What Causes Scaly Skin?

Our guide to the many causes of scaly skin will help you pinpoint your problem—and identify the steps you can take to fix it.

Photo: dimid_86/Getty Images

Dry skin can happen to anyone, but because your skin loses its ability to retain water as you age, it's more common as you get older. Additionally, dry skin can crop up anywhere, but some parts of the body—like the extremities, which don't have as many oil glands as the face—are more prone to becoming parched.

For a whole host of reasons—cold weather, indoor heat, hot water, aggressive washing, and aging—skin can allow moisture to escape. When the water content drops below a certain point, your skin becomes dry, scaly, and itchy.

Here are conditions that may be responsible for your dry skin as well as some remedies for them.

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If you develop raised red patches with a silvery-white coating over your knees, elbows, lower back, or scalp, you probably have plaque psoriasis. It's the most common form of psoriasis, a chronic disease that seriously speeds the process by which skin cells mature and reach the skin's surface. Because the rate at which old cells are shed remains unchanged, the new cells stack up and become thickened patches covered by the dead, flaking skin.

The precise cause of psoriasis isn't known. "Something is happening at the level of the T-cell, one of the immune cells in our body, that signals the skin to overproduce," explained Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine. Psoriasis can also have a genetic component, meaning that it's possible for psoriasis to affect people with and without family history of the condition. Psoriasis can begin at any age—"You can come out of the womb with it or develop it late in life," Dr. Gohara said—but most people get it between ages 15 and 30.

Psoriasis can come and go with varying degrees of severity, and attacks may be triggered by emotional stress, skin injury, and physical illness. There's no cure for the condition, but many treatments are available. Your dermatologist will choose the right one based on the degree of your psoriasis and where on the body it occurs.

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Red, scaly, or even oozing crusty patches that itch a lot usually signal eczema, which is often called "the itch that rashes." An umbrella term for a group of conditions, eczema is very common as it affects more than 30 million Americans. It's not known what causes eczema, but researchers believe a combination of environmental factors and genetics are involved.

People with eczema tend to have very dry skin, possibly the result of a mutation of the gene that controls creation of filaggrin, a protein that helps create a healthy barrier on the top layer of skin to keep moisture from escaping and bacteria from entering, according to the National Eczema Association. The immune systems of people with eczema also tend to overreact to allergens or irritants, attacking their bodies instead of protecting them. The result is inflammation that leads to red, itchy, and painful skin.

Eczema can be exacerbated by a variety of things, including hot baths and heavy use of soaps; tight, scratchy clothing; anything that makes your skin hot, such as sunbathing or excessive sweat-inducing exercise; scratching, which only inflames the already irritated skin even more; and stress, which can precipitate or aggravate an outbreak. Everybody's eczema triggers are different, though, so it's important to identify yours.

There's no cure for eczema, but there are many treatments, including over-the-counter remedies, prescription meds, light therapy, immunosuppressants, and biologic drugs. But self-care, including regular use of a moisturizer with a high oil content to keep the skin hydrated and less reactive, is key to managing flares.

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Seborrheic Dermatitis

Seborrheic dermatitis is a very common condition that usually affects the scalp, ears, eyebrows, sides of the nose, eyelids, and chest. (Many babies develop a type of seborrheic dermatitis known as cradle cap.) It usually consists of white or yellowish greasy scales on oily areas of the body. The cause isn't entirely understood but may be related to yeast that naturally lives on the skin flourishing in oily secretions to a degree that your skin finds irritating.

Seborrheic dermatitis usually affects adults between the ages of 30 and 60, and men are slightly more prone to developing it. Once you get it, you tend to have it for life, according to MedlinePlus. The condition comes and goes, often clearing and flaring without warning. Cold, dry weather can trigger flare-ups, as can stress.

To shake the scales, Dr. Gohara recommended using a dandruff shampoo that contains zinc pyrithione, selenium sulfide, or ketoconazole. These ingredients have antifungal properties that may keep the yeast on the skin at bay. You may need to try several shampoos to find the one that works best for you. Massage the shampoo onto the scalp and other affected areas and leave it in place for a few minutes before rinsing to give the active ingredient time to work. Seborrheic dermatitis can be stubborn, so if an OTC shampoo isn't working, see a dermatologist.

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Tinea Versicolor

Yeast on the skin can also cause tinea versicolor—also known as pityriasis versicolor, according to John Hopkins Medicine—a condition that triggers dry, scaly, discolored patches on areas of high sweat like the neck, chest, back, and groin. "Yeast loves moist environments, so when some people sweat, it overgrows," Dr. Gohara explained. The spots can be lighter or darker than your skin and may itch. The spots may become more noticeable after spending time in the sun.

Tinea versicolor is very common in tropical or subtropical areas of the world, according to the American Academy of Dermatology Association (AAD); some people who live in these environments have it year-round. The solution is the same as for seborrheic dermatitis: "Reel the yeast in with an antifungal shampoo," Dr. Gohara said, who recommended using it head to toe every day for a month and then once or twice a week for the following month to maintain the results.

Especially if you live in a warm, humid environment, tinea versicolor often returns so using an antifungal cleanser once or twice a month can help prevent the yeast from overgrowing again.

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Actinic Keratosis

These crusty, scaly, precancerous growths form on skin that soaks up a lot of sun over the years. The most common spots for actinic keratosis are the face, ears, bald scalp, shoulders, neck, forearms, and the backs of the hands. Actinic keratoses develop slowly and initially are felt rather than seen: "It's like you're running your finger over sandpaper," Dr. Gohara said.

Most actinic keratoses become red, but some are light or dark tan, white, pink, flesh-toned, or even a combination of these colors. Often several actinic keratoses show up at the same time, and they may disappear only to reappear later. The growths are considered precancerous because if left alone, they have approximately a 10% chance of turning into a type of skin cancer called squamous cell carcinoma. Treatment typically includes one of a number of different surgical procedures to remove the growth or the use of a prescription medication.

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Allergic Contact Dermatitis

There are many things you might put on your skin that you could be allergic to—and those irritants can cause inflammation that leads to itching, redness, and rough, scaly skin, technically called allergic contact dermatitis.

Nickel is a common culprit: Between 10% and 20% of people are sensitive to this metal, according to the CDC, and nickel allergies affect more women than men. Other common possible causes of allergic contact dermatitis include things such as medications, dyes, poison ivy, foods, rubber, and cosmetics, as noted by the American Academy of Allergy, Asthma & Immunology (AAAAI).

Treating allergic contact dermatitis may vary beyond avoiding the trigger and confirming that the contact dermatitis is not another skin condition. A dermatologist might recommend topical options (steriods, immunomodulators, or antibiotics); systemic steriods; antihistamines; or phototherapy (which might be necessary if your skin doesn't get better with any of the other options).

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Skin Cancer

Especially at an early stage, squamous cell carcinoma (SCC), the second most common form of skin cancer, typically appears as scaly patches on areas of the body that receive a lot of sun exposure per the American Cancer Society. These spots can also look like warts and sometimes appear as open sores with a raised border and a crusted surface.

Unlike dry skin, these lesions, which range from pea-size to chestnut-size, can bleed if bumped, scratched, or scraped. They may persist, but they can also heal and then return. Anyone can develop SCC, but people with fair skin, light hair, and light eyes are at highest risk. SCC can become disfiguring and sometimes deadly if allowed to grow, so be sure to see your healthcare provider if you notice any change in a preexisting skin growth or the development of a new one.

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An underactive thyroid, also called hypothyroidism, can affect many parts of the body, and the skin is no exception. A small gland that sits at the base of your neck, the thyroid produces hormones that control your metabolism. Along with feeling colder and sluggish and becoming forgetful and depressed, having a thyroid that produces too little thyroid hormone leaves many people with dry, rough, and scaly skin.

If you think you might have an underactive thyroid, your healthcare provider can confirm it with a series of blood tests. The most common reason your thyroid gland can't make enough thyroid hormone is due to an autoimmune disease like Hashimoto's disease, in which your immune system mistakenly attacks your thyroid gland.

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When someone has ichthyosis, the skin often looks like it's covered in fish scales. Ichthyosis results from the same gene mutation that may cause eczema that results in having too little filaggrin in your skin. Without enough of this protein, skin cells aren't shed as they should be and tend to pile up on the surface, causing thickened, scaly skin, Dr. Gohara explained.

Ichthyosis usually begins at birth or in a baby's first year, but it can affect people at any age. People inherit the gene mutation from one or both parents, neither of whom needs to have the disease to pass on the genes. There are more than 20 different types of ichthyosis, but 95% of people who develop it get the mildest form of the disease, according to the American Osteopathic College of Dermatology (AOCD).

There's no cure for ichthyosis, but exfoliating and moisturizing regularly can usually control the symptoms. Dermatologists have recommended taking long soaking baths to soften the scales, then using a washcloth, loofah, or pumice stone to gently slough them away. Once out of the tub, apply moisturizer to damp skin to help seal in water. Opt for a moisturizer that contains urea, glycolic acid, or lactic acid, ingredients that can both hydrate skin and reduce scaling. If the problem persists, see a dermatologist.

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Athlete's Foot

You don't have to be an athlete to get this fungal infection, but the warm, dark, moist environment inside a sporty sneaker is the perfect place for fungus to grow, said Brian Adams, MD, a dermatologist in Cincinnati and chair of the American Academy of Dermatology Sports Committee. The condition is particularly common between the toes, though it often spreads to the soles, the heels, and the edges of the feet. The fungus can cause skin to redden and crack, and the affected scaly areas flake and may become itchy.

Unlike most other causes of scaly skin, athlete's foot is highly contagious. It's also difficult to get rid of, so prevention is key. The American Podiatric Medical Association recommended changing shoes and socks regularly; wearing light, airy shoes; and washing your feet daily then drying them carefully. Additionally, athletes should opt for synthetic, moisture-wicking socks, which keep feet cool and dry, and wear flip-flops in community locker rooms and showers—contracting athlete's foot is as easy as stepping on a tiny flake of skin from someone with the infection.

Topical antifungal creams, gel, or sprays usually clear the infection quickly, but to be sure the skin is completely free of the fungus, you may need to treat it for a week or two after the rash has gone (follow the instructions on the label). Many other problems of the feet—including contact dermatitis, psoriasis, and dryness—may mimic athlete's foot, so seeing a dermatologist is best if you find that the problem persists.

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Scaly skin due to a peeling sunburn might not seem like a good thing at the time, but it's actually how the body gets rid of the UV-damaged cells, explained Steven Wang, MD, director of dermatologic surgery and dermatology at Memorial Sloan-Kettering Cancer Center at Basking Ridge, New Jersey, and chair of the Skin Cancer Foundation's Photobiology Committee. "As a reaction to the massive UV assault, the cells commit suicide as a way to prevent those with an excessive amount of DNA mutation from propagating."

Unfortunately, this process isn't perfect, and some of the surviving cells stick around and cause further mutations that could eventually become cancerous. A single blistering sunburn in childhood or adolescence more than doubles your risk of developing potentially deadly melanoma later in life.

If you get burned, take quick action to prevent peeling: Cool your skin with cold compresses or take a cool shower or bath, then moisturize skin while it's still damp (steer clear of petroleum or oil-based ointments that can trap heat and make the burn worse, the Skin Cancer Foundation advised). To avoid getting burned in the first place, apply a broad-spectrum sunscreen with an SPF of 30 or higher on all exposed skin; seek shade whenever possible; and cover up with hats, sunglasses, and UV-protective clothing.

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Pityriasis Rosea

This rash follows a very distinctive pattern, appearing first on the body as a single, oval, scaly patch. Known as the "herald" or "mother" patch, this isolated spot usually develops on the trunk, upper arms, neck, or thighs, and rarely, on the face, scalp, palms, and soles. "Then, a couple of weeks later, you erupt in smaller patches from your neck to your thighs," Dr. Gohara said. One telltale sign of pityriasis rosea is that the patches often form a pattern that resembles a Christmas tree.

The cause of pityriasis rosea isn't known, but it's thought to be triggered by a viral or bacterial infection, per John Hopkins Medicine. What is known is that the condition is harmless, neither contagious nor sexually transmitted, and usually clears up on its own after one to three months without treatment—though healthcare providers may prescribe topical steroids if the skin itches, as it does about half the time. Getting overheated can worsen the rash, so take lukewarm showers and baths.

"Pityriasis rosea can really freak people out because it's this weird thing that pops up, and then it just sort of goes away leaving no trace," Dr. Gohara said. See a healthcare provider if you think you have this distinctive rash.

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What Else To Do About Dry, Itchy, and Scaly Skin

Moisturizing daily is an obvious solution to dryness, but your entire skincare regimen should help you avoid skin issues in general. Wash with a mild cleanser, take shorter showers with lukewarm water, and apply sunscreen every day, as UV rays can also lead to dryness.

Opt for moisturizers with ingredients that supplement those found naturally in the skin, such as lipids, ceramides, cholesterol, and hyaluronic acid, Dr. Gohara suggested.

Ultimately, if you find that you're still having issues with your skin or difficulties with skin conditions, see a dermatologist to determine treatment options that may be best for you.

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