Dry skin and eczema flare at this time of year. Dry skin occurs naturally as we age. The dryness and coldness of the winter air further irritates our skin and leads to embarrassing scratching. Furthermore, applying the incorrect cream or ointment may cause allergies or sensitization, which causes inflammation, redness, and itching. The scratch-itch cycle is amplified insofar that the skin becomes thickened, cracked, or weepy with infection, thus interfering with sleep and other everyday activities.
People, especially children, who have atopic eczema – the common hereditary condition associated with the family history of asthma, hay fever, or eczema – are particularly affected in the winter. The skin serves as a barrier to retain moisture: when impaired, as with atopic eczema or aging, dryness and itching occurs.
Mothers of young children, nurses, along with others, who are exposed to water, frequently experience dry skin, eczema, or dermatitis.
Treating dry skin or eczema begins with moisturizers. Applying moisturizers within three minutes after a quick, non-hot shower or after washing hands maximizes benefit. There are many moisturizers available today. I frequently recommend Eucerin, Aveeno, Cetaphil, CeraVe, Vanicream, and Ammonium lactate.
Soap is an irritant and should be restricted to the parts where needed the most: under the arms and groin.
Liquid, fragrance free soaps with moisturizers, when used sparingly, are beneficial. For hand dermatitis, hand sanitizers are generally preferable over soap. Exposure to water must be minimized. I like cotton gloves for non-wet household chores: keeping your hands clean enables the avoidance of additional hand washing. When washing dishes, place vinyl gloves, over cotton gloves, to minimize sweating. Moisturize immediately after removing the gloves.
Topical steroids, both over-the-counter and prescription, are frequently needed when moisturizers alone are not working. Applying moisturizers over the steroids works best.
Prescription tacrolimus is an alternative to topical steroids.
Other treatments include antihistamines, enhanced moisturizers, and antibiotics. Crisaborole, a new gel for children, (over 2 years) and adults affected with atopic eczema, is expected to be released January 2017. Additionally, individuals who do not respond to conservative measures, targeted immunotherapy, dupilumab, will be available soon.
Dry skin and eczema may be much more than a daily annoyance: interfering with daily activity, loss of sleep, and embarrassing scratching. Although for most patients, effective therapies exist today, I enthusiastically look forward to using the new classes of medication to help patients.
Gary Lichten, M.D.