Dermatologist Explains What Causes Dry Skin?

Your skin becomes dry when it loses both water and it’s natural skin oils. 

In the lab we see big differences between dry skin and hydrated skin in both the composition of the chemistry of the skin layers and the way they look structurally when examine under a microscope.  The structural and chemical characteristics of dry skin translates to skin that’s also more vulnerable.

We call this vulnerability of dry skin an impaired barrier function.  For you, dry skin means that:

  • your body’s water, which is normally present in your skin, is escaping more easily (called transepidermal water loss).
  • soaps and solvents are better able to penetrate deeply into your skin and pull out your natural skin oils.

You can see why the problem compounds, getting worse and worse, and you’ve undoubtedly experienced it.  The most common example is chapped hands.  Once your hands are chapped they get worse and worse every time you take them outside into harsh weather or do the dishes without gloves again.  Your skin becomes rougher, dryer, itchier, starts to crack, hurts, becomes rougher and dryer etc…

What’s happening is that your impaired barrier can’t stand up to the usual insults of weather and soaps.  Harsh weather ‘pulls’ water out of your skin into the dehumidified wind.  Soaps seep into chapped skin  ‘cleaning-out’ more of your skin’s natural oils.  Unless you intervene, your skin gets drier and drier and its barrier weaker and weaker.

The intervention is actually simple – stop exposing the skin to situations that decrease its water and oil content, and instead do something to increase these important components of healthy skin.

Dermatologist’s advice to heal dry skin:

1.  For starters, wear gloves, clothing or facial mufflers to protect skin from harsh weather so that water isn’t ‘pulled’ out so rapidly.

2.  Increase the relative humidity of the air that you expose your skin to by adding an indoor humidifier. (Or, hello Hawaii!).

3.  Minimize the exposure of your skin to harsh solvents and soaps that ‘clean out’ the oils you need for a healthy skin barrier.  This means wearing protective gloves when you must come into contact with these things, such as when doing the dishes.

4. Use only gentle cleansers when you wash your skin because skin cleansing also ‘cleans out’ your natural skin oils.  Have only gentle cleansers handy at your sinks and in the shower.  Rinse them off well too because soap residue can irritate skin and even gentle soaps will pull oils out of your skin given hours of opportunity.

For chapped dry skin care I recommend only skin cleansers with a high glycerin content and no sodium laurel sulfate foaming agents.  Safe options include pure glycerin bar soaps and naturally made bar soaps that retain their natural glycerin.  Whole Foods 365 brand glycerin bar soap is a deal at about $2 and is a great all-purpose skin cleanser.  Other commercially available liquid cleansers that meet this criteria include Toleriane Cleanser, which is my ‘go-to’ cleanser for cleansing dry sensitive facial skin. best facial dry skin cleanser

5.  Apply a high quality skin moisturizer that’s rich in oil immediately after washing or bathing skin.  This will add oil back and help to trap water. Water enters your skin during water exposure and oils prevent its evaporation by sealing it in.  The oils will also seep into your skin to replace your lost natural oils. Find a product you like and use it as often as possible.

Most commercial moisturizers have petrolatum or mineral oil as their therapeutic oil ingredients and many scientific studies over the years have proven the effectiveness of these oils for repairing skin barrier impairment.  There are also products with natural oils that work beautifully too such as almond oil, shea butter, olive oil, jojoba oil etc.  Other moisturizing oil ingredients that can be helpful are ceramides which more closely resemble your skin’s natural oils and are important for healthy skin barrier.

Moisturizers that also contain humectants (water binders) are even more effective than those based solely on their oil content.  Look for humectant ingredients such as

  • urea,
  • the alpha hydroxy acids called lactic acid and glycolic acid,
  • glycerin
  • hyaluronic acid.

These humectants boost skin water content by binding water in the skin, thus preventing it’s loss.  Urea and alpha hydroxy acids however can irritate severely chapped skin and you need to heal your chapped skin before you start using them.

It’s possible to find products that specifically heal and protect dry, chapped, barrier impaired skin and that are not heavy or oily.  For example, my favorite humectant containing hand moisturizer is Dry Skin Hand Cream with glycerin, dimethicone (a skin protecting ingredient added to prevent water loss and protect an impaired barrier) and the palm oil emollient isopropyl palmitate.  It’s a cleaver, non-greasy formulation that protects and hydrates hand skin.  I keep it in my lab coat pocket and I apply it numerous times a day to prevent dry skin from washing.

The bottom line is that to treat and prevent dry skin you need to protect it from water robbing circumstances.  You also need to moisturize it after bathing or washing to help recreate the water and oil content of healthy skin.

References:

Lodén M.”Role of topical emollients and moisturizers in the treatment of dry skin barrier disordersm” Am J Clin Dermatol. 2003;4(11):771-88.

Imokawa G. Stratum corneum lipids serve as a bound-water modulator. J Invest Dermatol. 1991 Jun;96(6):845-51.

Cho HJ. “Quantitative study of stratum corneum ceramides contents in patients with sensitive skin.” J Dermatol. 2011 Oct 31. [Epub ahead of print]

Photo: Thanks and gratitude to Hanaan Rosenthal

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12 Responses to “Dermatologist Explains What Causes Dry Skin?”

  1. Melissa France January 24, 2012 at 9:49 am #

    My husband has severely dry skin on his face that seems to be aggrevated when we take our daughters swimming at our health club. We have a humidifier that we run constantly in the winter, he is using a Hyaluronic Acid based moisturizing serum and he has even tried vaseline. We are pretty certain that the chlorine in the pool is making the dry skin worse, which makes us wonder if the humidifier could be doing the same thing since we put tap water in it (chlorinated). Do you think it would help if we used bottled water?

  2. Cynthia Bailey MD January 24, 2012 at 5:03 pm #

    I’ve never seen any scientific reference to chlorine from humidifiers causing irritation but it’s an intriguing thought. It would be interesting to give the bottled water a try and see. I have had patients who felt that their facial skin did better when washed with bottled water instead of tap/public water.

  3. Melissa France January 25, 2012 at 5:31 am #

    Thank you for your response. We will try the bottled water and see if it helps. It is frustrating because he gets the same patches of dry, red skin right below his eyes every winter no matter what he tries. We live near Denver, so we are accustomed to dry air. We aren’t strangers to skin care as we both work in the industry, so it makes it even more frustrating. I am a copy writer and author content for skin care articles and have written many times about dry skin solutions, but we have not been able to figure this one out. I do appreciate your thought on the humidifier and I will let you know how it turns out.

  4. Cynthia Bailey MD January 25, 2012 at 8:02 am #

    Have you considered a different diagnosis. The location is curious. Is there anything that touches that area of the skin that could be an allergen such as the rubber in ski goggles, the metal rims of a pair of winter glasses? What about an airborne contact allergen such as wood burning smoke, indoor air freshener, pine resin in the home? Eyelids are the ‘canary in the mine shaft’ for airborne allergen reaction and often manifest as ‘dry’ red skin. When a person wears glasses the upper lids may be spared and just the lower ones react though more typically the uppers are worse to an airborne contact allergy. Just some food for thought about an alternative explanation.

  5. Melissa France January 25, 2012 at 8:13 am #

    None of the above…I should be more specific about the area- it is the upper cheek, below the eyes and only happens on one side. It isn’t the delicate tissue under the eye, but where the cheek begins. Nothing has changed with the interior of our home except for the heat coming on in the last couple of months and the Christmas Tree- but it was gone before the redness showed up-although it could be lingering. I will have him see one of the Derms I write for. It could be another seasonal allergy that we are not aware of. Thank you again for your input!

  6. Cynthia Bailey MD January 25, 2012 at 11:08 am #

    Very interesting. I love a mystery (of course I’m on the right side of the problem). No asymmetrically fitting glasses or goggles that only touch one cheek?

  7. Ali Lasch January 30, 2012 at 9:10 pm #

    Thank you for sharing these professional tips and advice. I am the queen of dry skin, especially during the change in weather. I’m going to take your suggestions and reduce the number of times I put my skin in these situations.
    I appreciate the recommendation to wear rubber gloves when doing the dishes. However, what about after we take a shower or wash our hands? Do you think we should be constantly applying lotion or moisturizers? Is there such thing as too much moisture?
    Your suggestions on types of hand/skin creams will be very beneficial to my skin and is added to my pharmacy market list.
    Your bulleted format and numbered list made it easy for me to follow and find the dry skin solutions I was looking for.
    Thanks so much for sharing!

  8. Jennifer Smith February 2, 2012 at 8:35 am #

    Dr. Bailey,

    Could you recommend a rich yet gentle moisturizer that is non-comedogenic for sensitive maturing skin during the day?

    I use Retin-A and the antioxidant kit without glycolic acids. My skin is sensitive to AHA, glycolic acids and parabens. Thanks!

  9. Cynthia Bailey MD February 2, 2012 at 9:10 am #

    Hello Jennifer,
    My ‘go-to’ facial moisturizers are Glycolix Ultra Lite for a light feel or Glycolix Fortified for a richer feel on the skin. Both are non-comedogenic and wonderfully hydrating, but they are preserved with parabens. I’ve found that the more natural moisturizer formulas (that use more natural, food-based preservatives) usually have oils in their formula and these can clog some people’s pores. The more traditional non-paraben product options usually use other preservative systems such as the formaldehyde-releaser family and I try to steer clear of them. This is actually a tough question! I looked around on the web for fun and didn’t find any great options. When patients are on a search like this I recommend that they read ingredient labels and just realize they are going to have to try some different products until they find the right fit for their skin.
    Cheers,
    Cynthia Bailey MD

  10. Diyo February 8, 2012 at 2:19 pm #

    Hii , Thank you for providing useful information.

    Im from UK.. i have a really bad dry skin! i have used and tried so many different types of skin creams but none of them worked.
    At the moment my both arms have black small patches and my body always dry/warm .. just cant find the right cream. beacuse of the black small patches on my both arms , I dont feel confident to show my arms.
    I dont know what caused the small black patches..

    can you please advice me something that i can use to get rid of the black patches??

    thank you

  11. Cynthia Bailey MD February 9, 2012 at 5:01 pm #

    Hello Diyo,
    Actually, I don’t and can’t give specific advice over the web. My information is general educational information only. All personal medical care and decisions need to be guided by a personal physician.
    Warm Regards,
    Cynthia Bailey MD

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