Dry skin (Xerosis)

A clear guide to differentiate between usual dryness, clinical xerosis, and signs that warrant dermatological evaluation.

Summary in 60 seconds

• Dry skin, also called xerosis , occurs when the outermost layer of the skin loses water and lipids.
• It may feel tight, rough, dull, with fine flaking or cracks.
• It is not contagious.
• It is often related to cold or dry weather, long showers, harsh soaps, age, certain medications, or underlying illnesses.
• In many people, it improves with gentle hygiene and suitable emollients.
• Not all dry skin is due to «lack of water»: often there is an alteration of the skin barrier.
• Persistent itching, pain, cracking, bleeding, or yellow crusting require further attention.
• It is also advisable to check if the dryness is widespread, new, intense, or does not improve with reasonable care.
• The dermatologist usually looks for causes, irritants, medications, and signs of eczema, psoriasis, ichthyosis, or other conditions.
• The goal is not to «hydrate for fashion’s sake», but to restore skin barrier function and safety.

What is it?

Dry skin is a condition in which the skin loses some of its ability to retain water and maintain a sufficient protective lipid film. In medicine, the most common term is xerosis or xerosis cutis . It can occur at any age and is not contagious (MedlinePlus 2024 ; AAD 2026 ).

The skin barrier functions as an organized structure: surface cells, lipids—including ceramides—and natural moisturizing factors work together to limit water loss. When this structure is disrupted, the skin becomes rough, tight, flaky, and more sensitive to irritants (Gade 2023 ; Barco 2008 ).

In everyday language, the term «dry skin» can describe many different sensations. From a dermatological perspective, the important factors to consider are duration, extent, itching, cracking, inflammation, triggering factors, and associated diseases .

Why does it appear?

Dry skin is usually caused by multiple factors. It doesn’t always indicate a disease, but it shouldn’t be interpreted solely as a cosmetic problem either.

Among the most common causes are cold or dry weather, heating, long or very hot showers, alkaline soaps, detergents, perfumes, jobs with repeated exposure to water, advanced age, and progressive loss of skin lipids. It can also appear due to medications—for example, retinoids, diuretics, or some cancer treatments—or due to diseases such as atopic eczema, psoriasis, diabetes, thyroid disease, or kidney disease (AAD 2026 ; Gade 2023 ).

Dermatological evidence describes xerosis as an alteration of the stratum corneum: there is disorganization of the barrier, decreased water retention, and changes in keratinocyte differentiation (Barco 2008 ). In other words, with dry skin, it’s not just a matter of «applying cream,» but of restoring a functional skin surface.

A practical point: drinking water is important for overall health, but it doesn’t usually repair a damaged skin barrier on its own. For persistently dry skin, the most effective strategy typically combines gentle cleansing, appropriate emollients, and addressing triggers.

What does it look like?

Dry skin may appear dull, rough, flaky, or whitish/grayish , with more pronounced fine lines. It may feel rough to the touch. The person may notice tightness, itching, burning, or sensitivity when applying products. In more severe cases, fissures, deep cracks, pain, and even bleeding may occur (AAD 2026 ; MedlinePlus 2024 ).

Common areas include legs, arms, hands, and feet, although it can affect any area. On the hands, it is usually aggravated by repeated washing, gels, detergents, gloves, or wet work. On the legs, it can intensify in winter or with age.

When dryness is accompanied by redness, plaques, crusts, oozing, or intense itching, we are no longer just talking about a feeling of «dryness»; there may be dermatitis, eczema, secondary infection, or another condition that requires diagnosis.

In what diseases or conditions do they usually occur?

Remember that dry skin is a symptom , not a complete diagnosis. This classification is for guidance only and is ordered from most common to least common in general clinical practice.

1. Very frequent

• Simple or seasonal xerosis: related to dry weather, cold, heating, hot showers or harsh soaps.
• Dry skin from excessive washing or irritants: common on hands, especially in wet or chemical work.
• Atopic eczema: dryness is a central feature of barrier disruption.
• Dry skin associated with age: over the years, skin lipids and water retention capacity decrease.

2. Frequent

• Irritant contact dermatitis: caused by soaps, detergents, alcohols, solvents or friction.
• Allergic contact dermatitis: may look like “dry skin”, but is accompanied by inflammation and itching.
• Psoriasis: the plaques may be dry, thick and scaly, although not all scaling is psoriasis.
• Asteatotic eczema or cracked eczema: a form of dermatitis related to very dry skin, typically on the legs.
• Diabetes, hypothyroidism, and kidney disease: these can be accompanied by xerosis, especially if there is generalized itching or persistent dryness.

3. Infrequent, but relevant

• Hereditary ichthyosis: more persistent dryness and scaling, often from early stages.
• Sjögren’s syndrome or other autoimmune diseases: especially if there is dryness of the eyes and mouth.
• Cholestasis or liver disease: may be associated with intense itching.
• HIV or other systemic diseases: in specific clinical contexts.
• Cutaneous or hematologic lymphomas: rare, but should be considered if there are atypical lesions, persistent itching, weight loss, or other general symptoms.

Guidelines and reviews agree that xerosis can coexist with inflammatory dermatoses and systemic diseases; therefore, the clinical context matters more than a single photograph of the skin (Gade 2023 ; Augustin 2019 ).

When should I consult?

Consult a dermatologist if any of these signs appear:

• Intense dry skin that does not improve after 2 weeks of reasonable care.
• Persistent itching that interferes with sleep, work, or daily life.
• Deep cracks, pain, bleeding, or significant burning.
• Yellow crusts, pus, bad odor, increased local heat or swelling.
• Fever or general malaise along with skin lesions.
• Generalized dryness of recent onset without a clear cause.
• Very red, thick lesions with defined borders or marked scaling.
• Dryness accompanied by weight loss, extreme tiredness, intense thirst, excessive urination, cold intolerance, swelling, or jaundice.
• Appearance after starting a medication or during cancer treatments, dialysis or immunosuppression.
• Severe dry skin in babies, older adults, or people with chronic illnesses.

The American Academy of Dermatology recommends evaluating persistent dry skin because it may be due to conditions such as atopic eczema, psoriasis, kidney disease, or the effects of medications (AAD 2026 ).

What NOT to do?

It’s not advisable to treat dry skin as if all causes were the same. Some common mistakes can perpetuate irritation.

• Avoid excessively long or very hot showers. They can remove protective lipids.
• Do not use harsh soaps, perfumes, or strong exfoliants if there is burning, cracking, or itching.
• Apply multiple active ingredients at once —acids, retinoids, homemade peels—to irritated skin.
• To assume that a pure oil will solve the skin barrier problem. Some European guidelines warn against using pure oils as a substitute for suitable emulsions on skin with a compromised barrier (EuroGuiDerm 2022 ).
• Scratching repeatedly. Scratching perpetuates the itch-damage-inflammation cycle.
• Self-medicating with corticosteroids, antibiotics, or antifungals without a diagnosis, especially on the face, genitals, in children, or for prolonged use.
• Change your product every day. The skin barrier needs consistency and tolerance.

For sensitive dry skin, the AAD suggests avoiding products with fragrance, certain alcohols, and potentially irritating active ingredients when they aggravate dryness or itching (AAD 2026 ).

What does a dermatologist usually do?

The dermatologist usually begins with a detailed medical history: when it started, what areas it affects, what products are used, frequency of bathing, type of cleanser, occupation, history of eczema, asthma, allergies, psoriasis, medications, recent treatments and general illnesses.

Next, examine the skin: distribution, scaling, inflammation, fissures, signs of infection, plaques, ring lesions, thickening from scratching, or findings suggestive of another dermatosis. In many cases, the diagnosis of xerosis is clinical (AAD 2026 ; DermNet 2023 ).

Depending on the case, additional tests may be ordered: glucose, thyroid function, kidney or liver function, iron, vitamins, contact allergy tests, mycological examination, or targeted studies. Treatment may include emollients with ceramides, glycerin, urea, lactic acid, or petrolatum; soap substitutes; occupational therapy; and, if inflammation is present, topical anti-inflammatory medications for defined periods (BAD 2026 ; NHS 2017 ).

Frequently Asked Questions

Are dry skin and dehydrated skin the same thing?

• Not exactly. In cosmetics, «dehydrated» is often used to refer to a lack of water and «dry» to a lack of lipids. In dermatology, both phenomena can coexist. What matters is whether the skin barrier is compromised, and whether there is itching, cracking, or inflammation.

Which is better: lotion, cream, or ointment?

• It depends on the area, the severity, and individual tolerance. In general, lotions are lighter, but may not be sufficient for severe dryness. Creams balance comfort and effectiveness. Ointments tend to retain moisture better, although they are greasier. The AAD notes that creams and ointments tend to be more effective than lotions for very dry skin (AAD 2026 ).

How often should I apply moisturizer?

• For persistently dry skin, it is usually necessary to apply emollient at least once or twice a day, and more frequently to the hands or highly exposed areas. Many guidelines recommend applying it after bathing, on gently patted skin, to help retain moisture (EuroGuiDerm 2022 ; National Eczema Society 2023 ).

Can dry skin itch?

• Yes. Itching is common and can lead to a cycle of scratching, micro-cracks, inflammation, and more itching. If the itching worsens at night, becomes widespread, or is accompanied by lesions, it’s advisable to consult a doctor.

Could this be a sign of an internal illness?

• It can be, although it is often explained by environmental or care-related factors. Diabetes, thyroid disease, kidney disease, some medications, and cancer treatments can be associated with dry skin. The key is to assess the context: recent onset, intensity, general symptoms, and response to basic care (MedlinePlus 2024 ; AAD 2026 ).

Is dry skin the same as eczema?

• No. Dry skin can exist without eczema. However, atopic eczema and asteatotic eczema often present with dryness, itching, and inflammation. If there is redness, plaques, crusting, cracking, or chronic scratching, dermatitis should be ruled out.

Do I need topical corticosteroids?

• Not always. Emollients are the primary treatment when xerosis is the predominant symptom. If there is active dermatitis, inflammation, or intense itching, a dermatologist may prescribe a topical anti-inflammatory for a limited time. Using them without a diagnosis can mask infections, irritate sensitive areas, or cause adverse effects.

Bibliography and sources

• AAD 2026 . American Academy of Dermatology Association. Dry skin: overview [Internet] . Rosemont: American Academy of Dermatology Association; 2026 [citado 2026 May 8] .
• AAD 2026 . American Academy of Dermatology Association. Dry skin: who gets and causes [Internet] . Rosemont: American Academy of Dermatology Association; 2026 [citado 2026 May 8] .
• AAD 2026 . American Academy of Dermatology Association. Dry skin: signs and symptoms [Internet] . Rosemont: American Academy of Dermatology Association; 2026 [citado 2026 May 8] .
• AAD 2026 . American Academy of Dermatology Association. Dry skin: diagnosis and treatment [Internet] . Rosemont: American Academy of Dermatology Association; 2026 [citado 2026 May 8] .
• MedlinePlus 2024 . MedlinePlus. Xerosis [Internet] . Bethesda: National Library of Medicine; 2024 [citado 2026 May 8] .
• DermNet 2023 . DermNet. Dry skin: xeroderma, causes and treatment [Internet] . New Zealand: DermNet; 2023 [citado 2026 May 8] .
• BAD 2026 . British Association of Dermatologists. Emollient use in skin conditions [Internet] . London: BAD; 2026 [citado 2026 May 8] .
• NHS 2017 . National Health Service. Emollients [Internet] . London: NHS; 2017 [citado 2026 May 8] .
• National Eczema Society 2023 . National Eczema Society. Emollients factsheet [Internet] . London: National Eczema Society; 2023 [citado 2026 May 8] .
• EuroGuiDerm 2022 . EuroGuiDerm, European Dermatology Forum. Guideline on atopic eczema: basic emollients and moisturizers [Internet] . European Dermatology Forum; 2022 [citado 2026 May 8] .
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• Boat 2008 . Barco D, Giménez-Arnau A. Xerosis: a dysfunction of the epidermal barrier. Actas Dermosifiliogr. 2008;99:671-682.
• Augustin 2019 . Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, et al. Diagnosis and treatment of xerosis cutis: a position paper. J Dtsch Dermatol Ges. 2019;17 Suppl 7:3-33.
• Amin 2021 . Amin R, Lechner A, Vogt A, Blume-Peytavi U, Kottner J. Molecular characterization of xerosis cutis: a systematic review. PLoS One. 2021;16(12):e0261253.
• van Zuuren 2017 . van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen APM, Arents BWM. Emollients and moisturizers for eczema. Cochrane Database Syst Rev. 2017;2:CD012119.
• White-Chu 2011 . White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.