Dry Skin: Why It Happens and How to Fix It

What dry skin looks and feels like

• tightness, especially after showering or swimming
• rough texture and fine flaking or scaling
• itching, sometimes intense
• fine lines or cracks, which may deepen and bleed
• dull, gray or ashy-looking skin in darker skin tones
• a "crazy paving" or cracked pattern, typically on older adults' shins (asteatotic eczema)

The shins, hands, forearms, sides of the trunk and feet are most often affected because they have fewer oil glands.

Why skin gets dry

The outermost layer of skin, the stratum corneum, works like a brick wall: skin cells are the bricks, and fats (ceramides, cholesterol and fatty acids) are the mortar. Natural moisturizing factors inside the cells hold water. When the mortar is stripped away or the bricks cannot hold water, moisture evaporates and the skin becomes dry, cracked and irritated.

Common causes

Environment and habits

• Cold, dry winter air and indoor heating, which lower humidity
• Air conditioning and desert climates
• Long, hot showers and baths, which dissolve skin fats
• Harsh soaps, foaming cleansers, antibacterial and alcohol-based products
• Frequent handwashing and hand sanitizers, common in healthcare and food work
• Swimming in chlorinated pools
• Sun damage

Age

Oil production falls with age, and skin becomes thinner and holds less water. Most adults over 60 have some dry skin, and itch from dry skin is one of the most common skin complaints in older people.

Skin conditions

Medical conditions

• Hypothyroidism: dry, coarse skin with fatigue, weight gain and cold intolerance
• Diabetes: high blood sugar and nerve damage reduce sweating, especially on the feet
• Chronic kidney disease: dry, intensely itchy skin
• Malnutrition and deficiencies: low essential fatty acids, zinc, vitamin A or niacin
• Sjogren's syndrome: dry skin with dry eyes and mouth
• HIV and some cancers, such as lymphoma, which can cause acquired ichthyosis

Medicines

Diuretics, statins, isotretinoin and other retinoids, some cancer treatments (EGFR inhibitors), and topical acne treatments can all dry the skin.

When dry skin needs a doctor

See a doctor if dry skin:

• does not improve after 2 weeks of the steps below
• itches so much it disturbs sleep
• cracks deeply, bleeds or shows signs of infection
• covers large areas or comes with redness and scaling
• appears with other symptoms such as fatigue, weight change or thirst

A doctor will examine the skin, ask about bathing habits, products, occupation and medicines, and may order blood tests for thyroid function, blood sugar and kidney function. A dermatologist may do a skin scraping or biopsy if the diagnosis is unclear.

How to treat dry skin

Bathing

• Take short showers or baths, 5 to 10 minutes, in lukewarm, not hot, water.
• Use a fragrance-free, soap-free gentle cleanser, only where needed (armpits, groin, feet).
• Pat skin dry with a towel rather than rubbing.

Moisturizing

• Apply moisturizer within 3 minutes of bathing, while skin is still damp, to lock in water.
• Ointments and creams work better than lotions. Petroleum jelly is one of the most effective and least irritating options.
• Look for ingredients such as ceramides, glycerin, hyaluronic acid, shea butter, dimethicone and lanolin.
• For thick, rough skin, products with urea (5 to 10%) or lactic acid soften scale. They can sting cracked skin.
• Reapply moisturizer to hands after each wash.
• Choose fragrance-free products to avoid irritation.

Home and lifestyle

• Run a humidifier in the bedroom in winter, aiming for indoor humidity of about 40 to 60%.
• Wear soft cotton next to the skin; avoid wool directly on dry areas.
• Use gloves for washing up, cleaning and in cold weather.
• Use fragrance-free laundry detergent.
• For cracked heels and fingertips, apply a thick ointment at night under cotton socks or gloves.

Medical treatments

• Low-strength steroid creams for short periods if the skin is red and inflamed.
• Prescription barrier creams for persistent eczema.
• Treatment of an underlying condition, such as thyroid hormone replacement.

Preventing dry skin

The same habits prevent dry skin: lukewarm water, gentle cleansers, daily moisturizer, humidified air in winter, gloves for wet work and cold weather, and sun protection.

Frequently asked questions

What causes very dry skin?

Very dry skin usually results from a mix of low humidity, hot showers, harsh soaps and aging. If it is severe or persistent, conditions such as eczema, ichthyosis, psoriasis, hypothyroidism, diabetes or kidney disease, or medicines such as diuretics and retinoids, may be responsible.

What is the best treatment for dry skin?

Thick, fragrance-free creams or ointments applied within 3 minutes of bathing work best. Look for ceramides, glycerin, petroleum jelly or urea. Combine with short lukewarm showers, gentle cleansers and a humidifier. Most dry skin improves within 1 to 2 weeks.

Is dry skin a sign of a health problem?

Usually not, but it can be. Persistent dry skin with fatigue, weight gain and feeling cold may point to an underactive thyroid. Dry skin with thirst and frequent urination may suggest diabetes. Intense itch with dry skin can occur with kidney or liver disease.

Does drinking more water help dry skin?

Drinking water matters for overall health, but unless you are dehydrated, extra water does little for dry skin. The problem is usually a damaged skin barrier losing water from the surface. Moisturizers, gentle cleansing and humid air are far more effective.

Why is my skin so dry in winter?

Cold outdoor air and indoor heating both have low humidity, so water evaporates from the skin faster. People also take hotter showers in winter. Switching to lukewarm water, moisturizing right after bathing and running a humidifier usually helps.