Rashes are a very broad topic, but this Advisory has a narrow focus: dry skin and eczematous rashes. Dry skin is a problem faced by almost all of us on occasion, but it’s always a problem if you have eczema.

What is Eczema?

Eczema is a term used for a group of skin conditions having several things in common: dryness, itching, inflammation and thickening of skin, and recurrence. See the table below for descriptions of the usual types.

Type Location Symptoms Appearance Atopic dermatitis (common in kids with allergies or asthma, often gone by adulthood) See body map Itching Thickened, red, dry skin; sometimes crusty and oozing. Contact dermatitis (skin allergy or sensitivity to a substance) See body map Itching, dry skin Dry, thickened, cracked skin. Hand dermatitis (usually caused by irritants) Hands, sides of fingers Itchy, dry, painful; sometimes small blisters at sides of fingers Dry, red, skin; sometimes cracked and bleeding. Dry (chapped) skin Backs of hands, lower legs, or entire body None or sometimes itching Scaly, flaky; not thickened. Sometimes cracked if severe.

 

What Causes It?

Nobody knows exactly why some people are affected by these rashes and others with the same exposure aren’t. Those with atopic dermatitis often have non-skin allergies (like hay fever and asthma) but their rashes aren’t caused by skin allergies. On the other hand, those with contact dermatitis do have true skin allergies, but usually not other allergic problems like someone with atopic dermatitis. Contact dermatitis occurs at all ages, whereas atopic dermatitis is most often a problem in kids. Hand dermatitis is caused by skin irritants such as detergents or chemicals. Dry (chapped) skin occurs because of lack of water in the stratum corneum (outermost layer of skin). If your skin surface doesn’t have enough oil, there’s more evaporation of water which contributes to the dryness.

The Itch/Scratch Cycle

Characteristic sites of atopic dermatitis.

Scratching can actually trigger eczematous rashes. Initial mild itching makes you want to scratch, of course. But scratching damages the skin, worsens inflammation, irritates surface nerves, and leads to even more intense itching than you had before. This cycle aggravates and prolongs all of these rashes. In fact some eczematous rashes completely disappear without any treatment if you just stop scratching.

As you can tell, these rashes differ in many ways. So why do we lump them together? Because the underlying chronic inflammation makes them all look, feel and respond to treatment in the same ways.

If you have eczema or dry skin, you’ll probably have it again unless you take preventive steps. Advice below applies to all varieties of eczema and dry skin.

Avoiding Eczema and Dry (chapped) Skin

Do

• use moisturizers twice daily (more often on hands) to hydrate and soften skin, and reduce itching.

• try to determine what exposures aggravate your rash and avoid them (click here for Common Culprits of Skin Irritation/Allergy).

• humidify dry air, especially in your bedroom.

• clip fingernails short and even wear light cotton gloves to stop "sleep scratching."

• use soapless cleansers or non-alkaline (neutral) soaps (see Recommended Products section).

• wear gloves when washing dishes or clothing, and don’t allow your hands to be constantly wet.

Don’t

• scratch the itch!

• use regular bath soap.

• use any skin products or laundry products with added fragrances.

• shower daily. If you must, use recommended cleansers only (see Recommended Products section).

• allow wool clothing or blankets against your skin.

• expose your skin to very cold or hot air.

Eczematous dermatitis (contact) (a) Airborne allergens (plants, pollens, sprays; (b) jewelry, clothing, furs; (c) clothing straps; (d) deodorant, antiperspirant; (e) metal tags; (g) trunks and panties; (h) shoes or hose.

The Do’s and Don’t in the Prevention section are really the key to minimizing your eczema or dry skin, but there are medications and other products that help further.

• Hydrocortisone is an anti-inflammatory steroid cream. Its low potency makes it safe for self-care. Hydrocortisone blocks allergic/immune skin reactions which trigger eczematous rashes, and can speed healing of inflamed and cracked skin regardless of the cause. Hydrocortisone is probably the strongest anti-itching cream available.

• Colloidal oatmeal baths and cleansers re-moisturize the dry stratum corneum skin layer, lubricate and help control your itching. Use oatmeal-based cleansing bars as soap replacements since they won’t strip your skin of helpful surface oils.

• Moisturizers and humectants. Most of us call moisturizers "lotion" or "hand cream." They simply leave an oily coating on your skin which prevents more evaporation and dryness. Humectants take this a step further and actually draw moisture from the air into your skin. Both soften the rash and stop you from itching.

• Keratolytics actually break down dead, thickened skin and help remove flakes and heavy crusts. This speeds up your body’s natural skin healing process, and exposes the healthier skin below more quickly. Keratolytics should be used in combination with moisturizers or humectants to maintain hydration of the new skin.

When treating eczematous skin, always keep the old dermatologist’s refrain in mind: "If it’s wet, dry it. If it’s dry, wet it." Translation: solution or gel forms of medications are better to dry out puffy, moist or oozing skin. Lotion and cream types are for neutral or slightly dry skin, and ointments (greasy petrolatum-based products) are the ultimate for "wetting" your extremely dry or cracked skin problems.

• Wild Naturals Skin Cream is an interesting new product we have found. It is all natural, and quickly works to bring relief to damaged skin and stop the itching. It has none of the dangerous side effects of steroids, and for many people is even more effective. Other treatments include:

• Cortaid cream (hydrocortisone 1% cream). See the description of hydrocortisone above in the Treatment section. This particular brand of hydrocortisone cream has an excellent moisturizing base and vanishes after a thorough application, instead of clumping like some off-brands.

• Aveeno Cleansing Bar. As discussed above, this product may be substituted instead of soap to allow more of your skin’s natural oils to remain in the stratum corneum layer. Allowing those natural oils to remain and build up further is crucial to prevention and treatment of dry and damaged eczematous skin.

• Eucerin. The unscented form of this product contains standard emollients such as mineral oil and lanolin, but also the humectants sorbitol and propylene glycol (discussed above under Treatment). The humectants are what make this lotion more effective than other oil or lanolin based moisturizers.

• Eucerin Plus (keratolytic: urea). This is a slightly different formulation than the Eucerin moisturizing lotion, and is especially helpful for breaking down thickened, dry, crusty skin while helping to moisturize the new skin beneath.

• Aveeno Bath Treatment Soothing Formula (colloidal oatmeal). The exact mode of action of colloidal oatmeal is unknown, but it is proven to relieve itching for up to several hours. It leaves a rather slippery, smooth texture to the skin.

Many cases of eczema are too severe for self-care. Prescription steroid creams and other techniques can be a far more effective addition to the above measures if your rash gets out of control. Here are some signs that you are losing the battle:

• Enlargement, spread, or worsening of the rash despite your best efforts.

• Uncontrollable itching causing itch/scratch cycle.

• Signs of infection like intense redness, tenderness, or suddenly increased swelling around damaged skin areas.