Healthy Woman: Healing Dry Skin

— -- During the winter months, people wear layers of clothes to protect their bodies from the elements, but they don't always take steps to protect their skin. Some may end up paying for this oversight: The lack of humidity in the air, combined with dry indoor heat, can lead to dry, itchy and even flaking or cracked skin.

And while a long hot shower sounds like just the thing to warm yourself up in cold weather, it might be just the wrong thing to do to your skin.

Below, Robin Ashinoff, MD, chief of dermatologic and cosmetic surgery at Hackensack University Medical Center in Hackensack, New Jersey and an associate clinical professor of dermatology at New York University, discusses how to manage common dry skin conditions and how moisturizing skin daily can usually keep skin smooth and soft.

What causes dry skin?First of all, genetic background. Certain people just have a genetic predisposition to having drier skin or even worse, what we call eczema, which causes flaking and itching. In general, very fair-skinned, light-eyed people have a tendency towards drier skin.

Certainly humidity may play a role. You may not notice that you have dry skin if you live in a place like Florida or Louisiana, whereas if you live in the Northeast, especially in the wintertime, you'll experience your predisposition to dry skin.

You can worsen any sort of predisposition by using harsh cleansers or irritants, or by washing frequently, which removes the protective barrier on our skin and increases what we call transepidermal water loss. You lose more water through the skin if you break that barrier down. For your average person, taking more than one quick shower a day in the wintertime would probably dry you out.

How can people distinguish between regular dry skin and a skin disorder? Basically, with one thing: their comfort level. If you're starting to feel uncomfortable and itchy, or you're noticing redness, you may have a skin disorder. For example, eczema, also known as atopic dermatitis, is a type of inherited dry skin condition. It can start in childhood, and usually affects the face and the areas where your body bends.

Psoriasis is another defined condition with strong genetic and environmental components. People with psoriasis usually have thick, red plaques with a very thick white scale on top of them. Initially, these are on the scalp, elbows, knees, but they can spread. There are also nail changes, and you can have arthritis with psoriasis.

Why is dry skin more of a problem in the winter?Certainly, in the Northeast, the ambient humidity drops in the winter, so there's less moisture in the air. So through evaporative processes, you're losing moisture through your skin.

Some buildings have dry heat, which is even worse. I may tell people to either buy a humidifier for the house or, if they have the old steam radiators, just to put pots of hot water on the radiator and let the water evaporate into the air. It will be better for your respiratory system, which also dries out and cracks, as well as your skin. And of course, going out in the wind or doing anything that might disturb your epidermal barrier promotes dry skin.

What is dermatitis?Contact dermatitis is a dry skin condition that you can usually identify with a precipitating event. The most common contact allergen is probably nickel. Because nickel alloy is in a lot of jewelry worn around the wrist and fingers, you can actually see the outline of the material in red; sometimes you can even get little blisters.

Irritant dermatitis is something different. It may be more insidious in the sense that you may not realize that you're constantly exposing yourself to an irritant. It doesn't cause an explosive reaction like having poison ivy, but it can cause constant low-grade flaking, dryness, itching and redness, and eventually from the chronic scratching and rubbingof the affected area, the skin actually starts to thicken. So you see people with this leathery-like skin.

If people have hand dermatitis, they know that in the late fall, their hands will immediately start to dry out. You're constantly using your hands, and if you have fissures in your hands and you get water in them, it burns like crazy. For people with bad hand dermatitis in the wintertime, I may tell them to use Vaseline and sleep with cotton gloves on to try to rebuild that moisture barrier. And I tell them to try to keep their hands out of water and to use cotton-lined gloves to wash dishes.

What are other types of dry skin conditions?At this time of year, many people will notice that they get sort of chicken skin or bumpiness on the backs of their arms, upper arms and thighs and buttocks, and this is something called keratosis pilaris. I will tell people with this condition that it's time to really start laying on the moisturizers, taking quick, cooler showers, putting on a moisturizer when your skin is moist so that the skin absorbs it better, and then if that doesn't help, we can go on to prescription medications.

What does a good skin care regimen involve, during the winter especially?Quick, cool showers. You don't want to sit in a bathtub because it will dehydrate your skin more. You want to use a mild soap, preferably a moisturizing soap. There are also body washes now that have petrolatum in them, and when you use a puff to apply the body wash, it will coat you with sort of a lipid barrier, and that may be helpful for a lot of people.

When people come out of the shower, they should pat, not rub themselves dry with a towel, and then they can start out with an over-the-counter moisturizer.

I also tell people when they get undressed to go to sleep, put moisturizer on again. And for bad hands, I tell people to keep a tube of moisturizer in their pockets.

What should people look for in a moisturizer?People with dry skin should look for moisturizers that contain lactic acid, which is a humectant that draws moisture into the skin. There are over-the-counter products with lower concentrations of glycolic acid, which acts as an exfoliant, and moisturizers that contain urea, another humectant. Urea may help for badly dry skin, especially on cracked heels in the wintertime.

You want to look for ones that say "for heavy use" or "for body use" because the facial moisturizers typically have less petrolatum in them, so that people won't break out on their face. On your body, you care less about breakouts. You want something heavier. The best moisturizer, though we don't like it because it's not very cosmetically appealing, is something like Vaseline (petrolatum). It is very moisturizing, but it's very greasy.

Will drinking more water prevent dry skin?Unless you are dehydrated, excessive drinking of water is not going to help dry skin. And unless you are deficient in some sort of essential fatty acid, eating certain types of fats is also not going to moisturize your skin.

Are there any other behaviors to avoid other than baths or long hot showers?What can make a lot of people who have eczema and dry skin itch more in the wintertime is wearing wool or wool-like products. They're better off with cotton and cotton-like products, which breathe more.

At what point someone should visit the doctor?If they're scratching, if they're uncomfortable, if they're losing sleep, if they don't like what their skin looks like, it's worth a trip.

Christine Haran of Healthology wrote this report.