SymptomSkin, hair & nails
Dry or Flaky Skin
Dry or flaky skin is skin that has lost water and oils, so it feels rough and tight and sheds fine white scales. The medical term is xerosis. Most cases come from cold, dry air, long hot showers, harsh soaps and aging, and improve within 1 to 2 weeks of gentle cleansing and twice-daily moisturizer. Flaking that is thick, red, very itchy or does not improve can be eczema, psoriasis, a fungal infection, an underactive thyroid or another condition worth checking.
Also called: Xerosis, dry skin, flaky skin, scaly skin, asteatosis
At a glance
- What it is
- Skin low in water and oils that feels tight and rough and sheds fine scales.
- Most common causes
- Winter air, hot water, harsh soaps, frequent handwashing and aging skin.
- Conditions to consider
- Eczema, psoriasis, seborrheic dermatitis, fungal infection, ichthyosis and hypothyroidism.
- Typical course
- Simple dry skin improves within 1 to 2 weeks of better skin care.
- Main treatment
- Short lukewarm showers, gentle cleanser and a thick moisturizer applied to damp skin.
When to get help
See a doctor within a day or two
- Dry, peeling skin over large areas with fever, blistering or skin that is painful to touch
- Cracked skin that is red, hot, swollen or oozing pus, especially on the feet in someone with diabetes
- Widespread redness and scaling covering most of the body
Book a routine appointment
- Dry skin that does not improve after 2 weeks of regular moisturizing
- Thick, silvery, scaly plaques on elbows, knees or scalp
- Itch that keeps you awake or leads to broken, bleeding skin
- Dry skin with tiredness, weight gain, feeling cold or constipation
- A single scaly patch that does not heal, bleeds or keeps coming back in the same spot
Usually safe to manage at home
- Rough, tight, mildly itchy skin in winter, especially on the shins, hands and arms
- Dry hands from frequent washing or sanitizer use
Why skin becomes dry and flaky
The outer layer of skin (the stratum corneum) works like a brick wall. Skin cells are the bricks, and fats such as ceramides are the mortar. This barrier holds water in. When the fats are stripped away, water escapes, cells shrink and curl, and the skin looks dull, rough and flaky. Small cracks let in irritants, which cause itching, and scratching damages the barrier further.
Common causes
- Low humidity: cold winter air outside and heated air indoors.
- Hot water and long baths or showers.
- Harsh soaps and cleansers, including antibacterial and fragranced products.
- Frequent handwashing and alcohol sanitizers.
- Aging: oil glands become less active after 50 to 60, so dry skin on the legs and arms is very common in older adults.
- Swimming in chlorinated pools.
- Sun damage and wind exposure.
- Medicines: retinoids, diuretics, statins and some acne and cancer treatments.
Skin conditions that cause flaking
| Condition | Clues |
|---|---|
| Eczema (atopic dermatitis) | Very itchy, red patches in elbow and knee creases, neck and hands. Often a history of allergies or asthma |
| Psoriasis | Well-defined, thick red plaques with silvery scale on elbows, knees, scalp and lower back. Nail pitting |
| Seborrheic dermatitis | Greasy, yellowish flakes on the scalp (dandruff), eyebrows, sides of the nose and behind the ears |
| Contact dermatitis | Red, itchy, dry or blistered skin where a substance touched the skin |
| Fungal infection (tinea) | Ring-shaped, scaly patch with a clearer center, or peeling between the toes |
| Ichthyosis | Lifelong, fish-scale-like dry skin, often on the shins, from a genetic barrier problem |
| Actinic keratosis | Rough, scaly spot on sun-exposed skin in older adults; a precancer that should be checked |
| Asteatotic eczema (eczema craquelé) | "Crazy paving" cracks on the shins of older adults in winter |
Medical conditions linked to dry skin
- Hypothyroidism: dry, coarse skin with tiredness, weight gain, feeling cold, hair thinning and constipation.
- Diabetes: dry skin, especially on the feet, which can crack and become infected.
- Kidney disease: dry, itchy skin is common in advanced kidney failure and on dialysis.
- Nutritional deficiencies: low essential fatty acids, zinc, vitamin A or niacin, mainly in malnutrition or after weight-loss surgery.
- HIV and some cancers, such as lymphoma, can cause acquired ichthyosis.
How a doctor assesses dry skin
A primary care doctor or dermatologist will ask about bathing habits, products, work exposures, medicines and other symptoms, and examine where and how the skin is affected. Most dry skin is diagnosed by looking. Tests may include a skin scraping for fungus, blood tests for thyroid function, blood sugar and kidney function, and occasionally a skin biopsy.
Treatment and home care for dry, flaky skin
Bathing
- Keep showers to 5 to 10 minutes in lukewarm water.
- Use a gentle, fragrance-free cleanser, and only where needed (underarms, groin, feet).
- Pat skin dry rather than rubbing.
Moisturizing
- Apply moisturizer within 3 minutes of bathing, while skin is still damp, to lock in water.
- Ointments (petroleum jelly) and creams are more effective than lotions for very dry skin.
- Look for ceramides, glycerin, urea, lactic acid or shea butter. Urea and lactic acid help lift thick scale, but can sting on cracked skin.
- Reapply at least twice a day and after handwashing.
Other measures
- Use a humidifier in winter.
- Wear gloves for washing up, cleaning and in cold weather.
- Choose soft fabrics such as cotton, and wash clothes with fragrance-free detergent.
- For itchy patches, a short course of over-the-counter 1% hydrocortisone cream can help, following the label. Avoid using it on the face for long.
- Do not pick at flakes or scrub with harsh exfoliants.
Prescription treatments
If an underlying condition is found, doctors may prescribe stronger steroid creams or non-steroid creams for eczema, vitamin D or other treatments for psoriasis, antifungals for tinea, or thyroid hormone for hypothyroidism.
Preventing dry skin
The same habits prevent it: short lukewarm showers, gentle cleansers, daily moisturizer, humid indoor air in winter and protecting your hands. Start your winter skin routine before dryness appears.
Frequently asked questions
Why is my skin so dry and flaky even when I moisturize?
Common reasons are long hot showers, harsh soap, a moisturizer that is too light, or applying it to fully dry skin. Switch to a thicker cream or ointment, apply it to damp skin twice daily, and use lukewarm water. If it still does not improve in 2 weeks, eczema, psoriasis or thyroid problems should be checked.
What vitamin deficiency causes dry, flaky skin?
Deficiencies are an uncommon cause in people who eat a varied diet. Low essential fatty acids, vitamin A, zinc, niacin (pellagra) and biotin can cause scaly skin, mainly in malnutrition, alcohol misuse or after weight-loss surgery. Taking supplements without a deficiency does not improve dry skin.
Is dry, flaky skin a sign of diabetes?
It can be. High blood sugar draws fluid from the body and can affect nerves that control sweating, leading to dry skin, especially on the feet. Dry skin alone is very common, but with thirst, frequent urination or slow-healing wounds, get checked for diabetes.
How can I tell if it is eczema or just dry skin?
Simple dry skin is rough, tight and mildly itchy, and improves with moisturizer. Eczema is intensely itchy, with red or darker inflamed patches, often in the creases of the elbows and knees, and tends to flare repeatedly. Eczema often needs anti-inflammatory creams in addition to moisturizers.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Dry skin, diagnosis and treatment; Tips to relieve dry skin
- MedlinePlus: Dry skin
- NHS: Dry skin; Atopic eczema
- National Eczema Association: Eczema types
- Mayo Clinic: Dry skin