Helping Patients Manage Dry Skin
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Editor's note: This blog post was written by Annette Fonteneau, MSN, RNP, DCNP, who practices at School Street Dermatology in Pawtucket, R.I.
Although winter's end is approaching, patients are no doubt asking for advice about treating their dry, cracked, painful skin. The heat in their cars, homes and workplaces create an environment of low humidity that can be drying to the skin. Working with dry material such as paper or cardboard, and the use of sanitizers, harsh detergents and soaps (combined with hot showers) also contribute to dryness.
Bathing and hand washing with soap-free cleansers such as Cetaphil or CeraVe are helpful. Scratching and rubbing can lead to a worsening of the itch-scratch cycle, which may cause skin to become infected, hyper- or hypopigmented and even scarred.
The treatment of hands and feet can be particularly difficult. Feet are in the warm, moist, occlusive environment of our shoes all day. When footwear is removed, this damp skin rapidly dries out, becoming cracked. Hands that are in and out of water all day are damaged by repeated cycles of overdrying and subsequently develop hangnails and painful fissures.
The basic goal is to rehydrate the skin. I encourage patients to soak in tepid water for 3 to 5 minutes daily, and to then create a barrier to lock in moisture by applying Vaseline, Aquaphor or Bag Balm with socks or gloves before bed. In the morning, I advise them to apply a heavy emollient cream such as Eucerin, Cetaphil or CeraVe Cream after showering and handwashing. Light lotions should be avoided, since these are generally inadequate in harsh winter weather and may actually make dryness worse. Certain skin diseases are more susceptible to drying and irritation, such as rosacea, eczema and psoriasis. Patients with these skin conditions can be difficult to manage and may need to be referred to dermatology for consultation.