Photo Courtesy Of Dr. Patricia Wong Eczema and other dry-skin conditions can lead to chapped lips. they can also be a sign of actinic cheilitis, a premalignant skin problem.

During winter, psoriasis and eczema can flare and dry skin can become a problem. Unaware they are prone to eczema, most people experience their first episode when the heat is turned on and humidity and outdoor temperatures drop.

Not only is it important to moisturize, but one must also use the correct emollients to reduce water loss and avoid damaging the protective lipid barrier on the surface of the skin. Showering with harsh soaps can further contribute to dry skin.

It is better to be proactive than to frantically apply random lotions to treat dry skin after it develops.

Pay attention to symptoms such as itching, which is often the first signal of distressed skin. Itching typically appears before a rash. start treating your skin immediately – do not wait for a rash to erupt.

The importance of genetics

An eczema breakout depends on interactions between exposures to various environmental triggers and genetic composition. five major genes have undergone mutations and can cause atopic dermatitis (eczema). if you have inherited these mutations, it is likely that you will develop eczema irrespective of environmental influences. These genes cause a baseline hyperreactive state in the skin.

If you have only two genes with the mutations, then environmental triggers play a larger role in eczema flares.

The case of chapped lips

Although chapped lips can result from eczema or dry skin conditions, they can also be a sign of a premalignant skin problem – actinic cheilitis.

This condition commonly presents with discrete dry or crusted areas on the lower lip, where the border of the lip and the skin meet. Red, rough areas on the upper lip are also typical for precancers that can develop into squamous cell carcinoma, a type of skin cancer that has the potential to spread to lymph nodes in the neck and elsewhere.

If you have areas of dryness or scaling that are persistent, discrete and not resolved with moisturizing, seek evaluation from a dermatologist. Picking at the skin to remove the rough areas will not result in clearing the lesions and may delay treatment and result in more complex surgical procedures or irradiation.

Avoid cleansers that list sodium lauryl sulphate as the main ingredient. This chemical will strip the natural lipids out of the skin, damaging its protective layer, causing water loss and making the skin appear cracked, scaly, red and/or with a crazed tile or mosaic appearance.

Over-the-counter emollient washes, oatmeal-based cleansers, ceramide cleansers or nonsoap lipid cleansers, such as Aveeno, Balneum plus and Oilatum, are available and preferred. they are gentler on the skin and remove less of the moisturizing protective barrier.

Squeaky-clean skin results from overly aggressive washing and is not healthy. the use of exfoliating products is harmful for dry skin and is not recommended.

Avoid cleansers that contain fragrances and dyes. When the skin is irritated, the protective layer is damaged, allowing penetration of chemicals and harmful substances into the deeper layers and causing additional inflammation that prolongs recovery.

Dermatologists used to recommend less frequent bathing for dry skin. we now know that it is not the frequency of bathing that makes the difference, but how you moisturize the skin. Moisturizers should be applied within the first three minutes after bathing to trap water in and rehydrate skin layers. Balneotherapy – soaking the skin in acidic hot springs – has proven effective. Bathing also removes allergens and bacteria from the skin.

Adding bath oils or oatmeal to the bath does not promote skin hydration.

The best moisturizers contain humectants, substances that attract and hold water inside the skin. if you experience stinging, burning or redness with use, consult a dermatologist. Creams tend to be more effective than lotion formulations.

Dust mites and bacteria produce enzymes – proteases – that can dissolve the protective skin barrier. Measures to reduce dust mites may be helpful.

Topical corticosteroids can be a mixed blessing when treating eczema. although these medications can relieve itching, they can also damage – and do not repair – the lipid protective skin layer. they should be used judiciously and in conjunction with proper cleansing and emolliating under supervision of a dermatologist. Corticosteroids are not moisturizers.

When the water content of the skin drops below 10 percent, it loses its flexibility and will crack. Cracked heels on feet and cracked, sore fingers should be treated as discussed above. in addition, a liberal application of moisturizer and prescription medication at bedtime with cotton gloves for several nights can speed healing. never pick or pull the skin off – it can cause open sores leading to infection and can cause medications to burn.

Including foods that are high in essential fatty acids in your diet can strengthen the skin’s protective layer that seals in moisture. Docosahexaenoic acid and eicosapentaenoic acid are the two important omega-3 fatty acids. Walnuts, salmon, sardines, flaxseed and avocado are foods rich in omega-3 fatty acids.

There are many skin diseases that mimic eczema. Sometimes a biopsy may be needed to determine the correct diagnosis. if your skin problem is not improving with the above measures, seek evaluation and advice from a board-certified dermatologist.

Dr. Patricia Wong is a dermatologist in private practice in Palo Alto. For more information, call 473-3173 or visit patriciawongmd.com.

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