How can I prevent and treat winter‑related skin xerosis and flaking?

Winter Skin Xerosis and Flaking: Prevention and Treatment

Apply hypoallergenic moisturizing creams or emollients containing ceramides once daily to smooth the skin and prevent winter-related dryness, starting as soon as cold weather begins. 1

Understanding Winter Skin Changes

Winter climate causes skin dryness through multiple mechanisms that require proactive management:

• Low relative humidity combined with indoor heating promotes moisture loss and impairs the natural desquamation process, leading to dead skin cell accumulation and flaking 2, 3
• Even short-term exposure (6 hours) to heated indoor environments significantly increases skin temperature, pores, roughness, redness, and transepidermal water loss (TEWL) 2
• Ceramide levels in the stratum corneum decrease during winter, particularly CER[NP] and CER[NH] species, which strongly correlate with dry skin indicators including conductance, dryness, roughness, and scaliness 4, 5

Primary Prevention Strategy

Begin moisturizer application immediately when winter season starts, rather than waiting for symptoms to develop:

• Use hypoallergenic moisturizing creams or emollients once daily to improve skin hydration and address epidermal barrier dysfunction 1
• Choose formulations containing ceramides, as these maintain skin homeostasis, protect the skin barrier, and specifically increase CER[NP] levels that correlate with dry skin relief 2, 4, 6
• Select water-in-oil formulations for drier skin, with lipid content proportional to the degree of dryness 5
• Apply moisturizer to damp skin immediately after gentle cleansing to maximize hydration 7

Cleansing Practices

Proper cleansing prevents further barrier disruption during winter:

• Use pH-neutral (pH 5) non-soap cleansers or gentle soaps with tepid water only, avoiding hot water which exacerbates dryness 1, 7, 8
• Pat skin dry gently with clean, smooth towels rather than rubbing to minimize trauma 1, 8
• Avoid all alcohol-containing lotions or preparations, as these significantly worsen dryness and trigger inflammatory flares 8

Ingredient Selection for Specific Symptoms

Tailor moisturizer ingredients based on presenting symptoms:

• For scaling: Use urea-containing products, which have the strongest clinical evidence for xerosis treatment and work synergistically with ceramides 5
• For fissures or cracks: Apply urea or dexpanthenol 5
• For erythema: Consider licochalcone A 5
• For pruritus: Use polidocanol 5
• For barrier restoration: Prioritize ceramide-containing formulations, which demonstrate sustained improvements in skin moisturization for 24 hours 6

Sun Protection

Winter sun exposure remains a significant concern:

• Apply hypoallergenic sunscreen daily with at least SPF 30, providing UVA/UVB protection, preferably containing zinc oxide or titanium dioxide 1, 7, 8
• Stay out of direct sun exposure and wear protective clothing including hats 1, 7, 8

Products and Practices to Avoid

Critical pitfalls that worsen winter xerosis:

• Never use greasy or occlusive creams, as they facilitate folliculitis development through occlusive properties 1, 7, 8
• Avoid topical acne medications and retinoids, which irritate and worsen the condition through drying effects 1, 7, 8
• Do not manipulate or pick at dry, flaking skin, as this increases infection risk 1, 8
• Avoid synthetic clothing materials; wear fine cotton instead to reduce friction 1

Treatment Algorithm for Established Xerosis

When prevention fails and symptomatic xerosis develops:

• Continue or intensify ceramide-containing moisturizer application, as clinical improvements in conductance appear within 3 days and TEWL improvements within 14 days 4
• Increase application frequency if single daily application proves insufficient 5
• For inflammatory component with erythema: Apply hydrocortisone 1% cream short-term (maximum 2-4 weeks on face) to avoid skin atrophy and tachyphylaxis 7, 8

Common Pitfalls

• Starting moisturizer treatment only after symptoms appear rather than proactively at winter's onset reduces efficacy 1
• Using products without ceramides misses the opportunity to address the fundamental ceramide deficiency that underlies winter xerosis 4, 5
• Applying moisturizer to completely dry skin rather than damp skin reduces absorption 7
• Continuing hot showers or baths despite treatment undermines barrier restoration efforts 1, 7