under its umbrella are genetic in nature. Thus, it can be said that dry skin or xerosis is one of the predominant symptoms of ichthyosis.
People who suffer from long-term or severe xerosis often develop scaling and fissures on the skin, mostly due to the constant scratching. Dry skin is prone to cracking, which paves the way for inflammation and infections, and that is why proper skin care is of the utmost importance. (16)
If left untreated, xerosis can cause significant damage to your skin that may be difficult to undo. The complications of dry skin include:
- Excessive itching and the consequent rubbing or scratching can make the affected skin increasingly rough and thick (lichenification).
- Dry and thick skin is more likely to develop agonizing cracks, especially in the exposed areas of the body, such as your hands and feet.
- Xerosis can lead to more severe skin problems such as eczema or dermatitis in the absence of proper care. These conditions are characterized by the appearance of red, round spots all over the body that are rough, scaly, and itchy.
- At times, the scratch sites may get infected with bacteria. Such an infection is characterized by yellow crusts filled with pus. Seek the help of a medical professional in such a case.
Moreover, there is always the possibility that chronic xerosis may be triggered by some serious underlying systemic disease such as diabetes mellitus, end-stage renal disease, human immunodeficiency virus (HIV), hypothyroidism, and liver disease. In cases like these, the need for timely treatment is all the more urgent.
When to See a Doctor
Dry skin often causes itching, which may, at times, become troublesome. If the itching becomes too severe and persists for longer than 2 weeks without any apparent reason to justify it, seek medical help immediately.
Consult a doctor if:
- Preliminary treatment for five days or more fails to provide any noticeable relief.
- The dryness and itching keep you up at night.
- You develop open fissures on the affected skin due to excessive scratching.
- Your skin starts to itch without any visible rash or flakiness.
- The affected skin becomes red, swollen, and warm to the touch and starts oozing discharge, all of which are indicative of an infection.
- You run a fever.
- You are an older adult who is experiencing severe, unabated itching for more than two weeks at a stretch without any discernible cause.
- Large areas of your skin start peeling.
- You develop ring-shaped rashes.
What you may ask your doctor:
- How long would it take for the condition to improve?
- Do I need to undergo tests?
- Do I need to make changes in my daily routine?
- Are there foods or drinks to avoid?
What your doctor may ask you:
- How long have the symptoms been there?
- When did you first notice your skin becoming unusually dry?
- Is there anything that makes the dryness worse?
- Do you experience itching along with the dryness?