Skin Dryness and Peeling: Causes and Treatment

Why skin dries and peels

The outermost layer of skin, the stratum corneum, works like a brick wall: skin cells are the bricks and natural oils (lipids) are the mortar. When the mortar is stripped away, by soap, hot water, low humidity or inflammation, water escapes, the skin cracks and feels tight, and cells shed in visible flakes. Medically, dry skin is called xerosis, and visible shedding of skin is desquamation.

Peeling in sheets usually means a layer of skin has been damaged and is being replaced, as after sunburn or certain infections. Fine flaking is more typical of simple dryness and eczema.

Common causes

Environment and habits

• cold, windy weather and indoor heating
• long, hot showers or baths
• harsh soaps, sanitizers and frequent hand washing
• swimming in chlorinated pools
• aging skin, which makes fewer oils, so xerosis is very common over 60

Sunburn

A sunburn begins peeling about 3 to 7 days later as the damaged layer sheds. Do not pull peeling skin off; let it come away naturally.

Eczema and dermatitis

• Eczema (atopic dermatitis): dry, itchy, rough patches, often in skin creases, with flares and remissions.
• Contact dermatitis: irritation or allergy to soaps, detergents, latex, nickel, fragrances or skincare products causes red, dry, cracked and peeling skin where it touched.
• Dyshidrotic eczema: itchy blisters on the fingers and palms that later peel.

Psoriasis

Psoriasis causes thick, red, well-defined plaques with silvery scale, often on the elbows, knees, scalp and lower back.

Fungal infections

Athlete's foot causes peeling, cracking and itching between the toes or across the soles. Fungal infections can also cause a peeling ring-shaped rash elsewhere.

Peeling skin on the hands and feet

Medicines and medical conditions

• Medicines: topical and oral retinoids, benzoyl peroxide, salicylic acid, some chemotherapy drugs, and diuretics.
• Hypothyroidism: dry, rough skin with fatigue and feeling cold.
• Diabetes, kidney disease and malnutrition can cause dry skin.
• Ichthyosis: inherited dry, scaly skin, often looking like fish scales on the legs.

Emergency causes of peeling skin

• Stevens-Johnson syndrome and toxic epidermal necrolysis: a rare, severe reaction, usually to a medicine such as some anti-seizure drugs, allopurinol or sulfa antibiotics. Flu-like symptoms are followed by a painful, spreading red or purple rash that blisters and peels, with sores in the mouth and eyes.
• Staphylococcal scalded skin syndrome: in babies and young children, a toxin-producing staph infection causes fever and tender red skin that peels as if scalded.
• Toxic shock syndrome: fever, rash, low blood pressure, with peeling of the palms and soles 1 to 2 weeks later.

How doctors find the cause

A doctor will ask when it started, where it is, any new products, medicines, sun exposure and recent illness, and examine the skin, nails and mouth. Most cases need no tests. Skin scrapings check for fungus, patch testing identifies contact allergy, blood tests check thyroid function or infection, and a skin biopsy is used for unclear or severe rashes.

Treatment and home care

1. Moisturize within 3 minutes of bathing, while the skin is still damp, and again through the day. Thick creams and ointments (petroleum jelly, ceramide creams) work better than thin lotions.
2. Use lukewarm water and limit showers to 5 to 10 minutes.
3. Switch to a gentle, fragrance-free cleanser and use it only where needed.
4. Use a humidifier in winter.
5. Protect your hands: wear gloves for washing up and cleaning, and moisturize after each hand wash.
6. Ingredients that help very dry or thick skin: urea or lactic acid creams.
7. For sunburn peeling: cool baths, aloe or a gentle moisturizer, fluids, and do not peel the skin off.
8. Treat the cause: steroid creams for eczema and contact dermatitis, antifungal creams for athlete's foot, psoriasis treatments, and adjusting irritating medicines.

Frequently asked questions

Why is my skin peeling?

Common reasons are dry air, hot showers, harsh soaps, sunburn, eczema and contact with irritants. Peeling can also follow fungal infections, psoriasis, certain medicines, and infections such as scarlet fever. Widespread peeling with fever or mouth sores is an emergency.

What deficiency causes dry, peeling skin?

Deficiencies are an uncommon cause in people with a normal diet. Low essential fatty acids, zinc, niacin (pellagra) and vitamin A can cause dry, scaly or peeling skin, usually with other symptoms. An underactive thyroid is a more common medical cause.

How do I stop the skin on my hands peeling?

Moisturize after every hand wash with a thick cream, use lukewarm water and mild soap, wear gloves for wet work and cleaning, and avoid irritants. If peeling persists over 2 weeks, has blisters or itches strongly, see a doctor for eczema or fungal infection.

Should I peel off peeling skin?

No. Pulling off peeling skin exposes the new, delicate layer beneath and raises the risk of infection. Trim loose edges with clean scissors if needed and keep the area moisturized while it sheds naturally.