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    Managing Dry Winter Skin

    Jamie Mull, MD Deaconess Clinic Dermatology 12/11/2018
    The arrival of winter usually signals the arrival of dry skin. Anyone can develop dry skin, but the cold climate of the winter months, accompanied by the dry heat indoors, can aggravate the condition. Also, those long, hot showers and baths that feel so good usually end up causing even more problems (more on that below).

    As a dermatologist, I see more patients with itching related to dry skin than patients with a rash that itches. Unfortunately, dry skin often leads to having an "itch that rashes." What I mean by that is dry skin will itch and cause a person to scratch. That scratching leads to a raised, irritated rash that itches and causes more scratching. It’s a vicious cycle.
     
    What causes dry skin?
    To help explain why dry skin occurs, it’s helpful to understand the outer skin. Your skin cells are like bricks, and the "mortar" between them is the natural lipid/oils that seal your skin, keeping it soft and supple. Dry skin is the result of these fatty substances being stripped away, allowing the moisture to evaporate. This is often the result of both genetic and environmental factors.

    Environmental causes of dry skin:
    • Outside weather: Cold, dry air outside pulls moisture from our skin
    • Indoor heating: Central heat systems, wood burning stoves, space heaters and fireplaces all reduce humidity and dry your skin
    Products and/or activities that cause dry skin:
    • Frequent/hot baths and showers break down your skin’s protective barrier, as does swimming, particularly in heavily-chlorinated pools. Additionally, heat exposure from hot water releases histamine in the skin, a chemical that induces itch.
    • Harsh soaps and shampoos can dry out skin
    • Some medications, such as topical treatments for acne, can dry skin
    Medical conditions and other factors that can aggravate dry skin:
    • Diabetes and hypothyroidism can contribute to dry skin
    • Being an older adult is a risk factor for dry skin
    • Malnourishment in the elderly, or any age, can cause dry skin
    • Certain skin conditions such as chronic eczema, atopic dermatitis and psoriasis are worse in winter months
     
    What to do about dry skin?
    • Moisturize your skin: Moisturizers work to seal your skin to keep water from escaping, but some products work better than others. Studies have shown expensive products are no more effective than less costly ones. In fact, more expensive products may contain more potential allergens. I recommend moisturizers that are fragrance-free and alcohol-free. They should feel thick and greasy to work well. (A product with 100% white petroleum jelly, like Vaseline, is one of the best options.) If you need less grease, consider any moisturizer thick enough to scoop out of a jar instead of one thin enough to pump out of a bottle. Ceramide-containing moisturizers may be of added benefit.
    • Moisturize after bathing: After you get out of the bath or shower, gently pat your skin dry with a towel. Doing this keeps moisture on the skin. You can immediately apply the thick moisturizer to help trap water on the surface of the cells, preventing the evaporation of water from the surface of your skin. If your skin is still dry despite moisturizing once per day after bathing, then increase the frequency of moisturizing to two or three times per day.
    • Bathe less frequently: In the winter, most of us don’t need to bathe as often, maybe only every-other-day. Between times, a sponge bath may be enough to be clean and hygienic. When taking a bath or shower, use warm (rather than hot) water. Avoid taking long baths or showers, keeping the length to 5-10 minutes on average. Use a gentle, fragrance-free soap/cleanser and water in the areas that become dirty (face, under arms, groin and genital area) while avoiding scrubbing or rubbing vigorously in other areas.
    • Check your soaps and detergents: Harsh deodorant and antibacterial soaps can be extra drying. Try using cleansing creams, mild soaps or body washes that are fragrance-free. Your skin should feel soft and smooth after cleansing - not tight and dry.
    • Protect your skin: When indoors, turn down the thermostat a bit. Less heat means less evaporation. You can also add moisture to the air with a humidifier (just be sure to keep it clean to ward off bacteria and mold). When you do dishes, use long gloves to protect your hands. If outside, cover as much skin as possible with natural fabrics such as cotton. Avoid wool which can be irritating to already sensitive skin.
     
    When to see the doctor
    If you have any of the following symptoms, consider a visit to your physician or dermatologist:
    • Your skin doesn’t improve after trying multiple treatments (moisturizing, changing soap, etc.)
    • Deep cracks or fissures develop which can open up and bleed, causing an infection
    • Dry skin is accompanied by redness, tenderness or swelling
    • Dryness and itching that interferes with sleeping - for yourself or your partner
    • You have open sores or infections from scratching
    • You have large areas of scaling or peeling skin
      
    Hoping these tips help you have a more comfortable, itch-free winter.




     - retired Deaconess Clinic dermatologist Dr. Robert Martin contributed to this article
     
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