There are many types of rashes, of course, but this Self-Advisory focuses on dry skin and eczematous rashes. Most of us will deal with dry skin at one time or another, but those with eczema must cope with dry skin all the time. Therefore this is information that helpfully can help everyone. Those with another type of rash can find links to other relevant information at the end of this article.

What is Eczema?

Eczema is a term that actually refers to a group of skin conditions that cause symptoms such as dryness, itching, inflammation and thickening of skin. Symptoms frequently reoccur after initially clearing up. See the table below for descriptions of common types of dermatitis.

Type Location Symptoms Appearance Atopic dermatitis (common in kids with allergies or asthma, often gone by adulthood) See body map for typical locations Itching Thickened, red, dry skin; sometimes crusty and oozing. Contact dermatitis (skin allergy or sensitivity to a substance) See body map for typical locations 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, reddened skin; sometimes cracked and bleeding. Dry, chapped skin Backs of hands, lower legs, sometimes entire body Sometimes none, sometimes itching Scaly, flaky; not thickened. Sometimes cracked if severe.

 

What Causes Eczema and Dermatitis?

No one really knows why some people are affected by these rashes while others aren’t, even when exposed to the same allergens or irritants. Those with atopic dermatitis often have non-skin allergies (like hay fever or asthma) but their rashes aren’t caused by skin allergies. On the other hand, those with contact dermatitis do have skin allergies, but usually not other allergies causing respiratory problems or asthma. 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. If your skin surface doesn’t have enough oil, there’s more evaporation of water which contributes to the dryness. Dry and chapped skin may worsen in winter because the air tends to be less humid then.

The Itch/Scratch Cycle

Characteristic sites of atopic dermatitis.

Scratching can actually trigger eczematous rashes. It’s a cycle that begins with mild itching, which 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 types of rashes. In fact, some eczematous rashes will clear up all on their own 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 in the table below applies to all varieties of eczema and dry skin.

To Avoid Eczema and Dry or Chapped Skin:

Do

• Use moisturizers twice daily (more often on hands) to hydrate and soften skin, as well as 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 if necessary to prevent scratching in your sleep.

• Use soap-free cleansers or non-alkaline (neutral) soaps (see Recommended Products section).

• Wear gloves when washing dishes and don’t allow your hands to be wet for long periods of time.

Don’t

• Scratch, even though it itches!

• 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 very hot air.

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

The guidelines 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 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 are commonly known as "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 provide relief 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.

• DermCare 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). As discussed in the treatment section, hydrocortisone blocks the allergic response that causes eczema and helps heal dry, damaged skin. This particular brand of hydrocortisone cream has an excellent moisturizing base and vanishes after a thorough application, instead of clumping like some off-brands. It is not safe to use long-term though.

• 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, as well as the humectants sorbitol and propylene glycol, which actually draw moisture into the skin. The humectants are what make this lotion more effective than other oil or lanolin based moisturizers.  We also like its non-greasy feel.

• Eucerin Plus (keratolytic: urea). This is a slightly different formulation than the Eucerin moisturizing lotion because it also contains a keratolytic, which helps for break 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.

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