Medical Edge Newspaper Column

Help for Dry, Irritated Winter Skin

January 23, 2009
Dear Mayo Clinic:
My skin has always gotten dry in the winter, but this year it seems a lot worse. My usual lotion isn't helping. I have several areas on my legs and arms that are flaky and dry no matter what I do. What's the difference between winter skin and eczema? What can I do to prevent or treat either skin condition?

Answer:
Winter weather and eczema both can cause dry, itchy, flaky and red skin. In both cases, you'll see improvements from what I call sensitive skin care — common sense steps you can take at home to add moisture to the skin and avoid irritants. I've listed a few below.

Superficially, ordinary winter dry skin and eczema might look similar, but the conditions are unrelated, with different causes. Eczema will likely require a trip to see a dermatologist or your family doctor to discuss treatment options. The physician will also check you for signs of infection in the eczematous skin. Antibiotics will be necessary if the skin is infected.

Dry winter skin happens to most people who live in cold weather. Skin is a moisture producer. But in the winter, skin doesn't produce enough moisture to compensate for the drier air. That lack of moisture can make skin dry, itchy and flaky.

Eczema, also called atopic dermatitis, is a skin disorder that's related to an immune system sensitivity. The exact cause isn't known. The disorder appears as patches of inflamed skin that can be very itchy, weepy and crusty. Eczema can occur anywhere, but often appears on the hands and feet, behind the knees and on the ankles, wrist, face, neck and upper chest, and sometimes around the eyes and on the eyelids.

Eczema is common in babies. But eczema episodes can come and go into adulthood and can occur in adults who've never had it before. The incidence of eczema is increasing in industrialized countries, along with increasing prevalence of food allergies, hay fever and asthma. Theories — but no firm answers — suggest a potential link between these four conditions. About three out of four children who have signs and symptoms of atopic dermatitis later develop asthma or hay fever.

To treat eczema, nonprescription anti-itch creams can provide relief. A doctor also might recommend corticosteroid creams. Oral antihistamines (Benadryl, others) can help if itching is severe. If these treatments don't work, another class of ointment medications, called immunomodulators, might help. They help reduce flare-ups.

It doesn't sound like you suspect that an allergic reaction or environmental irritant is causing your skin problems. For example, nickel in jewelry can cause allergic contact dermatitis. Harsh chemicals, solvents or paint can cause irritant dermatitis. On the skin, these conditions resemble atopic dermatitis. Once the allergen or irritating substance is identified, treatment focuses on avoidance.

While there's no sure way to prevent the recurrence of eczema, keeping skin moist may help. Sensitive skin care tips to improve and prevent dry winter skin and eczema include:

• Two or three times a day, use a lotion that does not contain dyes and fragrances, which can irritate skin.
• Take warm (not hot) baths or showers. Hot water dries the skin. Use a mild, moisturizing soap sparingly. And moisturize immediately afterwards. For the most benefit, skin should be moisturized within three minutes after bathing.
• Laundry soap also should be dye- and fragrance-free. Skip the fabric softener and dryer sheets. Particles from these products can irritate skin.
• Avoid smoke. If you are a smoker, quitting benefits skin, in addition to reducing the risk of many serious health conditions. Microparticles from smoke adhere to and irritate the skin. (You can smell them in your clothes and hair.) Secondhand smoke is also an irritant.
• Increase the humidity inside your home.

It's wise to see a dermatologist when a change in your skin hasn't responded to normal self-care measures. Other skin disorders, such as psoriasis or even malignancies, also can appear as small areas that are dry, flaky, red, cracked or sore.

— Dawn Marie Davis, M.D., Dermatology, Mayo Clinic, Rochester, Minn.