Skin Dryness, Peeling, Scaliness or Roughness

What these changes mean

• Dryness: skin feels tight, especially after washing, and may look dull.
• Roughness: fine bumps or a sandpaper texture.
• Scaliness: small or large flakes stick to the skin surface, often in patches.
• Peeling: sheets or strips of the top layer lift off, as after sunburn.
• Cracking: deep lines that may bleed, especially on hands, heels and lips. See cracked skin.

The outer layer of skin, the stratum corneum, is like a brick wall: cells are the bricks and natural oils (lipids) are the mortar. When the mortar is stripped or cells shed abnormally, water escapes and scales form.

Common causes

Simple dry skin (xerosis)

The leading cause, especially in winter, in older adults and in people who wash often. It is worst on the shins, forearms, hands and feet. Our xerosis page covers this condition and its treatment in depth.

Triggers include:

• low humidity and indoor heating
• long, hot showers and baths
• harsh soaps, sanitizers and detergents
• swimming in chlorinated pools
• aging, as oil production falls
• dehydration and some medicines (diuretics, retinoids, statins)

Eczema (atopic dermatitis)

Itchy, dry, rough patches, often in elbow and knee creases, hands, neck and face, with flares. It usually starts in childhood, often with allergies or asthma in the family. See eczema.

Hand dermatitis

Frequent hand washing, wet work and irritants cause red, dry, peeling and cracked skin on the hands and fingertips.

Psoriasis

Well-defined, raised, red or purple plaques with thick silvery-white scale, typically on elbows, knees, scalp and lower back. Itch is variable. Nails may pit. See psoriasis.

Fungal infections

Ringworm (tinea) causes ring-shaped scaly patches with a clearer center. Athlete's foot causes peeling between the toes or a dry "moccasin" scaling on the soles. One hand may be affected along with both feet.

Seborrheic dermatitis

Greasy yellowish scale on red skin around the nose, eyebrows, scalp, ears and chest. Dandruff is the mild form. See seborrheic dermatitis.

Sunburn and sun damage

Peeling a few days after sunburn is normal. Actinic keratoses are rough, sandpaper-like, scaly spots on sun-exposed skin in older adults. They are precancerous and should be treated.

Other causes

How doctors find the cause

A doctor or dermatologist will look at the pattern and location, ask about itch, washing habits, products, medicines, family history and other symptoms, and check nails and scalp. Tests may include a skin scraping to look for fungus, a biopsy for unclear rashes, and blood tests for thyroid function, blood sugar or kidney function if a whole-body cause is suspected.

Treatment and home care

For dry, rough or flaky skin

1. Moisturize within 3 minutes of bathing to lock in water, and again at least once more during the day.
2. Choose thick products: ointments (petroleum jelly) and creams in tubs work better than thin lotions.
3. Look for helpful ingredients: ceramides, glycerin, urea (5 to 10%) or lactic acid help rough, scaly skin. Avoid urea and lactic acid on cracked skin, as they sting.
4. Bathe briefly (5 to 10 minutes) in lukewarm water, using a fragrance-free, soap-free cleanser.
5. Pat dry rather than rubbing.
6. Run a humidifier in winter.
7. Wear gloves for washing up and in cold weather.

For specific causes

• Eczema: moisturizers plus topical steroids or other anti-inflammatory creams for flares.
• Psoriasis: topical steroids, vitamin D creams, light therapy, and tablets or biologics for widespread disease.
• Fungal infections: antifungal creams such as terbinafine or clotrimazole, or tablets for nail or extensive infection.
• Seborrheic dermatitis: antifungal shampoos and creams.
• Actinic keratoses: freezing, creams or light treatment.

Do not pick or pull peeling skin. Trim loose edges with clean scissors and let the skin underneath mature.

Frequently asked questions

What causes dry, peeling skin?

The most common cause is simple dry skin from low humidity, hot water and soaps. Peeling also follows sunburn and some infections. Eczema, psoriasis, fungal infections, hand dermatitis, an underactive thyroid and certain medicines are other common causes.

Why is my skin rough and scaly?

Rough, scaly skin happens when skin cells build up on the surface instead of shedding normally, or when the skin barrier is damaged. Common causes are dry skin, keratosis pilaris, psoriasis, ichthyosis and sun-damaged actinic keratoses. Moisturizers with urea or lactic acid help many of these.

When should I worry about peeling skin?

Get emergency care if skin peels in sheets or blisters widely with fever or sore eyes, mouth or genitals, especially after starting a medicine. See a doctor for peeling with fever in a child, signs of infection, or patches that do not improve after 2 weeks of moisturizing.

What is the best treatment for very dry, scaly skin?

Apply a thick, fragrance-free ointment or cream right after bathing, at least twice a day. Products with urea or lactic acid soften scale. Keep showers short and lukewarm and use a gentle cleanser. If scaling persists, see a doctor to check for eczema, psoriasis or a fungal infection.

Can dehydration cause dry skin?

Severe dehydration can make skin dry and less elastic, but for most people, drinking more water does little for dry skin. External factors such as dry air, hot water and soap matter far more, and moisturizers are the most effective fix.