The seemingly incessant hand-washing between patients is a routine ritual that leaves my hands, and the hands of many healthcare workers, wanting for moisture. The deep skin fissures that sometimes appear burn as though I had rubbed cayenne pepper-laced hand cream on them. As irritating as this cycle is, my complaints pale in comparison to one of my patient battling a severe form of skin dryness known as ichthyosis. I have watched his skin flakes, like snow, fall to the exam room floor as I gently removed his socks. While not painful for him, it is terribly annoying and understandably embarrassing. He needed an urgent solution.
So for the myriad of other unsung people also with this persistent dry skin, I am going write out a treatment strategy: “Skin Care 101”: a seven step-by-step approach to managing severe dry skin.
- Cool it down. Instead of hot showers and baths, use cool or warm water. Limit shower and bath time to under 10 minutes. Blot your skin dry; do not rub the skin and use moisturizer generously immediately after drying the skin (while it is still moist) so it will better absorb the ointment.
- Lay off the lotions.Instead, use an ointment or cream. Lotions tend to contain additives that can irritate or dry the skin. Olive oil, jojoba oil, and shea butter are fine. Severe dry skin may require lactic acid, urea, glycerin, lanolin, mineral oil, petroleum, or hyaluronic acid (per the American Academy of Dermatology). Discuss these options with your medical provider.
- Send away your scents.Avoid scented skin care products and consider avoiding deodorant soaps when dry skin conditions worsen. These products may contain alcohol or other irritants that are too harsh for dry, sensitive skin. If you are using topical retinoids or alpha-hydroxy acids, hold treatment for a few days in order to allow your skin to retain its natural oils.
- Cover up.Consider moisturizing gloves and socks at night. I realize that this does not seems very glamorous for bedtime, but it really helps the skin retain the moisture. There are several brand on the market specifically for hand and feet dryness.
- Keep the cream close.Keep a hand cream and lip balm with you during the day so that are more likely to replenish your hands and lips regularly.
- Wash and wear your clothing with care. Consider hypoallergenic laundry detergent. Use silk underclothing; it will glide over your skin more easily and be less likely to rub against dry and irritated skin.
- Watch the flame.Avoid sitting close to high temperatures such as a heater or furnace. Instead, consider bundling up and using a humidifier to maintain air moisture.
You should consult your medical provider to be certain that you have no medical conditions causing the severe dry skin. Low thyroid, autoimmune diseases, and inflammatory skin conditions such as psoriasis or eczema are among other causes that need to be considered and treated.
For my patient, the prescription of urea cream along with his written list of instructions should help lessen discomfort and soothe his dry skin. While there is no definitive cure for the scaling and dryness, we can keep ahead of the condition by keeping his skin healthier. As for my embattled hands, “cracking me up” really is no laughing matter and I choose to fight! My weapon of choice is an unsurmountable supply of Cerave moisturizing cream and an iron will to win! I got this.