SymptomSkin, hair & nails
Flaking Skin: Causes and Treatment
Flaking skin means the outer layer of skin sheds in small white or silvery scales or peels in sheets. The most common cause is simple dry skin (xerosis), especially in winter and in older adults. Eczema, psoriasis, seborrheic dermatitis and fungal infections cause flaking with redness or itch in typical places. Widespread peeling with fever, blisters or painful skin can be a serious drug reaction or infection and needs urgent care.
Also called: Skin flaking, peeling skin, scaly skin, skin scaling, desquamation
At a glance
- What it is
- Shedding of the skin's outer layer as flakes, scales or peeling sheets.
- Most common cause
- Dry skin from low humidity, hot water, harsh soaps or age.
- Other common causes
- Eczema, psoriasis, seborrheic dermatitis, fungal infection, sunburn.
- Serious causes
- Severe drug reactions, scarlet fever, Kawasaki disease, staph skin infections.
- Treatment
- Moisturizers, gentle washing, and specific creams for the underlying condition.
When to get help
Call 911 or go to the ER
- Widespread painful red skin with blisters, peeling in sheets, or sores in the mouth, eyes or genitals, especially after starting a new medicine (possible Stevens-Johnson syndrome)
- Skin peeling over large areas with high fever, low blood pressure or confusion (possible toxic shock syndrome)
See a doctor within a day or two
- A child with fever for 5 days or more, red eyes, red lips and later peeling of fingers and toes (possible Kawasaki disease)
- Fever, sore throat and a sandpaper rash followed by peeling (possible scarlet fever)
- Peeling with spreading redness, warmth and pain (possible skin infection)
Book a routine appointment
- Thick, silvery, well-defined scaly patches on elbows, knees or scalp
- Ring-shaped scaly patches that spread outward
- A single rough, scaly spot on sun-exposed skin that does not heal or bleeds
- Flaking all over with fatigue, weight gain and feeling cold (possible underactive thyroid)
- Flaking that does not improve after 2 weeks of moisturizing
Usually safe to manage at home
- Mild flaking on shins, hands or face in winter that improves with moisturizer
- Peeling a few days after mild sunburn
What causes skin to flake?
The skin constantly makes new cells and sheds old ones invisibly. Flaking becomes visible when the outer layer loses moisture and its cells stick together in clumps, or when inflammation speeds up skin turnover so cells pile up as scale.
Common causes by pattern
| Pattern | Likely cause | Clues |
|---|---|---|
| Fine white flakes on shins, arms, hands | Dry skin (xerosis) | Worse in winter, after hot showers, in older adults |
| Itchy, red, flaky patches in elbow and knee creases | Eczema (atopic dermatitis) | History of allergies, asthma, childhood onset |
| Thick, silvery, well-defined plaques on elbows, knees, scalp | Psoriasis | Nail pitting, family history, joint pain |
| Greasy yellow flakes on scalp, eyebrows, sides of nose | Seborrheic dermatitis | Flares with stress and cold weather |
| Ring-shaped scaly patch with clearer center | Ringworm (tinea) | Spreads outward, itchy |
| Peeling between toes or on soles | Athlete's foot | Itchy, cracked, may smell |
| Peeling after redness from sun | Sunburn | 3 to 8 days after sun exposure |
| Rough scaly spots on sun-damaged skin | Actinic keratosis | Older adults, face, scalp, hands |
| Fish-like scales on legs since childhood | Ichthyosis | Runs in families |
| Oval scaly patches on the trunk after one larger "herald" patch | Pityriasis rosea | Christmas-tree pattern, clears in 6 to 12 weeks |
| Flaking on hands from work | Irritant or contact dermatitis | Frequent washing, gloves, chemicals |
Flaking skin on the face
Facial flaking is usually seborrheic dermatitis (around the nose, eyebrows and hairline), dry skin from harsh cleansers or retinoid creams, eczema or contact dermatitis from cosmetics. Perioral dermatitis causes small bumps and flaking around the mouth. Rosacea can also make facial skin dry and flaky.
Other causes of flaking skin
- Medicines: retinoids (tretinoin, isotretinoin), benzoyl peroxide, some cholesterol and chemotherapy drugs.
- Underactive thyroid: dry, rough skin with fatigue, cold intolerance and weight gain.
- Diabetes and kidney disease: dry, itchy skin.
- Nutritional deficiencies: zinc, niacin or essential fatty acid deficiency, which are uncommon.
- After an illness: peeling of hands and feet can follow scarlet fever, Kawasaki disease, toxic shock syndrome and hand, foot and mouth disease.
Serious causes of peeling skin
Stevens-Johnson syndrome and toxic epidermal necrolysis are rare but life-threatening reactions, usually to medicines such as some anticonvulsants, allopurinol, sulfonamide antibiotics and nevirapine. They start with fever and flu-like symptoms, then painful red or purple skin that blisters and peels, with sores in the mouth and eyes. This is an emergency. See Stevens-Johnson syndrome.
Staphylococcal scalded skin syndrome mainly affects young children, with fever and tender red skin that wrinkles and peels.
How doctors diagnose the cause
Most causes are diagnosed by looking at the pattern and distribution of the flaking, and asking about itching, timing, triggers, family history, medicines and other symptoms. Tests may include:
- skin scrapings for fungus
- a skin biopsy for unusual or persistent patches
- blood tests for thyroid function, diabetes or kidney disease
- patch testing for suspected contact allergy
Treatment for flaking skin
For dry skin
- Moisturize within 3 minutes of bathing, while the skin is still damp. Thick creams and ointments work better than lotions.
- Look for ceramides, glycerin, urea or lactic acid, which help skin hold water and loosen flakes.
- Shorten showers to 5 to 10 minutes with lukewarm water.
- Use soap-free cleansers and pat dry.
- Run a humidifier in winter.
- Wear gloves for cleaning and in cold weather.
Do not scrub off flakes with harsh exfoliants, which can irritate and worsen flaking.
For skin conditions
- Eczema: daily emollients, and steroid or non-steroid anti-inflammatory creams for flares.
- Psoriasis: steroid and vitamin D creams, coal tar, light therapy, or tablets and injections for more severe disease.
- Seborrheic dermatitis: antifungal creams and shampoos, with mild steroid creams for flares.
- Fungal infections: antifungal creams such as terbinafine or clotrimazole for 2 to 4 weeks.
- Sunburn peeling: moisturize gently and let it peel naturally. Do not pull off skin.
Frequently asked questions
Why is my skin flaking?
Most flaking comes from dry skin caused by cold, dry air, hot showers or harsh soaps. If flaking comes with redness, itching or thick patches, eczema, psoriasis, seborrheic dermatitis or a fungal infection are common causes. Medicines and thyroid problems can also cause it.
How do I stop my skin from flaking?
Use a thick, fragrance-free moisturizer straight after bathing, take shorter lukewarm showers, switch to a soap-free cleanser and use a humidifier. Creams containing urea or lactic acid help loosen scale. If flaking persists after 2 weeks, see a doctor to check for a skin condition.
What does flaking skin on the face mean?
Facial flaking is most often caused by seborrheic dermatitis around the nose and eyebrows, dry skin from harsh cleansers or acne treatments, eczema, or reactions to cosmetics. Gentle cleansers and a non-comedogenic moisturizer help. Persistent redness and flaking may need a medicated cream.
When is peeling skin serious?
Peeling is serious if it is widespread, painful, blistering, comes with fever, or involves the mouth, eyes or genitals, especially after starting a new medicine. These can be signs of Stevens-Johnson syndrome or toxic shock syndrome, which need emergency care.
Can vitamin deficiencies cause flaky skin?
Rarely. Deficiencies of zinc, niacin, vitamin A or essential fatty acids can cause scaly skin, usually with other symptoms. They are uncommon in people eating a varied diet. Dry skin, eczema and other skin conditions are far more common causes.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Dry skin: diagnosis and treatment; Psoriasis; Eczema types
- NHS: Dry skin; Psoriasis
- MedlinePlus: Skin - scaling
- National Eczema Association: Eczema types