Eczema vs dry skin: how to tell them apart

Dry skin and eczema can look alike, and only a doctor can confirm eczema. This guide sets out what ordinary dry skin is, what eczema adds, how the two are connected, and when dry skin needs a doctor. The complete guide to eczema explains eczema itself in more detail.

What ordinary dry skin is

MedlinePlus, the health site of the US National Library of Medicine, says dry skin happens when your skin loses too much water and oil. It is common and can affect anyone at any age. The medical word for it is xerosis.

MedlinePlus lists the usual causes:

• the climate, such as cold, dry winter air or hot, dry desert air
• dry indoor air from heating or cooling
• bathing too often or for too long
• some soaps and detergents
• skin conditions, such as eczema or psoriasis
• some other diseases, such as diabetes or an underactive thyroid
• some medicines
• aging, because older skin is thinner and makes less natural oil

Dry skin may get dry, scaly, itchy and red, with fine cracks, and MedlinePlus says it is usually worse on the arms and legs. The American Academy of Dermatology (AAD) says dry skin is common where the air holds little moisture, and in winter, when indoor heating removes moisture from the skin.

What eczema adds

Eczema, and atopic eczema in particular, includes dry skin but goes further. The AAD describes atopic dermatitis as a condition that causes itchy, dry and inflamed skin. Inflamed means red or discoloured, warm and swollen. The AAD says eczema creates tiny cracks in the skin, so the skin loses water quickly, which is why skin with eczema feels so dry.

Several signs point toward eczema instead of ordinary dry skin:

• Strong itch. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says itching is the most common symptom of atopic dermatitis and can be severe.
• Flare-ups. The NHS says eczema has times when symptoms get worse and times when they are better.
• Blisters, oozing or bleeding. NIAMS says rashes may ooze, weep clear fluid or bleed when scratched.
• Thick, leathery skin. The AAD says skin that is rubbed or scratched often can thicken.
• Typical places. Babies get eczema on the face and scalp, children in the bends of the elbows and knees, and adults on the hands, neck and around the eyes.
• Family history. The NHS says atopic eczema is more likely if a parent has it, or if you or a close relative has asthma or hay fever.

Side by side

Feature	Ordinary dry skin	Atopic eczema
Main cause	Loss of water and oil from dry air, long or hot baths, soap	Genes, the immune system and the environment together
Itch	Can itch	Itch is the main symptom and can be severe
How it looks	Dry, scaly, rough, fine cracks	Dry, scaly patches that can also blister, ooze, bleed, crust or thicken
Where	Often the arms and legs	Face and scalp in babies; elbow and knee creases in children; hands, neck and eyes in adults
Over time	Improves with care and better weather	Comes and goes in flare-ups, often for years
Response to moisturizer	The AAD says improvement often shows within 2 weeks	Moisturizer helps, and many people also need treatment from a doctor

Sources: MedlinePlus, the AAD, NIAMS and the NHS.

How the two are connected

Dry skin is part of how eczema develops. NIAMS says changes in the skin's protective layer make it lose moisture, and the dry skin then becomes damaged and inflamed. NIAMS also lists skin that is too dry among the environmental factors that can lead to atopic dermatitis. MedlinePlus Genetics says 20 to 30 percent of people with atopic dermatitis carry changes in the FLG gene, which makes a protein that helps the outer skin layer hold water.

Dry skin can also make eczema worse. MedlinePlus lists dry skin, cold and dry winter air, and frequent baths, showers or swimming among the things that worsen atopic dermatitis. The NHS says discoid eczema, a type with round patches, may be linked to dry skin, because dry skin cannot protect against things that touch it, so even a mild soap can irritate it.

Even the medical names overlap. MedlinePlus lists "asteatotic eczema" as another name for dry skin, which shows how closely the two are related.

Should eczema be kept dry or moist?

Eczema should be kept moisturized. The AAD says atopic dermatitis causes excessively dry skin, and that keeping skin hydrated with an eczema-friendly cream or ointment can relieve discomfort and reduce flare-ups. That is why the AAD says dermatologists recommend that everyone with atopic dermatitis keep their skin moisturized with a mild, fragrance-free cream or ointment.

Weeping eczema, which leaks fluid, needs a different product. The NHS says lotions suit weeping eczema, and that ointments should not be used on it. Eczema that suddenly starts leaking fluid, crusting or forming pus also needs an urgent doctor's visit, because the NHS says these can be signs of infection.

Dry, cracked hands: where the two often meet

The hands are a common place for both problems. The AAD says adults are more likely than children to have atopic dermatitis on their hands, and that for some adults the hands are the only place it appears. The NHS says contact dermatitis, another type of eczema, is most often caused by irritants such as soaps, detergents, solvents or regular contact with water, and that it most often affects the hands and face.

The AAD adds that many people who had atopic dermatitis as children develop raw, cracked, irritated skin that may bleed when they do "wet work," which means having wet hands often or for long periods. Jobs with wet work include doctor, nurse, florist, hairstylist and bricklayer. The AAD says a dermatologist may be able to help people manage their skin so they can keep doing this work.

Why treating dry skin matters

Treating dry skin is worth the effort even when it is not eczema. The AAD says findings from a large German study suggest that people who live with dry skin may develop irritated skin or an allergic skin reaction. It says effective treatment strengthens the outer layer of the skin, which can make the skin more comfortable, reduce its sensitivity, lower the risk of a skin infection and stop dry skin from getting worse.

Care that helps both

Much of the care for dry skin and for eczema is the same:

• Moisturize often. The NHS says to apply moisturizing treatments at least twice a day, and to keep going even when eczema improves. The NHS page on moisturizers says they are safe and cannot be overused.
• Choose creams and ointments. The AAD says creams and ointments tend to work better than lotions for dry skin, because they hold more moisture in the skin.
• Use lukewarm water and pat dry. MedlinePlus says to use lukewarm bath water and to pat the skin dry with a towel instead of rubbing.
• Pick gentle cleansers. MedlinePlus advises cleansers free from dyes and perfumes, and the NHS advises washing with a moisturizer instead of soap for eczema.
• Moisten the air. MedlinePlus says a humidifier to keep home air moist helps people with atopic dermatitis.
• Be gentle. MedlinePlus says not to scrub or dry the skin too hard or for too long.

The guide to moisturizing and bathing for eczema goes through each step in more detail.

When dry skin needs a doctor

The AAD says that with the right self-care, many people heal dry skin at home and see improvement within 2 weeks. If dry skin continues or gets worse, the AAD says something other than dry air may be the cause, such as:

• a medical condition, such as atopic dermatitis or kidney disease
• a medicine you take
• something you touch during the day, such as certain foods
• age

MedlinePlus says that if a doctor suspects a health problem behind dry skin, tests will likely be ordered. The AAD also says dry or thickening skin can be a side effect of cancer treatment, and that anyone who develops it during treatment should see a dermatologist right away.

For eczema, the NHS says to see a doctor if you or your child have symptoms, and to ask for an urgent appointment if the skin is blistered, crusty, leaking fluid, painful, swollen, warm, suddenly worse, or if you have a high temperature. The guide to what eczema looks like explains how a doctor confirms it, and the guide to types of eczema covers other forms that start with dry patches.