The Role of Dry Skin in Eczema

One of the main symptoms of atopic dermatitis (eczema) is dry, itchy skin. Dry skin is also known as xerosis or xeroderma. It occurs when the skin loses too much water or oil.^1-3

Keeping the skin as moisturized and hydrated as possible is a major part of eczema treatment. It can help improve symptoms and reduce the risk of flare-ups and infections.^1-3

The link between dry skin and eczema

There are many potential causes of eczema. Most experts agree that the condition occurs due to a mix of factors that lead to a weakened skin barrier and an overactive immune system.^1,4

Many proteins in the skin keep it strong and prevent water and oil loss. One of these proteins is called filaggrin. Some people with eczema have a change in their gene (genetic mutation) for filaggrin that makes it not work correctly. This impacts the skin's ability to hold water and can lead to dry skin.^1,4

Other proteins or cells can be affected by genetic mutations too. Many of these proteins also impact the skin’s ability to stay moist and strong.¹

The itch-scratch cycle

When the skin is dry and weak because of eczema, irritants, allergens, and germs can enter the body more easily. This can lead to swelling (inflammation) and itchiness.¹

Dry skin on its own can also be irritating and itchy. And when the skin is scratched, it gets even more damaged. This itch-scratch cycle makes dry skin even worse and can lead to further eczema symptoms and flare-ups.¹

Long-term scratching can lead to skin thickening and scarring. This process is called lichenification. The resulting thick skin plaques can also be itchy, which further fuels the cycle.¹

On top of all this, some experts think people with eczema may have a stronger urge to itch (itch response) than those without eczema. This urge may also play a role in the worsening of dry skin.¹

Other causes of dry skin

While eczema itself causes dry skin, it is not the only possible cause. And anything that leads to skin dryness can act as a trigger for eczema symptoms. The many possible causes of dry skin include:^2,3

• Bathing or scrubbing the skin too often
• Cold weather
• Low humidity or extended exposure to air conditioning
• Contact with skin irritants or allergens
• Infections
• Skin conditions like psoriasis or xeroderma pigmentosum
• Diabetes
• Kidney issues
• Thyroid issues
• Pregnancy or menopause
• Dehydration
• Poor nutrition
• Drug side effects

If you notice your skin is drier than usual, talk with your doctor. Sometimes a change in your skin is one of the first signs of an underlying health issue.^4,5

Types of moisturizers

One of the first-line treatments for eczema is moisturizing the skin. This can help keep the skin barrier as strong as possible. Many eczema creams can also help control itching. Some of the most common eczema moisturizers are:^6,7

• Lotions – Lotions are easy to get and quickly absorb into the skin. But many over-the-counter lotions contain fragrances and ingredients that can irritate.
• Creams – Creams are higher in oil content and have less water. They take longer to absorb than lotions, but they can be applied less often.
• Ointments – Ointments are the thickest kind of moisturizer. They are considered occlusives, which means they help lock moisture into the skin. They can sometimes be messy to apply and clean up. A common ointment is petroleum jelly.
• Anti-itch creams – Some anti-itch creams can act as moisturizers too. However, many are used along with other lotions, creams, or ointments to moisturize.

There are different ingredients in each type of moisturizer. Some help draw water into the skin or keep it there. Examples of these ingredients are humectants and occlusives. Other ingredients, like emollients, help repair the skin barrier. Talk with your doctor about the best moisturizers for you and how often to apply them.^6,7

Skin hydration tips

Keeping the skin hydrated can be challenging for people with eczema. Each person’s skincare routine will be different. Some common ways to help keep the skin moist and strong are:^2-7

• Taking showers or baths with lukewarm water rather than hot water
• Avoiding aggressive scrubbing during bathing
• Using soaps, cleaners, and detergents without dyes or irritating chemicals
• Moisturizing damp skin right after bathing
• Drinking lots of water
• Having an air humidifier in your home or at work during dry winter months
• Dressing in fabrics that are less irritating to the skin, like cotton
• Using all medical treatments as recommended or prescribed