What are the best treatments for dry skin?

Treatment of Dry Skin

The cornerstone of dry skin management is regular application of emollients (at least once daily to the entire body) combined with avoidance of dehydrating practices such as hot water, excessive bathing, and harsh soaps. 1

Immediate Management Strategy

Cleansing Practices

• Use dispersible creams or mild, pH-neutral (pH 5) non-soap cleansers as soap substitutes to preserve the skin's natural lipid barrier, as soaps and detergents strip natural lipids from the skin surface. 1, 2
• Bathe with lukewarm or tepid water rather than hot water, which worsens dryness and stimulates excess oil production. 1, 2
• Pat skin dry with clean, smooth towels rather than rubbing after bathing. 2

Emollient Application

• Apply emollients immediately after bathing (within 5 minutes) to damp skin to provide a surface lipid film that retards evaporative water loss from the epidermis. 1, 3
• Use a dose of at least 1.0 mg/cm² (approximately two fingertip units per body area) for adequate coverage. 2, 3
• Apply emollients twice daily—once immediately after bathing at night and once in the morning—as this frequency demonstrates superior improvement in skin barrier function compared to once-daily application. 3
• Reapply moisturizer every 3-4 hours and after each face washing for optimal hydration maintenance. 2

Product Selection

• Choose fragrance-free moisturizers containing petrolatum or mineral oil for occlusive properties. 2
• Urea-containing preparations (5-10% concentration) are particularly effective for non-inflamed dry skin, providing both hydration and relief from itching. 4, 2
• Alternatively, select products with polidocanol or glycerin as humectants. 1, 2
• Avoid alcohol-containing lotions or gels, which worsen facial dryness. 1, 2
• Avoid greasy or occlusive creams, which may facilitate folliculitis development. 1, 2

Treatment of Complications

Inflammatory Changes (Eczema/Erythema)

• Apply low-potency topical corticosteroids such as hydrocortisone 1% or prednicarbate 0.02% cream for significant erythema and inflammation. 1, 2
• Limit corticosteroid use to 2-4 weeks maximum, especially on the face, due to risks of skin atrophy, telangiectasia, and tachyphylaxis. 1, 2
• Use the least potent preparation required to control symptoms, with intermittent breaks when possible. 1

Severe Pruritus

• Prescribe oral H1-antihistamines with sedative properties (cetirizine, loratadine, fexofenadine, or clemastine) as short-term adjuvants during severe flares with intense itching. 1, 2
• Apply topical polidocanol-containing lotions for additional pruritus relief. 1, 2
• Avoid non-sedating antihistamines, which provide no benefit for dry skin-related pruritus. 2

Fissures

• Apply propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing to accelerate wound closure. 1, 2
• Alternatively, use antiseptic baths with potassium permanganate (1:10,000 concentration) or topical silver nitrate solutions. 1

Secondary Bacterial Infection

• Watch for crusting, weeping, or impetiginization suggesting bacterial superinfection (typically Staphylococcus aureus). 1, 2
• Obtain bacterial swabs and initiate appropriate antibiotic therapy (e.g., flucloxacillin for S. aureus). 1, 2
• Look for grouped, punched-out erosions or vesiculation indicating herpes simplex superinfection, which requires acyclovir treatment. 1, 2

Critical Avoidance Measures

Practices to Eliminate

• Hot showers or baths and excessive bathing frequency. 1, 2
• Harsh soaps and detergents. 1, 2
• Rubbing skin dry after bathing. 2
• Skin manipulation, which increases infection risk. 1, 2
• Topical acne medications (especially retinoids), which cause irritation and worsen dryness through their drying effects. 1, 2

Products to Avoid

• Alcohol-containing preparations. 1, 2
• Products with common allergens including neomycin, bacitracin, and fragrances. 2
• Greasy or occlusive creams for basic care. 1, 2

Special Considerations

Scalp Involvement

• Use shampoos, gels, solutions, or foams rather than ointments and creams, as hair makes traditional formulations messy and difficult to apply. 2
• Apply treatment no more than twice daily for scalp involvement. 2

Sun Protection

• Apply hypoallergenic sunscreen daily (at least SPF 30 with UVA/UVB protection containing zinc oxide or titanium dioxide). 2
• Wear protective clothing and hats. 2

Common Pitfalls

The most frequent error is undertreatment due to fear of steroid side effects, leading to inadequate control of inflammatory changes. 1 When topical corticosteroids are indicated, use them appropriately for limited periods rather than avoiding them entirely. Conversely, avoid prolonged continuous corticosteroid use beyond 2-4 weeks, particularly on facial skin. 1, 2

Another critical mistake is inadequate emollient application—patients often apply insufficient quantities or with inadequate frequency. 3 Emphasize the twice-daily regimen with proper dosing (two fingertip units per area) for optimal barrier restoration. 2, 3