Dry Skin (Xerosis): Causes, Treatment, and When It Is Something More
Dry Skin (Xerosis): Causes, Treatment,
and When It Is Something More
When a client tells me their skin is dry no matter what they put on it, there is usually a shelf of creams behind the complaint. Most of the time the cause is ordinary: the wrong texture, the wrong soap, or a winter that is drier than it feels. Sometimes the dryness is the first visible sign of something a physician needs to see. This is what the research says about both, and how to tell them apart.
Xerosis is the medical term for dry skin. It happens when the skin loses too much water and oil, and it is common at any age.[3] By 60, nearly everyone has it.[1] Most dry skin improves with short, warm showers, a gentle fragrance-free cleanser, and a cream or ointment applied while the skin is still damp.[2] When it does not, the cause may be underneath the skin. Diabetes, thyroid disease and kidney disease are all known causes of excessively dry skin, and so are low levels of certain vitamins and minerals.[1] Dry skin that cracks into a crazy-paving pattern has become asteatotic eczema, which needs medical care.[4] If good skin care has not worked, the next step is a physician, not another cream.[2]
- What dry skin actually is
- Who gets it, and why age matters
- What dries skin out
- Why your skin stays dry even when you moisturize
- The skin microbiome: promising, not settled
- Comparing the approaches
- The Dry Skin Home Treatment, described honestly
- When dry skin turns into eczema
- When dry skin needs a doctor
- What happens at a skin and scalp evaluation
- The evidence behind this article, graded
- Frequently asked questions
What Dry Skin Actually Is
MedlinePlus, the National Library of Medicine's consumer reference, defines dry skin simply: it occurs when your skin loses too much water and oil. The medical term is xerosis. It usually shows up as dry, scaly, itchy or red skin, sometimes with fine cracks, and it is usually worse on the arms and legs.[3]
The part that holds water in is the outermost layer of the skin, the stratum corneum. It is often described as bricks and mortar. The bricks are flattened dead skin cells, and the mortar is a sheet of fats between them. A 2024 review by two of the field's senior barrier researchers gives the composition of that mortar by weight as roughly 50% ceramides, 25% cholesterol and 15% free fatty acids, with very little else.[5] Counted by molecules rather than by weight, the three are present in about equal amounts.[5]
Water inside the skin is also held by small molecules called natural moisturizing factor. Some of these come from the breakdown of a protein called filaggrin. According to MedlinePlus Genetics, a lack of filaggrin leads to a shortage of natural moisturizing factor, which allows excess water to be lost through the skin and causes dry skin.[6]
That filaggrin figure matters more than it looks. More than 40 mutations in the gene cause ichthyosis vulgaris, a relatively common inherited disorder of dry, scaly skin that tends to worsen in winter when the air is dry.[6] Someone who has had dry, scaly skin since childhood, especially with family members who share it, may be describing a genetic condition rather than a skin type.
Who Gets It, and Why Age Matters
Dry skin can affect anyone, at any age.[3] The American Academy of Dermatology is blunt about the trend with age: “By 60 years of age nearly everyone has dry skin.”[1]
The best pooled figure I can find comes from a 2023 systematic review of 28 studies in older adults. It found xerosis in 53% of them, with a 95% confidence interval of 36 to 69%. Rates were highest in nursing homes and in developed countries, and similar in men and women.[7] That range is wide because the studies measured dryness in different ways and in different places. I would read it as “about half,” not as a precise number.
You will see higher and more exact figures repeated online, including claims about the share of adults or older people affected and precise percentages for oil production after 70. I could not trace those to a primary source, so they are not in this article.
Several things change in aging skin at once. The AAD notes that the skin makes less sebum, the oil that keeps skin soft, and that the amount drops dramatically by your 40s and keeps falling after that.[1] A 2020 review of aging skin in the journal Aging adds that the skin surface becomes less acidic. Skin surface pH begins to increase at about 55, with marked rises in people over 70. The reviewers link that change to weaker barrier repair, more inflammation and more skin infections in older people.[8]
Dry skin is usually worst on the arms and legs. MedlinePlus says so plainly.[3] The 2023 review found xerosis of the lower legs relatively common in older adults.[7] The lower legs are also where dry skin most often turns into eczema, as explained further down.[4] When I hear that the shins are the problem, I ask how long it has been going on before I ask what has been tried.
What Dries Skin Out
The AAD's summary is simple: when skin loses water too quickly, it becomes dry.[1] The reasons sort into everyday causes, which you can usually change, and medical causes, which need someone to find them.
Cold, dry air and indoor heating
Cold winter air, hot dry desert air, and heating or cooling systems all dry the skin.[3] When outdoor temperatures fall, the air holds less moisture.[1]
Long, hot or frequent bathing
Long, hot showers dry the skin, and so does bathing too often.[1][3] Jobs with constant wet work, such as hairdressing, nursing and cooking, carry a higher risk.[1]
Harsh soaps and cleaning products
Deodorant soaps and harsh cleaning products strip oils and fats from the skin.[1] In studies of older adults, milder synthetic cleansers improved dryness compared with standard soap.[9]
Less oil, a less acidic surface
Sebum falls with age, and the skin surface becomes less acidic from around 55.[1][8]
Filaggrin mutations
Reduced filaggrin means less natural moisturizing factor and more water lost through the skin. It is the cause of ichthyosis vulgaris.[6]
Eczema, psoriasis, ichthyosis
Atopic dermatitis, ichthyosis, psoriasis and seborrheic dermatitis can all cause excessively dry skin.[1]
The link with climate shows up even in what people search for. A 2026 study from Stanford dermatology compared nine years of state climate data with Google searches for dry skin and moisturizers. Colder states, and states with drier air, searched more, while warmer, more humid states searched less.[13] It measured searches, not skin, so it shows where people notice dryness rather than how dry their skin is. The authors report that it was not funded.
Why Your Skin Stays Dry Even When You Moisturize
This is the question at the center of most frustration with dry skin, and the honest answer is less exciting than the marketing. The AAD's advice points at texture, timing, water and soap far more than at any brand, and I trust the dull advice here more than the exciting advice.
- Texture. The AAD says ointments and creams add more moisture to skin and are more effective than lotions.[2] A light lotion applied often can do less than a richer cream applied well.
- Timing. Apply moisturizer when your skin is still damp after a shower or bath, after washing your hands, and whenever your skin feels dry.[2]
- Water. Limit baths and showers to five to ten minutes in warm water, and pat dry rather than rubbing.[2]
- Cleanser. Use a gentle cleanser, only as much as you need, and only where you need it.[2]
- Air. Run a humidifier, ideally in the bedroom overnight, and clean it regularly.[2]
- Irritants. The AAD advises people with dry skin to stop using products that contain alcohol (other than hand sanitizer), fragrance, or retinoids.[2]
The AAD also names ingredients worth looking for in a cream or ointment: jojoba oil, dimethicone, glycerin, hyaluronic acid, lactic acid, lanolin, mineral oil, petrolatum and shea butter.[2] MedlinePlus singles out creams or lotions containing urea and lactic acid.[3] A systematic review of 63 skin care studies in older adults reached the same practical conclusion: low-irritating cleansers and oily leave-on products containing humectants are helpful for treating dry skin.[9]
A January 2026 review in Cureus argues that traditional moisturizers’ “effectiveness is limited by the lack of essential components needed for barrier repair, suboptimal pH, absence of anti-inflammatory properties, and inclusion of potential irritants or allergens.” It also notes that a slightly acidic pH, around 5.5, helps the enzymes that process barrier lipids.[12] Both points are plausible. But the review was written to examine one company's moisturizer. Its medical writing was funded by that manufacturer, and two of its authors work there. The review itself says independent, well-controlled studies are needed to confirm its observations.[12] I would not build a buying decision on it.
Here is the turning point I want you to take from this section. If you have changed the texture, the timing, the water and the soap, and given it a few weeks, and your skin is still dry, the AAD's advice is to see a board-certified dermatologist. The reason it gives is the important part: your dry skin may be due to an underlying medical condition such as atopic dermatitis, psoriasis or kidney disease.[2]
The Skin Microbiome: Promising, Not Settled
The bacteria that live on the skin interact with the barrier, and this is an active area of research. It is also an area where marketing has moved well ahead of the evidence.
The study most often quoted is a 2022 paper in Scientific Reports. Women aged 18 to 55 with moderately dry skin on their lower legs used a body lotion for five weeks at a single center. Afterward, the outer layer of their skin held more ceramides, cholesterol and long-chain fatty acids, and the mix of bacteria on the skin had shifted, including a rise in Staphylococcus epidermidis.[10] The authors connect that rise to earlier laboratory work, which found that some S. epidermidis strains secrete an enzyme that may release free ceramides on the skin. That enzyme finding came from earlier work they cite, not from this study. The study was funded by Unilever, which employed most of its authors, and it was limited to premenopausal women.[10]
A 2025 review in the Annals of Dermatology states that “Microbiome-friendly products enhance barrier function by promoting the production of essential lipids like ceramides.” The same review is candid that individual variability, formulation problems and a limited understanding of how microbes and skin interact remain real obstacles, and that long-term clinical trials are needed to validate microbiome-focused skin care.[11]
I find the direction interesting, and I would rather say plainly where it stands than sell a cream on a mechanism nobody has proven in a person. No one has shown that choosing a particular product for its effect on skin bacteria treats dry skin better than the ordinary measures above.
Comparing the Approaches
This compares approaches and ingredients rather than brands. For most dry skin, the differences between good moisturizers matter less than using one consistently, on damp skin, in a rich enough texture.[2]
| Approach | How it works | Worth knowing |
|---|---|---|
| Light lotions | A lighter texture, with humectants that draw water into the skin | Pleasant to use, but the AAD rates creams and ointments as more effective |
| Humectant creams (glycerin, hyaluronic acid, lactic acid) | Draw water into the outer layer, with oils in the cream slowing its loss | Oily leave-on products with humectants reduced dryness and itch in older adults |
| Occlusives (petrolatum, mineral oil, lanolin) | Form a film on the surface that physically slows water loss | On the AAD's list of recommended ingredients; heavy, and the first two are petroleum-derived |
| Urea and lactic acid creams | Bind water and soften rough, scaly skin | Named by MedlinePlus as the moisturizers to look for |
| Ceramide-containing moisturizers | Supply one of the main lipids of the barrier directly | Biologically sensible; the most recent review I found was funded by a manufacturer |
| Gentle cleansers instead of soap | Clean with less stripping of the skin's own oils | Improved dryness compared with soap and water in studies of older adults |
| Prescription options a physician may consider | Treat inflammation or an underlying condition | For inflamed, itchy or cracked skin, or a medical cause; a physician's decision, not routine dry skin care |
| Kapyderm Dry Skin Home Treatment | A rich botanical cream with a tonic mixed in, plus two dietary supplements | Plant-based and made under EU cosmetic rules; contains fragrance; no controlled trial of it exists |
The sources for that table are the AAD's dry skin guidance,[2] MedlinePlus,[3] the review of skin care studies in older adults,[9] the barrier lipid review[5] and the manufacturer-funded Cureus review discussed above.[12] None of the options is a bad choice. If a cheaper cream is keeping your skin comfortable, keep using it.
The Dry Skin Home Treatment, Described Honestly
Kapyderm sells a four-part routine for dry skin, the Dry Skin Home Treatment. Here is exactly what is in it, as the store lists it. The broader picture is on Kapyderm's dry skin treatment page.
Revital and Shock Ecológico are dietary supplements. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. If you are pregnant, breastfeeding or taking medication, check with your physician before starting a supplement.
Three things I want to say plainly. First, the kit does not include a cleanser, and cleansing is half of dry skin care. Use a gentle, fragrance-free one, as the AAD advises.[2]
Second, the AAD advises people with dry skin to avoid products containing fragrance or retinoids.[2] Special K Cream contains fragrance and a low level of a vitamin A ester, and Base Tonic contains fragrance. If your skin is cracked, stings easily or reacts to scented products, patch-test first. If anything you apply burns or stings, stop and tell whoever is advising you.
Third, no controlled trial of any Kapyderm product in dry skin or xerosis exists, and none is implied here. The products are cosmetic and nutritional care. The ordinary measures earlier in this article, the water, the soap, the texture and the timing, do most of the work whatever cream you choose.[2][9]
When Dry Skin Turns Into Eczema
Dry skin and eczema are not the same thing, but one can lead to the other. When dry skin cracks and becomes inflamed, the result is asteatotic eczema, also called eczéma craquelé, xerotic eczema or winter eczema.
The clinical reference from the National Library of Medicine describes it as a common eczema that develops on dry skin. It typically affects older adults, with “pruritic, dry, and scaling skin with fine fissures in a polygonal or curvilinear pattern, producing a characteristic ‘crazy paving’ or ‘dried riverbed’ appearance.” The lower legs are the most frequently involved area, although it can spread to the arms and trunk. Age-related loss of barrier lipids, cold weather and frequent bathing drive it, so it flares in winter.[4]
The same reference notes it is among the most common causes of dermatitis in older adults. Early diagnosis and therapy prevent complications such as painful bleeding fissures and secondary bacterial infection.[4] The AAD makes the same point about excessively dry skin in general: left untreated, it carries a higher risk of a serious skin infection.[1]
Cracking in a crazy-paving pattern on the shins, especially in someone over 60, is a reason to see a physician, not to change creams. Diagnosis is predominantly clinical, and inflamed areas may need medical treatment alongside moisturizing.[3][4] There is a second reason to take it seriously. The reference notes that while asteatotic eczema is usually benign, it can occasionally be a clue to an underlying systemic disease, which is the subject of the next section.[4]
When Dry Skin Needs a Doctor
Some dry skin starts inside the body. When it does, no cream will fix the cause, and the right step is a physician who can look for it. These are the conditions the medical sources name.
- Hypothyroidism and other thyroid disease. Named by the AAD and MedlinePlus as a cause of dry skin, and reported in association with asteatotic eczema.[1][3][4]
- Diabetes. Known to cause excessively dry skin.[1][3]
- Kidney disease. Known to cause excessively dry skin, with a further rise in risk on dialysis, which removes water from the body. The fluid shifts of nephrotic syndrome, a kidney condition, are also reported with asteatotic eczema.[1][4]
- Atopic dermatitis, psoriasis and ichthyosis. Skin conditions that cause dryness and need their own diagnosis and treatment.[1][6]
- Nutritional deficiency. Too little vitamin D, vitamin A, niacin, zinc or iron, or not eating enough, as in anorexia.[1] Malnutrition is also reported with asteatotic eczema.[4]
- Sjögren syndrome, an autoimmune condition, is listed by MedlinePlus.[3]
- Cancer and its treatment. Chemotherapy, targeted therapy and radiation can cause extremely dry skin.[1] Rarely, asteatotic eczema appears as a sign of an underlying cancer, most notably lymphoma.[4]
- HIV. Excessively dry skin is common in people who are HIV positive, including those on treatment.[1]
Some medicines also dry the skin.[1][3] If your dryness started after a new prescription, raise the timing with the prescriber. Never stop a prescribed medication on your own.
MedlinePlus describes what a physician does with this: an examination, questions about your health history and symptoms, and tests if a health problem that has not yet been diagnosed is suspected.[3] If a deficiency is the question, test for it before treating it. Supplements are worth taking for a deficiency that has been measured, not one that is suspected.
What Happens at a Skin and Scalp Evaluation
I am a trichologist. My training is in the scalp and hair, and the scalp is skin, so dryness is something I assess as part of my work. An evaluation with me is an assessment of the skin and scalp barrier. It is not a medical diagnosis, and I never present it as one.
Under magnification, I look at what the dryness actually is. Fine, dry scale reads differently from flaking that looks greasy, which suggests something other than simple dryness. I look for redness, scratch marks and weeping, which suggest inflammation rather than dryness alone. I look for cracking, and whether it follows a pattern. And I ask the questions that matter most: how long it has been going on, where on the body, what has already been tried, and whether anything else about your health has changed.
I write it down. A record of where the dryness is, what it looks like and what you are using gives the next visit something to compare against. Without it, “a bit better” is a guess.
Where the picture points to something medical, such as eczema with cracking, dryness that has resisted good skin care, or dryness that arrived with other changes in your health, the right outcome of my appointment is a referral to a physician. The AAD says the same thing in its own words: if dry skin continues after the basic measures, it is time to see a board-certified dermatologist, because an underlying medical condition may be the cause.[2]
The Evidence Behind This Article, Graded
Not every statement above rests on the same quality of evidence. Here is what each main claim is actually standing on.
Well established
Decades of barrier research, summarized in the 2024 review: about 50% ceramides, 25% cholesterol and 15% free fatty acids by weight.[5] The limit: knowing what the barrier is made of does not prove that putting those lipids on the skin restores it in any given person.
Well supported, imprecise
A pooled 53% across 28 studies, with a range of 36 to 69%,[7] and the AAD's statement that nearly everyone has dry skin by 60.[1] The limit: the studies used different definitions and settings, which is why the range is so wide.
Reasonably supported
A systematic review of 63 studies in older adults,[9] and consistent dermatology guidance.[2] The limit: the review's authors describe substantial differences between the studies' designs, products and outcomes.
Plausible, early
One industry-funded, single-center study in premenopausal women,[10] and a narrative review that itself calls for long-term trials.[11] Not established as a treatment for dry skin.
Weak
The main recent source is a narrative review written to examine one manufacturer's moisturizer, with funding from that manufacturer.[12] The AAD's guidance does not depend on any such claim.[2]
The honest gaps
No controlled trial of any Kapyderm product in dry skin or xerosis exists. No study shows that a topical product corrects the medical causes of dry skin, such as thyroid disease, kidney disease, diabetes or a deficiency; those need to be found and treated. The commonly repeated precise figures for how many adults have dry skin, and for how much oil older skin makes, could not be traced to a primary source and are not used here.
Frequently Asked Questions
- American Academy of Dermatology Association. “Dry skin: Who gets and causes.” aad.org. Accessed October 4, 2026. Source for nearly everyone having dry skin by 60, sebum falling by the 40s, the list of risk factors (medications, wet work, low outdoor temperature, vitamin and mineral deficiency, smoking, skin conditions, diabetes, thyroid disease, kidney disease, dialysis, cancer treatment, anorexia, HIV), and the higher risk of serious skin infection when excessively dry skin goes untreated.
- American Academy of Dermatology Association. “Dermatologists’ top tips for relieving dry skin.” aad.org. Last updated January 2, 2026. Source for bathing, cleanser, moisturizer timing and humidifier advice, creams and ointments over lotions, recommended ingredients, the advice to avoid alcohol, fragrance and retinoids, and when to see a dermatologist.
- MedlinePlus Medical Encyclopedia. “Dry skin.” medlineplus.gov. U.S. National Library of Medicine. Review date October 13, 2024. Source for the definition of xerosis, its causes including diabetes, underactive thyroid and Sjögren syndrome, where it appears, testing, and urea and lactic acid moisturizers.
- Srivastava D, Sathe NC, Persaud Y. Asteatotic Eczema. In: StatPearls. Treasure Island (FL): StatPearls Publishing. ncbi.nlm.nih.gov. NCBI Bookshelf ID NBK549807. PMID 31747214. Updated January 10, 2026. Source for the description, distribution and causes of asteatotic eczema, its complications, and its reported associations with hypothyroidism, malnutrition, nephrotic syndrome and lymphoma. The authors declare no relevant financial relationships.
- Feingold KR, Elias PM. The role of ceramides in the disruption of the cutaneous permeability barrier, a common manifestation of skin disorders. Journal of Lipid Research. 2024;65(8):100593. doi:10.1016/j.jlr.2024.100593. PMID 39002948. PMC11348431. Source for the lipid composition of the stratum corneum by weight and by molar ratio.
- MedlinePlus Genetics. “FLG gene.” medlineplus.gov. U.S. National Library of Medicine. Accessed October 4, 2026. Source for filaggrin and natural moisturizing factor, the 20 to 30% and 8 to 10% mutation frequencies, and ichthyosis vulgaris.
- Yao D, Gong X, Ma Y, Gong T, Wang G. The prevalence and interventions of xerosis cutis among older adults: a systematic review and meta-analysis. Geriatric Nursing. 2023;54:219–228. doi:10.1016/j.gerinurse.2023.09.018. PMID 37844538. Pooled prevalence of 53% (95% CI, 36% to 69%) across 28 articles; highest in nursing homes and developed countries. The authors declare no competing interests.
- Wang Z, Man MQ, Li T, Elias PM, Mauro TM. Aging-associated alterations in epidermal function and their clinical significance. Aging. 2020;12(6):5551–5565. doi:10.18632/aging.102946. PMID 32217811. PMC7138575. Review. Source for reduced sebum in aged skin and the rise in skin surface pH from about age 55, marked over 70.
- Lichterfeld-Kottner A, El Genedy M, Lahmann N, Blume-Peytavi U, Büscher A, Kottner J. Maintaining skin integrity in the aged: a systematic review. International Journal of Nursing Studies. 2020;103:103509. doi:10.1016/j.ijnurstu.2019.103509. PMID 31945604. Systematic review of 63 articles on skin care in people aged 50 and over. The authors report substantial heterogeneity between studies and no conflicts of interest.
- Murphy B, Grimshaw S, Hoptroff M, et al. Alteration of barrier properties, stratum corneum ceramides and microbiome composition in response to lotion application on cosmetic dry skin. Scientific Reports. 2022;12(1):5223. doi:10.1038/s41598-022-09231-8. PMID 35340018. PMC8957616. Single-center, five-week lower-leg study in premenopausal women aged 18 to 55 with moderate dryness. Funded by Unilever Research and Development, which employed most of the authors.
- Hong JY, Kwon D, Park KY. Microbiome-based interventions for skin aging and barrier function: a comprehensive review. Annals of Dermatology. 2025;37(5):259–268. doi:10.5021/ad.25.009. PMID 41044805. PMC12505367. Narrative review. The authors report nothing to disclose.
- De A, Sarveswari KN, Tolat S, Hameed S, Bhat S, Jain S, Swami OC. Oryza Ceramax in dermatologic care: a multi-pathway approach to skin hydration and barrier repair. Cureus. 2026;18(1):e100886. doi:10.7759/cureus.100886. PMID 41658751. PMC12873553. Narrative review built around one commercial moisturizer. Medical writing was funded by Alembic Pharmaceuticals, and two authors are its employees.
- Aframian K, Naimi S, Xu J, Bae G. Climate, humidity, and population-level interest in dry skin: infodemiology analysis using Google Trends across the United States. JMIR Dermatology. 2026;9:e93639. doi:10.2196/93639. PMID 42184334. Published May 25, 2026. Compares state climate data with Google search interest, 2016 to 2025. Not funded; the authors declare no conflicts.
Last reviewed October 2026.
Most Dry Skin Is Ordinary.
The Rest Is Worth a Proper Look.
If your skin cracks or bleeds, if it has formed a crazy-paving pattern, if it stays dry after weeks of good skin care, or if it arrived alongside other changes in your health, that is worth an evaluation rather than another product. That is how I work, and it is how the Kapyderm specialists near you work: look at the skin under magnification, record what is there so the next visit has something to compare against, and refer to a physician when that is what the picture calls for.
