Like razor blades dug into my skin, so are the deep fissures created by the dry cracks of my hands. The never-ending repeated hand-washing between patients is a routine ritual that leaves my hands wanting for moisture. But my complaints pale in comparison to my patient with a severe form of skin dryness known as ichthyosis.His skin, like snowflakes, falls to the floor of the exam room as I gently remove his socks. It is not painful for him, but terribly bothersome and (understandably) embarrassing. He needed an urgent solution.
Turning my office into a classroom and the computer a chalkboard, I write out our treatment strategy: “Skin Care 101”. As this is a common condition, I will share the seven step-by-step directions to managing severe dry skin.
- Cool it down. Instead of hot showers and baths, use cool or warm water and limit shower and bath time to under 10 minutes. Blot 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 hand gloves and socks at night. I realize that this seems very glamorous for bedtime, but it helps the skin retain the moisture. There are several hand gloves and socks 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.
- Fan 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.
Your medical provider should be certain you have no medical conditions that cause 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, a prescription of urea cream along with a written list of numbered instructions should help lessen his discomfort and soothe his dry, irritated skin. While there is no definitive cure for the scaling and dryness, we can keep ahead of the condition and keep his skin healthier.