How to Tell If Your Dry Skin Is Something More Serious

If you’ve ever suffered from dry skin, it can take several different products, scaling back on the hot showers and a bit of trial-and-error before you get things under control. But what happens when none of your efforts work and your dry skin is in fact something more difficult to treat, such as eczema or psoriasis? Here, dermatologists explain the difference between dry skin and common skin conditions eczema and psoriasis that are linked to dryness, and when it’s time to call the doctor.

Characteristics of Dry Skin

“Dry skin results when our environment is less humid than our skin and we lose moisture to our surroundings,” explains New York dermatologist Orit Markowitz, MD. “Moving to the tropics would cure your dry skin, but if that is not an option, then a humidifier and moisturizing after a shower with a moisturizer that seals in moisture like Alastin or Aquaphor Spray, will help as well.”

Eagan, MN dermatologist Charles Crutchfield III, MD advises his patients to always use a gentle soap that contains no detergents (or a low amount) when they shower or bathe. “I recommend Vanicream’s Cleansing Bar or Dove’s Unscented Bar. That’s as important as the lotion is, which you should apply directly after bathing. Use a cotton towel to pat dry and then apply the lotion. Be sure to also put lotion on your hands every time you wash them, especially in the winter. That makes a big difference.”

“Anytime the dry skin develops into cracks, fissures, irritation, bleeding, and/or there is pain or discomfort, then it should be treated,” adds Dr. Crutchfield. “Usually, a dermatologist can tell the difference between eczema and psoriasis, but the main thing is to keep your skin hydrated so xerotic eczema (dermatitis from excessive dryness) does not happen.”

Characteristics of Eczema

“There are different categories of dry skin just like there are different categories of eczema, but the classic dry skin category is on the spectrum with the classic nummular eczema category,” Dr. Markowitz explains. “When does it officially become nummular eczema? When we start to see patches of flaking, not just overall flakiness or dryness. Avoiding scrubs and harsh soaps is important, and if things do not improve, then you may have a more severe form of eczema and seeing a board-certified dermatologist may be the next step.”

Dallas dermatologist Rebecca Marcus, MD says eczema tends to occur on the inner arms, backs of the knees, hands, neck, and around the eyes, though it can occur on any part of the body. “The difference between dry skin and eczema essentially is inflammation in the skin,” adds New York dermatologist Joshua Zeichner, MD. “When the skin barrier becomes disrupted, it can lead not only to loss of hydration, but also inflammation that translates to a red, itchy rash. That’s what we call eczema.”

“Eczema can be flared with dry skin, but can also be triggered by stress, certain fabrics, scents or perfumes, and other factors, and is due to an inherent weakness in the skin barrier,” explains New York dermatologist Rachel Nazarian, MD. “Eczema often evolves into an inflammatory itchy rash, increasing risk of skin infection. One of the most important aspects of eczema is skin care and method of cleansing. Harsh or aggressive cleansing can directly cause eczema flares, and increase risk of future flares by weakening the skin further. I recommend for all my patients struggling with eczema to minimize hot showers, use only unscented gentle cleansers, and moisturize their skin daily.”

If a flare cannot be managed by these simple changes, or by the use of a topical over-the-counter steroid cream (hydrocortisone) for a week, Dr. Nazarian recommends contacting your dermatologist for evaluation. “Keep in mind always that eczema has a risk of becoming infected, and oftentimes secondary antibacterial medications are required, or stronger steroid and non-steroid prescription creams are necessary.” 

Characteristics of Psoriasis

Germantown, TN dermatologist Purvisha Patel, MD says psoriasis is when your T cells attack your skin and create inflammation in your body, resulting in rashes that vary in color. “These flares can be caused by strep throat or viruses and stress.”

“Psoriasis tends to be distributed on the scalp, elbows, knees and lower back, but like eczema, it can occur anywhere on the body,” Dr. Marcus explains. “It typically presents with red, inflamed, scaly patches and plaques on the skin, often in distinct shapes with areas of demarcation, whereas dry skin tends to be more widespread. Psoriasis may also be associated with joint pain or nail pitting, or it may have no associated symptoms. Dry skin tends to improve with the use of moisturizer, whereas this will have minimal effect for eczema and psoriasis. If you have dry, scaly, inflamed skin that is not getting better with over-the-counter moisturizers, it’s time to call a dermatologist.”

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