I recently had an encounter with a 70-year-old patient who is new to southern Utah. He grew up in the southern United States and spent most of his working life in California. He was brought to Saint George by the beautiful desert landscape, the golf and the exceptional healthcare. He showers daily and uses whatever soap his wife has for him. He likes the water to be hot and loves a long shower (sometimes staying in up to 20 minutes). He rarely uses lotion but if he does he just grabs whatever is lying around. His hand soap is a strong antibacterial soap that he buys in bulk. He notes that his house is new but doesn’t have a water softener. He likes his clothes washed in Tide because it smells so good. Additionally his wife loves dryer sheets for the same reason. He has never had a problem with dry skin but once he was here and the weather turned a bit colder he noticed his skin becoming increasingly dry. With the dryness he reports itching “all over.” The itching moves around. Sometimes there is a rash associated with it and sometimes there is just itch.
This is a common scenario for new arrivals to the desert but occurs in many longstanding residents as well. I affectionately refer to this as winter itch. It seems to occur just as the weather becomes more consistently cool. The cool air is accompanied by additional dryness. This cool dry air saps the skin of what little moisture it has and creates the perfect opportunity for irritants to work their way into the top layer of skin and create some mild inflammation and its accompanying symptoms of dryness and itch.
The top layer of the skin is the epidermis. The epidermis consists of multiple distinct layers of keratinocytes (skin cells) which are bound together with proteins and cell to cell connections. Skin cells produce a variety of oil based products which lubricate the skin and serve to regulate skin cell turn over. Ceramide is perhaps the most well known epidermal lubricant and has been included in a number of over the counter creams in an effort to bolster the epidermal barrier. Oil glands in the skin also secrete sebum which combines with ceramide and other oils to create a water impermeable barrier. This barrier is important in maintaining skin hydration. It also serves to inhibit penetration into the skin and body by bacteria and other irritants.
Our dry climate combined with our hygiene habits of daily bathing strip away these natural oils promoting water loss and dryness of the skin. Additionally our skin becomes more susceptible to irritants from detergents, soaps, dryer sheets and fabric softeners. These products contain added preservatives and fragrances which can percolate through our dry skin and create small amounts of inflammation and itch.
To reduce inflammation and winter itch there are a few easy interventions that can make a big difference.
- Apply a good moisturizing cream to your body immediately after showering. Creams are thicker than lotion and offer superior hydration. In dermatology we call this the “soak and smear” technique. It traps some of the water from your shower in your skin while restoring some of the oil that has been lost. Look for ceramides on the cream label.
- Use fragrant free products. Unscented products just add more fragrance to cover up the smell of fragrance while fragrance free products have removed the fragrance all together. Look for the word “free” on the label.
- Install a water softener. Southern Utah water is hard water and is hard on our skin. Adding a water softener to your home helps minimize dry skin.
- Avoid harsh antibacterial soaps. Regular soaps used appropriately are generally adequate for hand hygiene and body washing.
By adopting these suggestions and by making a few changes to daily rituals and routines, winter itch can be reduced or avoided.
