Dry Skin How to Know When Your Dry Skin Is Something More
By Cynthia Bailey MD.
The major difference between "regular" dry skin vs. dry skin that may be due to a condition like eczema/atopic dermatitis
Atopic eczema is a genetic condition where skin is very prone to allergic reactions to products, has a weakened barrier and, is thus, exquisitely prone to irritation and dryness. Skin can also break out in a rash that starts by looking "dry" for no apparent reason that you can connect. It is a genetic abnormality of both skin structure and immunity.
"Regular" dry skin is skin that has become dry for good reason, such as weather, harsh cleansing routines, and contact with harsh products and solvents that break the skin barrier. These are all conditions that eventually become irritant dermatitis, a form of eczema due to disturbed skin barrier and the eventual consequences.
What other skin conditions can cause dry skin?
"Dry skin" is a term people often use when they see scale on their skin. Skin may feel tight and may itch.
The most common cause is irritant dermatitis (dermatitis is synonymous with eczema). As mentioned above, this is due to exposures with things that are harsh to skin and that disrupt the two essential components of the skin’s barrier – lipids and keratin protein.
The lipids and proteins of your skin exist in a brick-and-mortar like structure; protein "bricks" are surrounded by "lipid" mortar. Loss of skin lipids and damage to skin keratin-protein cause barrier damage. This, in turn, leads to increased water loss (called trans epidermal water loss) – ultimately causing "dry skin."
Scale and a feeling of dryness can also occur with early, allergic dermatitis.
Great examples are eyelid dermatitis and chronic chapped lips due to allergic reactions. Allergic contact dermatitis (eczema) is common. It is why all of my products are hypoallergenic. Some are ultra-hypoallergenic.
I have seen so many patients over the course of my long career who think they have dry skin when they are really allergic to something they are using on their skin. I encourage everyone to use hypoallergenic products so as not to taunt your immune system into becoming allergic to skin care ingredients!
Rashes caused from unknown internal conditions can also have scale that makes the skin look "dry."
These include seborrheic dermatitis, psoriasis and ichthyosis vulgaris (a genetic condition causing scaly skin) among others.
What dry skin symptoms be a sign that you're struggling with eczema?
Dry skin that isn't easily soothed with regular moisturizer.
Eczema is a general term for a type of skin perturbation called a spongiotic dermatitis. See the little word root, “spongi,” in the term? It means the skin structure looks like a little sponge under the microscope; there is space between cells filled with water just like there are little spaces in a sponge where water can accumulate.
It means the dead cells layer (stratum corneum) and the living layer below (epidermis) have been damaged. They now have little spaces filled with water. You experience that by seeing tiny blisters and moist-weeping on the skin. The damage is accompanied by inflammation in the skin and that keeps the eczema going.
The rash of eczema, and it’s inflammation, can be caused by allergy, irritation or atopic eczema. It’s all a form of "eczema" (spongiotic dermatitis). Lay persons tend to use the term "eczema" synonymously with atopic dermatitis. However, by medical definition, eczema implies spongiotic dermatitis of differing causes – allergic, irritant, internal-like seborrhea, and atopic eczema.
The reason you can’t get rid of eczema with just moisturizer is because it is more complex than dry skin.
Eczema has a cause and is accompanied by your body’s immune inflammation which gets activated in your skin. To get rid of eczema, you have to get at the cause that turned on the inflammation.
This means you have to find the allergen or irritant that started things. In the case of atopic eczema, we don’t always know why the skin flared up. Moisturizer is important for healing eczema including atopic prone skin. But, often medicine is needed too, such as topical cortisone creams and other, immune-suppressing medicines.
Why does skin that has eczema itch, especially at night?
Skin with eczema is inflamed. The body’s brilliant system to fight disease and maintain health is complex and includes white cells and an intricate cascade of chemical messenger molecules and receptors. When they are turned on and make eczema, the process also makes itch.
Skin itches more at night because we heat up, which increases itch. Also, the mind is quiet, and itch messages that have been being sent to the brain all day are now more apparent when the mind has no distractions.
Why does skin feel especially tight and dry after a long shower or bath?
This can indicate impending eczema from a number of causes. It tells you that skin barrier is compromised, skin is drying too much and circumstances with skin structure and function are not ideal. People with atopic eczema often feel this after a long bath or shower because their skin barrier structure is inherently frail.
Eczema from allergy or irritant eczema also can feel this way in the early stages. It is a warning sign that moisturizing and more gentle skin care is needed.
This tight and dry feeling happens especially after a hot shower because of the increase in skin blood-flow brought on by exposure to heat. You see it as redness after the shower. Heat, including hot water, opens the skin capillaries, and that brings in the building blocks of inflammation to make matters worse. We recommend tepid showers for eczema prone skin during times of flare.
Why do antibacterial soaps make your skin especially dry?
Soaps can strip skin oils and can denature skin keratin protein. Many antibacterial soaps are formulated in a strong soap base.
You should only use gentle, foaming hand cleansers and hypoallergenic soaps or soapless cleansers if you are eczema-prone.
What should you do if you're struggling with dry skin?
It is called hydrating gentle skin care. The key steps are:
How to Deal With Eczema on Your Hands
Eczema on the hands is so common that it has its own name - hand eczema! There are two, main causes of hand eczema.
The first type of of hand eczema is irritant hand dermatitis.
This happens to people who expose their hand skin to harsh conditions. Examples include people who do a lot of wet work such as mothers, restaurant workers or even people who have to wash their hands often during the coarse of their day like nurses and doctors. People whose hands are exposed to harsh climactic conditions, chemicals or solvents are also prone to irritant hand dermatitis.
Irritant hand dermatitis often starts in the creases between the fingers, called the web spaces. It is often worse on the back of the hands, too. Skin both stings and itches.
The second common type of hand eczema is a variant of atopic hand dermatitis.
The genetic frailty and hyperimmune reactivity of an atopic tendency can play out specifically on the hands – sometimes, only on the hands! Small blisters (called vesicles) often stud the sides of the fingers and spread along the thicker palm skin. The back of the hands can be involved as well. Itching is a common complaint. Contact with soaps, solvents and weather will compound atopic hand dermatitis with irritant hand dermatitis because barrier weakness make hand skin excessively fragile.
Why are hands prone to getting eczema?
Hand eczema happens due to damage to the key components of skin barrier, the lipid and keratin protein in its brick and mortar structure. This structure is essential to prevent loss of skin water (trans epidermal water loss).
Everyone uses their hands constantly and often exposes them to harsh chemicals and weather. The skin on the palm side of the hands is thick to hopefully withstand the use. It is not indestructible, though. Irritant hand eczema occurs when your hand skin’s threshold of tolerance has been surpassed by exposure.
Atopic hand eczema happens because of internal immune reactivity. It also is driven by inherent structural frailty of the skin barrier. If you have a genetic predisposition to atopic eczema, you need to take special care to protect hand skin from harsh conditions and allergen contact. These include products with fragrances and other, notorious allergens like some botanical essences and preservative systems.
What steps can you take if you are struggling with hand eczema?
Wear gloves! Use rubber gloves when you do the dishes or plan to expose your hand skin to other harsh solvents or chemicals. Reducing exposure to dish soap and hot water, both of which pull out skin lipids and denature skin keratin protein, will help keep hand skin healthy.
The same is true with exposure to solvents. When you are in harsh, cold, windy weather, wear gloves or mittens. This will help reduce water being pulled out of your skin, which leads to dryness, disruption of barrier and the cycle of damage that can end in eczema.
Avoid using antibacterial soaps. Antibacterial soaps sound smart, but they aren’t. They are harsh, and eczema is caused by the harsh soap base. They also contain triclosan. This is only rarely an allergen. That said, triclosan is to be avoided. It leads to bacterial antibiotic resistance.
Hand sanitizers, on the other hand, are alcohol-based. Alcohol also pulls out skin lipid and denatures keratin protein. They contribute to irritant hand eczema. Avoid them when possible.
Always wash your hands with gentle products and rinse all cleanser off entirely. Retained cleanser will continue to damage lipid and protein. Best is to use a hypoallergenic, foaming hand cleanser like my All Natural Hand Cleanser.
Moisturize your hands often. Moisturizing is always more effective right after water exposure because the water can be trapped to help replace any moisture lost by damaged barrier-integrity due to eczema. You can also moisturize in between washing, too, but definitely aim to moisturize after toweling hands dry when you wash them.
Ingredients to look for in the most effective hand moisturizers include dimethicone.
This ingredient helps to seal skin barrier and protect it while skin is healing. Water binders like glycerin or lanolin will help hold water in skin. My popular, Dry Skin Hand Cream works wonders to both seal-in and hold moisture to dry hand skin.
You want a gentle foaming hand cleanser and hand cream at every sink where you wash and wet your hands.
Should you soak in a bleach bath to heal eczema?
The American Academy of Dermatology recommends considering a bleach bath to help prevent flares of eczema. Also, the Mayo Clinic recommends a diluted-bleach bath to decrease bacteria on the skin and related infections. It can help with atopic dermatitis type of eczema if bacteria colonization is part of the trigger. Bleach is irritating and is only of value if bacteria are a trigger.
What are some of the triggers of eczema to try to avoid?
Atopic eczema triggers are complex and can include foods (eggs, milk, soy, and wheat, to name a few) and environmental allergens (pollen, dust, animal dander, etc.) along with topical allergens that touch skin from products (fragrance, some preservatives, even wool alcohol – it’s complex). Talk with your doctor if this is you. The evaluation process is fascinating and you'll benefit from an educated "guide."
Hand eczema can be triggered by direct contact of skin with allergens.
These include botanical essences such as citrus, foods touched in preparing meals (again, citrus is a great example) and from using products with notorious allergens such as fragrance ingredients. Irritant eczema will worsen upon contact with harsh soaps/solvents that pull out lipids and denature keratin protein. Harsh weather will pull out skin moisture/water and that should be avoided, too. Wear gloves in harsh/cold/windy weather.
Does how you towel dry your skin after bathing matter if you have eczema?
Yes it can. Gently pat your skin dry after you wash. You don’t have to be extremely gentle, but avoid vigorously rubbing skin. The brick-and-mortar structure of skin barrier can be abraded. Think rope-burn in the extreme, but dial-down the concept when it comes to a towel. To a much lesser extent, rubbing with even a towel can perturb the structure, especially when eczema is developing.
Also, you want a little moisture left on your skin so that it can get trapped by the moisturizer you are about to apply after toweling dry.