As the weather cools in October and the humidity decreases, we commonly see more patients with dry skin problems. These can range from having skin that just feels a little "tight" after showering or bathing, to visible scaling of skin, all the way to eczema with patches of redness with scaling or scabbing which may be intensely itchy. Skin is naturally kept moisturized by oil production from the sebaceous glands, which release oil on the skin and hold in the moisture which soaks into the outer layers of skin during washing or bathing. Humans have a significant increase in this oil production during puberty, but after about age 25 they gradually produce less each year, eventually developing dry skin. For this reason, young children and the elderly have the most difficulty with dry skin, but this problem can be seen at any age. Factors which increase water loss in the skin are: hot bath or shower water, use of detergents or soaps, and contact with cleaners and solvents.
Skin that feels a little tight after washing may be easily treated by using gentle, non-soap cleansers, such as Cetaphil Gentle Cleanser. Bars or liquid washes which contain soap, such as Ivory, or are antibacterial, such as deodorant soaps like Dial or Irish Spring, are drying to the skin and should be avoided if your skin feels dry or tight. If you feel that you need to use these washes under the arms you may do so, but avoid them on the arms, legs and trunk. As soon as you are done rinsing the skin, pat the excess water off with your towel and then immediately apply a fragrance-free lotion or cream. If you are prone to acne on the face then try to avoid heavy moisturizing creams and use oil-free moisturizers instead.
Skin that is itching, but not red or eczematous, may be treated similarly to "tight" skin, but you should use thicker creams instead of lotions. Using the lotions properly is more important than exactly which brand you choose. The intensive moisturizing lotions from Vaseline or Jergens work very well, are fragrance-free, and come in a pump bottle which is easy to use after bathing. Do not use bath oils or baby oil in the bath because they are too thin to last very long on your skin and also make the bathtub very slippery and dangerous. Cetaphil cream is an excellent moisturizer, but it is thicker and comes in a tub, which is not as convenient for tub-side use. As long as the moisturizer is fragrance-free it should work if you use it properly. Increasing the humidity of the home and using softened water in hard water areas will help prevent dry skin problems, as well, but will not work by themselves.
Dry skin and itching are very common on the back because it is difficult to lotion and most people stand with their back to the water while they wash and shampoo their hair. This can be avoided by keeping shower or bath water moderate in temperature, and by using a lotion applicator to apply lotion of the hard-to-reach areas. The applicators consist of a thin sponge on a long handle and can be used for months before needing to replace the sponge part. In Fort Dodge, these applicators are available at Daniel Pharmacy and Walgreens pharmacy (you must ask at the pharmacy desk). These retailers also sell the replacement sponges.
Eczema is a skin disease which consists of dry skin and red, scaly, itchy patches on the skin. Common areas are lower legs and back, but eczema may be seen anywhere on the skin. The redness of eczema is caused by inflammatory cells which attack the dry skin, inducing blood vessels to temporarily enlarge, as well, and thus causing the loss of heat from the skin. Because of the inflammation involved, treatment of eczema requires both treatment of the underlying dry skin, as above, but also use of topical corticosteroids, or non-steroid creams which reduce inflammations. Sometimes, in severe cases, oral cortisone tablets may be given for a couple of weeks, or a long-acting cortisone shot which lasts about four weeks, to reduce the inflammation and allow the skin to return to normal. Once the eczema is gone, the skin must still be treated with moisturizers to reduce the frequency of flares of the eczema and this part of the treatment is just as important as the prescription medications used.
For extremely dry skin, plain Vaseline or shortening may be used instead of lotions or creams. Let the Vaseline or Crisco sit on the skin for a few minutes after showering and then gently blot off the excess with a clean towel.
One skin problem which may mimic dry skin is ichthyosis vulgaris, a term describing the most common type of "fish scale" skin. Some severe types of this disease will have actual overlapping scales, but ichthyosis vulgaris skin just looks dry, with significant visible scaling of the skin but without itching or discomfort. People who have this common genetic disease will look very dry, but they are not uncomfortable. Unlike eczema, patients with ichthyosis are treated with lotions designed to remove the excess scales from the skin so it appears more normal. Two commonly used lotions for this purpose are 12 percent lactic acid lotions, such as Amlactin, or urea preparations, such as Carmol 10 or 20 percent. Thick, scaly feet are usually treated with 40 or 50 percent urea lotions.
In summary, dry skin can be prevented and treated by using mild cleansers, avoiding steamy hot water, using moisturizers properly, increasing the humidity of the home, and softening the water. If dry skin develops into eczema it should be treated by a physician.
Carey A. Bligard. M.D., is affiliated with Trimark Dermatology.