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Just Dry Skin, or Something Else?

By Howard LeWine, M.D. | June 1, 2020 | Harvard Health Letters

Q: My skin has become very dry and itchy over the past year. Could it be some other skin problem, not just dry skin?

A: Our skin's top layer, or epidermis, is normally thick with naturally occurring fats and oils that act as a barrier to help retain moisture and prevent irritants from entering the skin. But as we age, the skin thins and we lose some of those fats and oils. This in turn allows vital moisture to escape from the skin, allowing it to become dry and cracked.

While dry skin in itself is the most common cause of itchy skin, sometimes it's tough to tell if the symptoms are caused by a different condition, such as contact dermatitis, eczema or psoriasis.

People with contact dermatitis are more vulnerable to allergens and irritants such as fragrances that could cause inflammation. When they come in contact with something that causes a reaction, they develop a red, cracked, itchy rash.

Eczema is another term for atopic dermatitis, a condition that is mostly diagnosed in children. Some kids with eczema have inherited a gene for a defective protein that causes the top layer of skin not to work as well as it should.

In older adults, eczema is a more general term for skin that's chronically dry, cracked, and itchy and hasn't improved with use of moisturizers. It may appear the same as eczema in children, but it's not caused by an inherited defect in the skin. It's due to age-related skin changes.

Psoriasis causes thick raised, red or silvery patches of scaly skin on the elbows, knees, scalp, and trunk. This skin condition isn't as itchy as eczema. Psoriasis is the result of an overactive immune system that causes a rapid turnover of skin cells and leads to cells piling up on the surface.

Psoriasis usually develops in childhood or middle age. But some people don't recognize psoriasis for years.

For simple dry skin, a concerted effort to moisturize the skin throughout the day may be all it takes to get rid of itching and dryness. But most people don't moisturize often enough, or they use lotions that contain too much water to be effective on very dry skin.

Instead of liquid lotion, look for an oil-based cream that's so thick it comes in a jar, not a pump bottle. It should be free of fragrances, dyes, and preservatives. Apply a thick layer of moisturizer immediately after showering or washing your hands, and spend a good amount of time massaging it into the skin.

If moisturizing alone isn't working, it's time to make an appointment with your doctor or a dermatologist.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

This article is written by Howard LeWine, M.D. from Harvard Health Letters and was legally licensed via the Tribune Content Agency through the NewsCred publisher network. Please direct all licensing questions to legal@newscred.com.

Howard LeWine, M.D.
Harvard Health Letters

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