What prescription medications are used to treat dry skin?

Prescription Medications for Dry Skin

The most effective prescription medications for dry skin are topical corticosteroids of varying potencies, with selection based on severity and location, followed by other agents like pimecrolimus for specific cases where steroids are contraindicated. 1

First-Line Prescription Options

Topical Corticosteroids

Topical corticosteroids are classified by potency and should be selected based on the severity of dry skin, affected area, and risk of adverse effects:

• Mild potency:

  • Hydrocortisone 1% (0.1-2.5%)
  • Dioderm (hydrocortisone 0.1%) 2

• Moderate potency:

  • Eumovate (clobetasone butyrate 0.05%)
  • Betnovate-RD (betamethasone valerate 0.025%) 2

• Potent:

  • Betnovate (betamethasone valerate 0.1%)
  • Elocon (mometasone 0.1%) 2

• Very potent:

  • Dermovate (clobetasol propionate 0.05%) 2, 3

Application Guidelines

• Apply once or twice daily for up to 3 weeks for super-high-potency corticosteroids
• Medium to high-potency corticosteroids can be used for up to 12 weeks
• Low-potency corticosteroids have no specified time limit 1
• Use the fingertip unit method: one fingertip unit covers approximately 2% body surface area 1

Cautions

• Risk of adverse effects increases with:
  • Prolonged use
  • Large application area
  • Higher potency
  • Occlusion
  • Application to thin-skinned areas (face, genitals) 1
• Systemic absorption may occur, potentially affecting plasma cortisol levels 3

Second-Line Prescription Options

Calcineurin Inhibitors

• Pimecrolimus (Elidel) cream:
  • Indicated when corticosteroids are contraindicated or for sensitive areas
  • Should not be used continuously for long periods
  • Not for use in children under 2 years old 4
  • Apply a thin layer to affected areas twice daily
  • Can be used with moisturizers (apply moisturizers after pimecrolimus) 4

Combination Therapies

Corticosteroid/Antimicrobial Combinations

For dry skin with signs of infection or inflammation:

• Mild potency combinations:

  • Canesten HC (hydrocortisone 1% + clotrimazole 1%)
  • Daktacort (hydrocortisone 1% + miconazole nitrate 2%) 2

• Moderate potency combinations:

  • Trimovate (clobetasone 0.05% + oxytetracycline 3% + nystatin)
  • Fucidin H (hydrocortisone 1% + fusidic acid 2%) 2

• Potent combinations:

  • Betnovate-C (betamethasone valerate 0.1% + clioquinol 3%)
  • Fucibet (betamethasone valerate 0.1% + fusidic acid 2%) 2

Special Formulations

• Calmurid HC (hydrocortisone 1% + urea 10% + lactic acid 5%) - particularly effective for very dry skin 2

Non-Prescription Adjunctive Treatments

Emollients and Moisturizers

Essential adjuncts to prescription treatments:

• Recommended products:

  • Eucerin intensive lotion (10% urea)
  • E45 Lotion
  • Dermol 500 lotion (as soap substitute)
  • Aveeno lotion 2

• Application guidelines:

  • Apply regularly and generously (200-400g/mL per week)
  • Use after bathing when skin is still damp 2, 5
  • For face and neck: 15-30g of cream/ointment per 2 weeks
  • For trunk: 100g per 2 weeks 2

Treatment Algorithm Based on Severity and Location

1. Mild dry skin:

   • Low-potency corticosteroid (hydrocortisone 1%) + daily emollients
   • Duration: As needed, with no specific time limit 1

2. Moderate dry skin:

   • Moderate-potency corticosteroid (Eumovate) + twice-daily emollients
   • Duration: Up to 12 weeks 2, 1

3. Severe dry skin:

   • Potent corticosteroid (Betnovate) + intensive emollient therapy
   • Duration: Short-term (2-3 weeks), then reassess 2

4. Sensitive areas (face, genitals, skin folds):

   • Low-potency corticosteroid or pimecrolimus
   • Avoid occlusion 4, 1

Special Considerations

• Elderly patients: More prone to dry skin due to reduced sebum production; may require more intensive moisturization 6, 7

• Underlying conditions: Dry skin may be a sign of hypothyroidism, occult carcinoma, lymphoma, or renal/biliary disease; treat the underlying condition 7

• Environmental factors: Address environmental triggers (arid climate, frequent bathing, oil-depleting soaps, indoor heating) 7

• Soap substitutes: Use aqueous emollients and soap substitutes instead of regular soaps 2

Common Pitfalls to Avoid

1. Overuse of high-potency corticosteroids: Can lead to skin atrophy, striae, and systemic effects 1

2. Inappropriate vehicle selection: Ointments are more occlusive and better for very dry skin than creams or lotions 7

3. Inadequate moisturization: Emollients are essential adjuncts to prescription treatments 8

4. Ignoring underlying causes: Dry skin can be a symptom of systemic disease 7

5. Neglecting patient education: Proper application technique and frequency are critical for success 1