Winter Skin Care for the Dry Skin Sufferer: Prevention is Key

It is important to consider the temporality of various skin conditions, and how they increase and/or decrease based on the time of year. Just like how certain skin infections are both more likely to make an appearance during the summertime, due to the increased participation in activities involving sweating and swimming, there are also skin conditions that prefer the dry skin environment seen with many people’s skin in the winter time. When the colder, drier winter months come, many individuals that already suffer from dry skin, or have conditions such as eczema, find the condition of their skin to be noticeably worsened. As a result, the search for pragmatic solutions begins, and unfortunately for many people, they find their questions about winter skincare are largely met with anecdotal evidence and colloquial advice. Ultimately, many are left wondering if there is anything they can actually do to change or improve their situation.  

The truth is that although many individuals do in fact have drier skin than other people, organizations such as the American Association of Dermatologists (AAD) and American Academy of Family Physicians (AAFP) have produced substantial amounts of medical literature with guidelines to help those with weary winter skin. The recommendations summarized below can be broadly applied to any individual prone toward developing dry skin. There are also other recommendations that can be made based on the presence of some specific underlying dermatologic diseases, but the key takeaway to remember is that the best treatment for dry skin in the winter is to prevent one’s skin from getting excessively dry in the first place.

Strategies for Prevention of Dry Skin formation in the Winter months:

1. Hypoallergenic ointments – always use ointments first, as they create a seal on the skin to help trap in moisture and promote healing, or to help prevent the skin from drying out in the first place. Creams should only be used if ointment is not available.
2. Using hydrating vs. dehydrating soaps – many store-bought soaps have more effects than just the ones listed on the bottle, and it is important to keep these in mind. Common household soaps such as Dove and Dial serve as good examples. Dial soap is better used during the summertime because it is a more dehydrating soap. Dove soap is better used in the wintertime because it is a more hydrating soap. In general, it is better to use fragrance-free moisturizing bars of soap as opposed to scented body washes.
3. Bathing with hot vs. cold water – as relaxing as a hot shower can feel, it is quite tough on one’s skin. The hotter the shower, the more moisture one’s skin loses, making it more vulnerable to drying out. The American Association of Dermatologists (AAD) stated that showering with warm water has been shown to not worsen dry skin nearly as much as hot water. The reason is that excessively hot water removes some of the oils that skin naturally has to help it retain moisture.
4. Bathing each body part too frequently – it may sound implausible, but vigorously washing every part of your body (aside from your groin and underarms) every single day can encourage the skin to dry out. While the groin and underarms need to be cleansed daily, in general one should be intentional about which body parts require a full soap and scrubbing cleansing each day.
5. Timing of lotion after bathing – ointments, creams, and lotions, although ointments are arguably the best, all function to accomplish the same goal: trapping moisture already present on your skin to keep your skin from drying out. The best time to accomplish this is right after bathing, when your skin is arguably wetter than it will be at any other time in the day.
6. Augmentation of the natural skin oil moisture barrier – oil-based moisturizers, especially ones containing vitamins E and C help to nourish the skin’s natural oils, thus helping to nourish the protective moisture-retaining layer of the skin.
7. Stay hydrated – make sure to drink lots of water and eat a diet high in omega-3 fatty acids. The water content and lipid integrity of your skin’s cell membranes will thank you.
8. Wear gloves – since the hands have very few oil glands, it is difficult to keep one’s hands moist, even when it is not wintertime. Routinely wearing gloves can help to keep the oil and moisture trapped in your hands for longer.
9. Twice weekly skin exfoliation –the topmost layer of skin is predominately an accumulation of dry, dead skin cells. Removing part of this layer via exfoliation several times a week allows for more absorbent skin underneath to then be moisturized during the next application of skin products.
10. Sunscreen – when summer ends many individuals tend to shrug away the presence of the sun. Cold and cloudy days of winter serve as a distraction from the still present UV radiation of the sun, even when it does not feel particularly hot or muggy outside. Individuals that live in areas where it snows especially need to remember that the glare of UV rays off the snow can cause significant damage and drying out of skin. Remembering to put-on broad-spectrum sunscreen is just another layer of defense to prevent damaged and dry skin from developing in the first place.

So far, the recommendations have largely focused on those patient populations prone to dry skin as a whole. Individuals with any of the underlying dermatologic conditions listed below may also benefit from disease-specific recommendations.

Common Skin conditions that specifically become more prevalent during the wintertime:

1. Atopic dermatitis (i.e. Eczema) – dry very itchy or scaly (called pruritic) patches can be present at any time, but especially worsen during the winter months and with frequent bathing (because dries out the skin). Treatments include topical steroids (first line), calcineurin inhibitors (2nd line), moisturizers, use of a humidifier, antibiotics if skin co-infection is present, and antihistamines (such as Benadryl) if pruritis present.
2. Xerotic (Nummular) eczema – can be thought of as form of atopic dermatitis. Xerotic means “dry,” thus Xerotic nummular eczema can be thought of as a drier variant of atopic dermatitis that becomes more prevalent during the winter months. It often starts as fluid-filled sacs called vesicles, and papules, and then may form an erythematous (abnormally red, inflamed) coin-shaped lesion, with or without pruritis. The word “nummular” in nummular eczema refers to the characteristic round lesions that are said to be able to fit under a large coin (nummum is Latin for "coin"). Treatments include lukewarm/cool baths, emollients, topical steroids (eg, betamethasone dipropionate) [first line], tar preparations, and oral antihistamines (such as Benadryl) if pruritis is present.
3. Ichthyosis vulgaris – although patients with this condition often have it year-round, it usually gets noticeably worse/more prominent during the winter months, with cold, dry weather. Treatments include emollients, topical retinoids, topical steroids, alpha-hydroxy acids, and antihistamines (such as Benadryl) if pruritis is present. Just like with all 3 of these conditions, it is important not to scratch the skin lesions as much as is possible.

Regardless of one’s dermatologic history, taking active steps to prevent one’s skin from drying out is critical for maintaining healthy skin during the winter months. Remember, the best treatment is prevention. By implementing the strategies above, keeping one’s skin moisturized during the winter can become a reality.

Dr. Johnson is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community.