Jessica Amorosino, M.D.,  shares her top tips for maintaining healthy skin during the winter months.

What are the most common winter skin conditions?

The most common winter skin conditions we see in general pediatrics are xerosis and eczema (aka atopic dermatitis). Xerosis is dry, scaly, sometimes itchy skin. It most commonly is seen in winter and often occurs on the lower extremities, but can appear anywhere. Frequent bathing and hot, dry, indoor temperatures are associated with xerosis. Xerosis can sometimes be a precursor to eczema.

Eczema is a skin condition characterized by itching, chronic and recurrent dry, inflamed skin, and usually has an early age of symptom onset. Other physical findings typical of eczema include xerosis, Dennie-Morgan lines (tiny horizontal creases underneath the lower eyelids), darkened skin around the eyes and keratosis pilaris (red dots or bumpy skin, which may or may not be red, most commonly on the backs of the upper arms). Patients diagnosed with eczema often have a positive family history of allergic disease.

What should parents do to protect children’s skin? 

Hydration is a key factor in protecting skin from xerosis and eczema. In addition, especially for patients with eczema, eliminating known exacerbating factors helps prevent worsening skin conditions. This includes avoiding excessive bathing without proper moisturization, overheating the skin and exposing the skin to solvents and detergents.

Are there certain products that work better  to prevent or alleviate dry or chapped skin?

The key to maintaining skin hydration is understanding the numerous products that are available on the shelves. Lotions which have a high water and low oil content can worsen dry skin through the natural evaporation process of the water in the product. When the water evaporates, it leaves behind dried out skin. Creams, which have low water content, and ointments, which have virtually zero water content, protect best against dry skin. Whether you use a cream or an ointment, it must be applied at least two times per day and ideally immediately after bathing or hand washing for maximum skin hydrating effect. Cream products many eczema patients use include brand names Eucerin®, Cetaphil® and Cerave®. Common ointment products eczema patients use include brand names Vaseline® and Aquaphor®.

In addition to the frequent application of emollients as described above, rapid application of the emollients while skin is still wet after a bath or shower is very important to maintain skin hydration. Controversy exists concerning the frequency of bathing and whether showering or bathing is preferable in patients with eczema, but the key factor we know to adjust is water temperature. In terms of water temperature, it is thought that tepid bath or shower water helps cool the skin and relieves the itching that can be associated with dry and/or eczematous skin.

How do you control the itch associated with dry skin or eczema? 

It is well documented that sweating, sudden changes in temperature, clothing changes and direct contact with wool can lead to intense itching in patients with eczema. When this occurs, a vicious itch-scratch cycle ensues, in which injury to the skin from scratching stimulates more itching. This is a significant problem in patients who suffer from eczema and who also have trouble maintaining skin hydration. For all the reasons mentioned above, this is why it is very important for parents with children with dry skin and/or eczema to follow a daily routine that maintains hydration and controls itch.

Controlling itch is a huge part of the routine in caring for children with eczema or itchy dry skin. The details of treating itch could be a separate discussion and basically involves antihistamine medications, wet wraps (emollients are applied to the skin and dampened cotton dressings are put over the area and then covered with a dry dressing to be worn overnight) and keeping nails short.

Jessica Amorosino, M.D., is a pediatrician at Harvard Vanguard Medical Associates’ Peabody practice.