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People with dry skin and eczema spend a lot of time and money trying new supplements, dietary changes and treatments to combat winter itch, but they often neglect the most effective treatment of all: moisturizing.
By that I mean all of your skin, twice a day. Every day.
I think it’s because moisturizing is so basic — and because it takes time. People who are tortured by dry skin and itch have trouble believing that something as simple as moisturizing morning and night will really help. But the evidence shows it’s more effective than hydrating from the inside (a.k.a. drinking lots of water). And as long as you pick a thick, greasy product (think creams and ointments, not lotions, and get fragrance-free), you can use whatever moisturizer you can afford.
The most common winter skin flare-up I see in my dermatology clinic at Women’s College Hospital is worsening eczema — and that’s because the cold dehydrates the skin, allowing more irritants and allergens to get in. It’s like the rust you get on a car in spots where the paint has rubbed off.
For these patients, corticoid creams deal with the immediate problem, but frequent moisturizing will help prevent the next one. The people I see, even those who are being tortured by eczema, still don’t regularly moisturize twice a day. I suspect patients who do this are less likely to wind up in my clinic because they’re managing the condition better at home.
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Here’s why moisture, applied directly to the skin, is so important. The skin is the first barrier of protection against the environment. It protects us against cold, heat, infection, the sun’s ultraviolet rays and many other things. But when the various external aggressions get too strong (as they do during very cold weather) the skin starts to weaken as a defence system and you risk not just itching, but infections, frostbite, and chilblains, which is severe damage to the skin’s blood vessels. (Skiers sometimes get bad sunburn because there’s more UV radiation at higher altitudes.)
Winter itch, while much less serious than frostbite or chilblains, is much more common. It’s caused in a similar way: the cold damages the skin barrier, usually by dehydrating the skin, letting in various aggressors, like viruses, that cause the skin to be inflamed. The inflammation (usually not noticeable by the naked eye) causes the nerves in the skin to twitch, which we experience as itching.
We don’t fully understand all the science behind this, but there are probably multiple pathways, or immunological signals, between the brain and the nerves in the skin that result in the feeling of itchiness. A common trigger is the chemical histamine, which our immune systems release in response to allergens.
Other ways are directly related to the cold.
That’s why keeping the skin well moisturized is so important. It strengthens the skin, allowing it to fight off irritants that cause a chain reaction resulting in itching.
Here’s another reason to keep your skin healthy: the more you itch, the more you itch. Not only does scratching release more histamine, which causes more itching, but dermatologists are now starting to realize that it’s leading to even longer-lasting damage.
Research is suggesting that the inflammation caused by eczema and other skin diseases can increase the number of nerve endings in the skin. And the more nerve endings, the more itchy you’ll feel when they start to twitch.
When you see people scratching themselves obsessively, it is not their fault. They may be trapped in a vicious cycle where they’re more sensitive than other people and the itch feels even worse. Unfortunately scratching only leads to more inflammation, which may lead to more nerve endings, and therefore more itching.
Treatments try to disengage from this cycle, restoring more normal skin function over a few months. So the good news is that this damage seems to be reversible.
But as with everything in medicine, prevention is best — especially when prevention involves something as safe as frequent and thorough moisturizing. So if you experience winter itch, take the time to take care of your skin every morning and night.
Dr. Vincent Piguet is Director of the Division of Dermatology at the University of Toronto and Head of Dermatology at Women’s College Hospital. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email firstname.lastname@example.org.