Dry Skin (Xerosis) in Atopic Dermatitis

Reviewed by: HU Medical Review Board | June 2017 | Last updated: September 2023

Xerosis is the medical term for dry skin. Atopic dermatitis (AD) frequently causes xerosis. Xerosis from AD may appear dry, rough, flaky, scaly, or with cracks in the skin. In people with darker skin, xerosis may appear as ashy skin. In addition to being a symptom of AD, dry skin can also be a trigger for the chronic condition, causing a flare of symptoms. Reversing xerosis is a key element in the treatment of AD.1

What causes eczema dry skin?

Atopic dermatitis causes a damage in the skin barrier, which allows more water to be lost through the skin. In some people with AD, there is a decrease or lack of filaggrin, one of the proteins in the skin that is key to its structure and formation. A decrease or lack of filaggrin can also lead to a damaged skin barrier and a reduced ability to maintain the skin’s natural amount of water. The excess water loss can lead to dry skin.2

Does dry skin cause itchiness?

When skin becomes dry, it can also cause itchiness, and the itch-scratch cycle of atopic dermatitis is one of the processes that seems to continue the disease. Scratching the areas of skin affected by AD worsens the rash and can cause breaks in the skin, which increase the risk of infection. Repeated scratching also leads to areas of lichenification, thickened skin that may have knots or be lighter or darker than surrounding skin. Lichenified plaques are continuously itchy, causing significant distress for the person with AD.3,4

Reducing the eczema itch

One of the recommendations for atopic dermatitis is to avoid situations that trigger the itch sensation. In one survey of people with AD, 71% said that dryness increased the severity of their itch. Treating and preventing dry skin can reduce the itch as well as reduce the possibility of it triggering a flare of AD.3

How is eczema dry skin treated?

Without treatment, xerosis can get worse. Treating xerosis from atopic dermatitis involves a combination of proper skin care, including bathing and moisturizing, and medications.1

Moisturizers for dry skin

Moisturizers are one of the basic necessities for people with atopic dermatitis, regardless of the severity of their disease. Some of the anti-inflammatory medications available for treating AD also come in moisturizer formulations, which can help provide additional barrier repair and control itchiness.

There are different types of moisturizers that may be used by people with AD, including:

  • Humectants, which attract and bind water from deeper layers of the skin
  • Emollients, which contain lipids (fats) naturally found on the skin and smooth skin by lubricating the skin
  • Occlusives, which form a hydrophobic film to reduce the loss of water from the skin4

The choice of moisturizer is usually determined by a number of factors, such as individual preference, safety, effectiveness, and the absence of fragrances or other chemicals that may cause sensitivity.5

Medications for dry skin

Medicines that may be used for dry inflamed skin from atopic dermatitis include topical corticosteroids and immunomodulators. Corticosteroids may be used with wet-wrap therapy, a technique that involves applying the medication (if using) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.6

Other symptoms of atopic dermatitis

In addition to the itch, atopic dermatitis can cause a rash, scaly patches, weepy sores, bumps or papules, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by AD may become thickened.

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