How to tell the difference between eczema and dry skin

Eczema, also known as dermatitis, and dry skin are both common skin conditions. Most people in the UK will develop dry skin at some point in their life and around one in 10 adults and one in five children in the UK have atopic eczema, the most common type of eczema. 

While eczema can cause dry skin, dry skin doesn’t cause eczema, although it can worsen symptoms of pre-existing eczema. 

Eczema vs. dry skin

Dry skin occurs when your skin becomes dehydrated as it has lost too much water too quickly. It is usually caused by environmental or lifestyle factors, such as bathing too often and/or in very hot water, or exposure to irritants (eg harsh detergents) or dry environments, whether that is dry, cold weather or dry air indoors due to central heating. 

Eczema is an inflammatory skin condition. It is caused by a combination of your skin barrier not working properly and inflammation. This is due to several factors including your genetics (eczema tends to run in families), an overreaction of your immune system and environmental factors. 

Your risk of developing eczema is higher if you also have allergic conditions such as hay fever and asthma. Research has also identified that faults in a gene called filaggrin, which plays a key role in maintaining your skin barrier, occur in around 20–30% of individuals with atopic eczema. 

Symptoms of eczema and dry skin

Eczema causes the skin to become dry, itchy, inflamed and red. This can result in cracked, leathery skin, which may become darkened in areas. 

Dry skin, which is not caused by eczema, causes the skin to become rough, flakey and peeling. However, dry skin can also become itchy if it is left untreated and consequently becomes inflamed. 

Diagnosing eczema and dry skin

If you’re concerned that you may have eczema, see your GP. They can help determine whether you have dry skin caused by environmental or lifestyle factors, or whether you have an underlying skin condition such as eczema. 

A diagnosis is usually based on the appearance of your skin, which areas of your skin are affected, your symptoms, how long your symptoms have gone on and what, if any, triggers cause your symptoms to appear or worsen. 

For example, if your skin is only dry in the winter and clears up once the weather becomes warmer and more humid, you’re unlikely to have an underlying skin condition.

Treating dry skin

If you have dry skin, simple lifestyle changes are usually enough to resolve your symptoms. This includes regularly moisturising your skin with a hydrating cream or lotion and avoiding products that contain ingredients that will dry out your skin (eg products containing alcohol and fragrances). 

You should also be aware that certain skincare products can contain ingredients that irritate sensitive skin (eg parabens). Consequently, if you’re trying out a new skincare product, apply it to a small area of your body first to see how your skin reacts. 

You should also avoid overwashing and washing in water that is too hot. This is because washing removes your skin’s natural moisture barrier, which is made of oils, fatty acids and ceramides. The hotter the water, the more easily this barrier is removed. 

Treating eczema

Diagnosing eczema as soon as possible is key to preventing it from becoming worse. This is because early treatment ensures the skin stays as calm as possible, which reduces the frequency and severity of flare-ups. 

Home remedies

Eczema treatment starts with self-care. This involves being aware of whether you’re feeling rundown or tired, and making sure you get enough sleep and rest. As part of this, it is also important to follow a healthy, balanced diet. 

When it comes to your daily routine, make sure you moisturise at least twice a day using a thick, fragrance-free cream. You may need to try several creams before finding the one that works best for you. Avoid overwashing and when having a shower or bath, use warm — not hot — water, and pat yourself dry afterwards. 

Try to avoid scratching your skin as much as possible. This can be challenging, which is why it can be helpful to keep your nails short and your skin covered with light clothing to limit the damage from scratching. 

Be aware of anything that triggers flare-ups of your eczema and try to avoid them. This may include certain fabrics, soaps and detergents, as well as temperature changes.

It is important to note that in most cases, eczema is not an allergy; however, you may have both eczema and an allergy, in which case, you can talk to your GP about taking an antihistamine and/or about allergy testing. If you are reacting to a specific allergen, which is making your eczema worse, try to limit your exposure to it. 

Medical treatment

If the above home remedies aren’t enough to control your eczema and you’re experiencing frequent flare-ups, see your GP. Once they have assessed your symptoms, they may prescribe an antihistamine if you’re struggling with severe itching and/or a topical corticosteroid to reduce inflammation caused by a flare-up. 

They may also prescribe medicated bandages or wet wraps to wear over affected areas of your skin. These help prevent your skin from drying out, reduce scratching and consequently, help your skin heal. 

If these medical treatments are still not enough to control your symptoms, your GP can refer you to a doctor specialising in treating skin conditions (a dermatologist), who will tailor treatments to the particular areas of your skin affected. 

They may prescribe topical immunomodulators, such as tacrolimus ointment and pimecrolimus cream, which are often used on more sensitive areas of skin, such as the eyelids, face, neck, genitals and skin folds. 

If you have severe eczema, your dermatologist may discuss systemic treatments with you. 

Unlike topical treatments, where medication is applied directly to a specific area of affected skin, systemic treatment involves delivering medication more broadly eg through taking oral medication or undergoing phototherapy.