International Academy of Cosmetic Dermatology
Many patients believe that they have dry skin, when, in fact, they have scaling on the skin. The definitions of dry are many and diverse. While the word dry may refer to a lack of moisture, it should not refer to wrinkles or to scale. For more detail, see Dry Skin under Cosmetic Dermatology 101.
- A patient with rosacea or acne (Figure 1) cannot have dry skin, when there is oil (sebum) pouring out onto the face. The scale on the face is due to the inflammatory nature of these sebaceous gland disorders. Applying lotions to acne areas will just aggravate the condition.
- There is a condition called xerosis, asteotic dermatitis, or winter itch. The scaling and itching are actually due to a drying out of the skin that was more common in past times with forced hot air heating, lack of humidifiers, and rougher clothing. The skin would benefit from applying lubricating lotions and placing plants on the windowsills so that there would be more moisture in the air.
- Today, the most common type of dry skin often appears as nummular dermatitis (Figure 2), described in Neurodermatitis under Cosmetic Dermatology 101. This often occurs when the patient actually believes the old adage, “Cleanliness is next to Godliness”. While there is no evil attached to being clean, scrubbing the skin with a washcloth or loufah to make sure that soap is everywhere, may lead to red scaling patches, often appearing as round or coin-like patches, and even scratch marks. Prevention is simple: do not use washcloths or loufahs and limit the application of soap to the critical areas – hands, face, underarms, and private areas. Water is the main cleaning agent.
Figure 1: Acne aggravated by the application of moisturizers. This young woman thought her face was dry.
Figure 2: Nummular dermatitis was exacerbated by the use of a washcloth and soap.
Lawrence Charles Parish, MD, MD (Hon)
Philadelphia, PA USA