Dry Skin - tips and options on how best to manage this condition
Posted by Eamonn Brady on
Dry Skin
Treatment Options
There are many causes of dry skin including dermatitis, eczema, psoriasis, and seborrhoeic dermatitis. Today I will give a brief outline of basic treatment options. For specific conditions like psoriasis there are more specialised medication which I will return to in the future in this column.
Diet
In adults, food allergies or food intolerance do not appear to be a factor in dry skin conditions such as eczema and psoriasis so avoiding foods is not any benefit. In infants, avoidance of certain foods can be helpful, but healthcare professional advice is important. Common food triggers include eggs, nuts, peanut butter, chocolate, milk, seafood, and soya.
Maintaining adequate skin hydration
Evaporation of water on the skin leads to dry skin, especially in people suffering from dry skin conditions such as dermatitis, eczema, or psoriasis; skin hydration is a key component of their overall management. Thick creams (e.g., Diprobase®) which have a low water content, or ointments (e.g., petroleum jelly, Emulsifying Ointment), which have zero water content will better protect against dry skin than lotions. Hydration is best applied immediately after bathing when skin is hydrated. Improve hydration by soaking in a bath containing a bath additive such as Oilatum® for 10 to 20 minutes.
Urea
Urea is a hydrating agent naturally found in our skin and contained in emollients including Calmurid®, Eucerin® and Whelehans Intensive Moisturising Cream. There are markedly reduced amounts of urea in dry skin conditions. Urea is strongly hygroscopic (water-loving) and draws and retains water within skin cells. Urea softens the skin. Urea is beneficial in dry skin conditions where scaling and flaking occur and can be useful in elderly patients. Whelehans Intensive Moisturising Cream was developed by our pharmacist because brands such as Calmurid® Cream, while effective, are very expensive. Our cream contains 10% urea and is over half the price of brands such as Calmurid® Cream.
Use of steroids
Topical corticosteroid such as hydrocortisone 1% cream may be prescribed by a GP (or over the counter from pharmacies) for many dry skin conditions. The face and skin folds are areas that are at high risk of thinning and marking with corticosteroids, so care and moderation is important. The GP may prescribe more potent corticosteroid creams such as Clobetasone 0.05 % (e.g., Eumovate®), betamethasone 0.01% (e.g., Betnovate®) or clobetasol 0.05% (e.g.) Dermovate® for short periods during bad flare ups.
In relation to potency, topical corticosteroids are classed as follow:
- Mildly potent: Hydrocortisone 1%
- Moderately potent (2–25 times as potent as hydrocortisone): Clobetasone (E.g., Eumovate®), alclometasone (g., Modrasone®)
- Potent (100–150 times as potent as hydrocortisone): Betamethasone (g., Betnovate®), Mometasone (E.g., Elocon®)
- Very potent (up to 600 times as potent as hydrocortisone): Clobetasol (g., Dermovate®)
Corticosteroids, especially the more potent versions, should be used for the shortest period possible, and use of the most potent ones should be under strict medical supervision. The patient may need to be referred to a dermatologist in more severe cases.
When using a corticosteroid and a moisturiser, it is good practice to use the corticosteroid first and to put on the moisturiser after half an hour to allow the skin time to absorb the corticosteroid. In more severe cases, treatment may include tacrolimus (Protopic® Ointment) for eczema or UVB phototherapy and Psoralean plus ultraviolet A (PUVA) therapy for psoriasis.
Therapies with no evidence base
Supplementation with essential fatty acids, pyridoxine, vitamin E, multivitamins and zinc salts has no proven value. Reactions to washing powders are rare and avoidance of biological washing powders is of no benefit.
For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).