Operational Medicine 2001
Dry, Cracked Skin

Dry skin results from loss of the protective lipid layer on the skin surface.  The breakdown of the protective lipids allows for loss of moisture to the environment.  

Dry skin usually results from exposure to low humidity environments and is usually more prevalent in the winter months. As skin becomes more dry and scaly it may crack or fissure, creating an opportunity for infection. Itching may or may not be associated with dry skin. 

Dry, cracked skin (ichthyosis) may occur in response to:

• Environmental exposure

• Contact with detergents or irritants

• Rarely, as external evidence of an internal disease process

History

Ask about:

• Frequency of episodes of dry skin (Some people are genetically predisposed.)

• Family history of similar conditions; or if there is a familial tendency to dry skin.

• Frequency of bathing (Frequent bathing, particularly long, hot showers or baths removes protective skin oils.)

• Exposure to detergents. (May be causative)

• Exposure to chemicals and irritants in the workplace

• History of eczema

• Is the rash is itchy? (Dry skin is often asymptomatic, but scratching may lead to increased itchiness.)

• Is there associated fatigue, cold intolerance, weight gain, and brittle hair? (Dry skin can occasionally be a presenting symptom of hypothyroidism.)

Physical Exam

Examine the entire skin surface to assess severity and extent of dry skin.  Dry, cracked skin can occur anywhere, but is most likely to occur on the anterolateral aspect of the lower legs or hands.   Examine irritated, cracked areas for signs of infection.  Infected skin may ooze or have yellow, crusted material.  Infected skin will likely be painful.

Treatment

The goal for treating dry skin is to restore and maintain moisture in the skin.  

The first choices for therapy are regular lotions (Eucerin, Lubriderm, Aquaphor) applied to the affected area as needed to restore moisture.  Lotions are best applied immediately after bathing.  If commercial lotions are not available then petroleum jelly can be applied.  To use petroleum jelly, moisten skin with warm water for 5 to 15 minutes before applying a thin layer of petroleum jelly (petroleum jelly contains no water).   

• Wet dressings should not be applied to dry, cracked skin.  

• Limit bathing to once per day with warm, not hot water.  

• Limit the use of soap and use a mild soap such as Dove. (Dove is not really soap; it is basically a light oil with air whipped into it.) 

• Avoid scrubbing the skin. 

• Do not use calamine lotion to control the itching, as this will exacerbate the dryness.   

• If there is evidence of infection, the patient will need systemic antibiotics.  Topical antibiotics will not cure a skin infection in this situation. 

• Treat with either erythromycin, 250mg 4 times per day or dicloxacillin 200mg every 6 hours.

This section provided by 2LT Gary E. Means, MS, USAR

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Operational Medicine 2001
Health Care in Military Settings

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