Dry, Itchy Skin

History

Dry, itchy skin is among the most common dermatologic complaints seen at sick call.  

Usually, dry itchy skin is lumped into a category of conditions called eczematous reactions (or just eczema).  History is one of the most important diagnostic tools available.  It is important to ask when it started and what areas of the skin are involved.  

Contact or irritant dermatitis is usually fairly acute and will appear in very discrete areas such as the backs of the hands, around the neck where a shirt collar goes, on a patch of skin onto which something got spilled.  Make sure that you ask if there has been any change in soaps, detergents, cologne, deodorant, etc.  There does not have to be any obvious allergic exposure, just something irritating.  For example, a young sailor who just started mess cranking and has dry, scaly skin with some redness on the backs of the hands is probably getting irritated from washing pots all day long, not from poison ivy.  

Dry, itchy skin that has been going on for a longer time suggests a more chronic irritation such as chronic, frequent hand washing, wearing boots for too long for months at a time, or something constantly rubbing against the skin.  In these cases, there may be less of a red, inflamed look to the skin with more prominent thickening and scale.  Darkening of the skin in that area (called hyperpigmentation) may occur in these cases from the chronic inflammation.  Certainly, not all skin that is dry and itchy is due to eczema.  

Skin that looks dry and feels itchy can be due to fungal infection.  This can occur on the:

• Feet (tinea pedis)
• Head (tinea capitis)
• Groin (tinea crurus)
• Elsewhere on the body (tinea corporis)

Dry itchy skin can also be widespread with thick scale (called ichthyosis) but this is usually harmless.  Very rarely, dry, itchy skin that is widespread can be the signal for more serious systemic disease such as lymphoma, but these patients will usually feel ill for reasons other than their skin (weight loss, lymphadenopathy, fatigue).

Physical Exam

The location of the dry, itchy skin is the most important thing to note.  While there may be some surrounding redness to the skin, if the redness is very tender and hot then cellulitis may have set in.  There may be some papules but the main finding in eczema is red, dry scaly skin that may have some fissures (cracks) if severe enough.  Dry, itchy skin that is widespread and severe with prominent scaling should suggest that a more thorough physical exam needs to be done to look other signs of serious disease (lymphadenopathy, splenomegaly, weight loss, etc.).

Labs

Not many labs are needed.  Collect some of the scaly skin onto a glass slide and drop some potassium hydroxide onto it.  Then, examine the slide under a microscope to look for fungal elements.  If the scaling of the skin is generalized a CBC should be done if possible, again looking for signs of serious underlying disease (high WBC count, anemia).  An erythrocyte sedimentation rate can also be done easily in these cases, also looking for serious disease.

Treatment

Treatment of dry, itchy skin is straightforward.  

• Minimize contact with irritant substances. (for example, wearing rubber gloves while washing pots).  
• Simple changes in hygiene can also make eczema and dry skin better.  
• Showers should be taken with a water temperature that is as cool as the patient can tolerate and showers should also be brief.  
• Skin moisture can be restored with a variety of over the counter skin products like Lubriderm, Eucerin, etc.  If these are not available, then petroleum jelly works fine although this should be applied sparingly.  The best time to apply moisturizing cream is immediately after drying off from a shower.  
• If hands are the problem, application of moisturizer after each hand washing works the best.  
• If the skin is particularly inflamed, a mild topical steroid can be applied 2-3 times per day until the inflammation goes down.  If there is evidence of fungal or bacterial infection, they should be treated with topical anti-fungals or systemic antibiotics as necessary.

Medevac

Usually not required unless there is evidence of serious systemic disease.

Dyshidrotic Eczema of Hands

Tinea Capitis/Alopecia Ariata

Tinea Capitis/Alopecia Ariata

Branching Hyphae and spores

This section provided by LT Daniel A. Rakowski, MC, USNR

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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