During the winter, I regularly get questions from patients about dry, itchy skin. “Winter itch,” also known as xerosis cutis, has many possible causes. However, most cases of xerosis cutis occur when the skin loses moisture because of the cool, dry winter climate.
The mildest cases of xerosis cutis consist of flaking and scaling. However, more severe cases can cause painful fissures of the skin or severe eczema.
Although there is no “cure” for xerosis cutis, most symptoms can be alleviated with over-the-counter products. I typically recommend applying thick cream moisturizers twice daily. With many different skincare products available on the market, it can be quite confusing to decide on the best one.
Key ingredients to look for:
Ceramides – These are the lipids that keep our skin hydrated. We often lose ceramides in our skin as we age. Also, people with a history of eczema may have lower baseline levels of ceramides in the skin. Decreased ceramides, when combined with dry, cool weather, contributes to the development of xerosis.
Creams containing ceramides are great for treating winter skin because they replenish the ones lost and rehydrate the skin. There are several great, inexpensive creams that contain ceramides on the market right now and they can be found in your local grocery or drugstore.
Hydroxy acids – The most common hydroxy acids found in creams and lotions are ammonium lactate and salicylic acid. Hydroxy acid moisturizers improve the symptoms of xerosis because they gently exfoliate the dead, flaky skin cells that contribute to itching.
When mixed with emollient moisturizers, alpha-hydroxy or beta-hydroxy acids both treat and prevent the visible signs of winter skin. However, applying hydroxy acids to fissured or wounded skin can burn, so make sure to avoid these areas during application.
How to apply your new products:
When applying these products, I tell all of my patients to use the "3-minute rule" after bathing or showering. This means that, within 3 minutes of exiting the bath or shower, you need to apply a moisturizer.
This helps to lock in moisture after bathing. I also recommend reapplying moisturizer at least once throughout the day. Baths should be lukewarm (not hot!) and short (less than 5 minutes).
Skin products to avoid:
Anti-bacterial soaps or cleansers – These can be quite harsh for people that have dry skin and can often lead to further irritation.
Fragrance – Products containing fragrance should also be avoided, as they can irritate the skin and worsen xerosis. They can also cause allergic reactions that often require prescription pills or ointments. Beware of products that are marked as “unscented” because they can often contain a masking fragrance. Look for products that are “fragrance free.”
Exfoliators – Overzealous exfoliation of the skin can often lead to raw or irritated skin. The goal of treatment is to restore the skin barrier, not strip it away.
You may find it helpful to talk to a local board-certified dermatologist if you are experiencing very painful or itchy skin. The American Academy of Dermatology website is a great resource for finding a reputable dermatologist in your area.
Although many skin irritations encountered around the wintertime can be attributed to xerosis cutis, you should closely monitor your symptoms. Persistent dry or itchy skin can be a sign of a systemic medical problem, such as hypothyroidism or Vitamin D deficiency. Painful, fissured skin may be a sign of eczema, and will likely require treatment with a prescription ointment.
When our skin is dry, it's not an effective barrier to the outside world. Dry skin is more prone to both infections and allergic reactions. If you develop redness or blisters on the skin, see your dermatologist to rule out an infection or allergic reaction.