What Causes Scaly or Flaking Skin?

Dry patches of 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, scaly skin and some remedies for them.

Psoriasis

Plaque psoriasis is the most common form of psoriasis, a chronic condition that speeds up the process by which skin cells mature and reach the skin's surface. Because the rate at which old cells are shed is unchanged, the new cells stack up and become thickened patches covered by 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 it can affect people with and without a 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 there are two peaks when most people get it: the first at age 20 to 30 years and the second at age 50 to 60 years.

Symptoms

Symptoms of plaque psoriasis include:

• Dry, thick, raised red patches
• Silvery-white coating over your knees, elbows, lower back, or scalp

Psoriasis can come and go with varying degrees of severity, and attacks may be triggered by emotional stress, skin injury, and physical illness.

Treatment

There's no cure for the condition, but treatments depend on several factors and might include:

• Medicated creams or ointments
• Ultraviolet light therapy
• Medications, such as methotrexate

A doctor will recommend treatment based on the degree of your psoriasis and where on the body it occurs.

Eczema

Eczema is an umbrella term for a group of conditions and is very common as it affects an estimated 30% of Americans. It's unknown what causes eczema, but researchers believe it involves a combination of environmental factors and genetics.

People with eczema tend to have very dry skin, possibly due to a mutation of the gene that controls the creation of filaggrin. This protein helps create a healthy barrier on the top layer of skin to keep moisture from escaping and bacteria from entering.

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.

Symptoms

Common eczema symptoms are:

• Red, scaly patches
• Oozing crusty patches
• Itching

It is often called "the itch that rashes" because of these symptoms.

Eczema can be made worse by a variety of things, including:

• Hot baths
• Heavy use of soaps
• Tight, scratchy clothing
• Anything that makes your skin hot, like sunbathing or excessive sweat-inducing exercise
• Scratching, which inflames the already irritated skin even more
• Stress, which can start or aggravate an outbreak

Everybody's eczema triggers are different, so it's important to identify yours.

Treatment

There's no cure for eczema, but there are many treatments, including:

• Over-the-counter remedies
• Prescription medications
• Light therapy
• Immunosuppressants
• Biological drugs

And 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.

Seborrheic Dermatitis

Seborrheic dermatitis consists of white or yellowish greasy scales on oily areas of the body. It occurs in 1% to 3% of the general population and usually affects the scalp, face, chest, back, armpits, or groin.People often get seborrheic dermatitis for the first time as a young adult or over the age of 50, and males are slightly more prone to developing it. Once you get it, you tend to have it for life.

The cause isn't entirely understood but may be related to yeast that naturally lives on the skin flourishing in oily secretions to the degree that your skin gets irritated. The condition comes and goes, often clearing and flaring without warning. Cold, dry weather can trigger flare-ups, as can stress.

Symptoms

This dermatitis can appear anywhere on the body where there is oily skin. Common symptoms include:

• Flaking skin or dandruff
• Patches of flaky white or yellow scales on top of oily skin
• A rash that is dark on brown or black skin and lighter on white skin
• Itchiness

Treatment

To treat the condition, 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 for other treatment options.

Tinea Versicolor

Tinea versicolor—also known as pityriasis versicolor—is a fungal skin infection. It is caused by an overgrowth of a type of yeast that's naturally on your skin. This condition is very common in tropical or subtropical areas of the world. Some people who live in these environments have it year-round.

Symptoms

Symptoms of tinea versicolor include:

• Light or dark patches of skin that are round or oval-shaped
• The color of the patches can vary from pink to brown
• Patches often occur on the upper chest and back but can also appear on the upper arms, neck, and shoulders.

"Yeast loves moist environments, so when some people sweat, it overgrows," Dr. Gohara explained. The spots can be lighter or darker than your skin. The spots may become more noticeable after spending time in the sun.

Treatment

The treatment 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.

It's important to note that using antifungal shampoo may not be enough to treat tinea versicolor. Other treatments include:

• Antifungal soaps, creams, or lotions
• Medicated cleaners
• Antifungal oral medications (for short-term use under the monitoring of a dermatologist)

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

Actinic Keratosis

Actinic keratoses (AKs) are precancerous growths that develop slowly and initially are felt rather than seen: "It's like you're running your finger over sandpaper," Dr. Gohara said.

The growths are caused by longtime exposure to ultraviolet (UV) rays from the sun, tanning beds, or sunlamps.

Symptoms

Over time the UV rays damage skin cells, causing the following symptoms:

• Rough, scaly, discolored patch
• Patches are usually red, but some are light or dark tan, white, pink, flesh-toned, or even a combination of these colors.
• Patches appear on sun-exposed areas, including the face, neck, bald scalp, chest, shoulders, forearms, and back of the hands.

It's often the case that several AKs will show up at the same time. The growths are considered precancerous because, if left alone, about 10% will become cancerous, turning into a type of skin cancer called squamous cell carcinoma.

Treatment

The treatment for AKs is usually done by a dermatologist and might include surgical and non-surgical procedures such as:

• Cryotherapy: the freezing of lesions with a substance like liquid nitrogen
• Chemical Peel: a medical-grade chemical peel to remove the top layers of skin
• Curettage: scraping the AK off of the skin with a sharp instrument
• Photodynamic therapy: a solution is put on the AKs and then treated with blue or red light.

It's important to get routine skin exams even if AKs have been treated and cured: AKs may disappear only to reappear later.

Allergic Contact Dermatitis

Allergic contact dermatitis is an inflammatory skin condition that's caused by exposure to irritants on the skin, which leads to an immune response that creates inflammation.

Nickel is a common skin irritant: Between 10% and 20% of people are sensitive to this metal, and nickel allergies affect more women than men. Other common causes of allergic contact dermatitis include medications, dyes, poison ivy, foods, rubber, and cosmetics.

Symptoms

Typical symptoms include:

• Itching
• Redness
• Scaly skin

Treatment

Along with avoiding the irritant, how to treat allergic contact dermatitis can vary and may require confirming that it's not another skin condition. A dermatologist might recommend:

• Topical medications, such as steroids, immunomodulators, or antibiotics
• Systemic steroids
• Antihistamines
• Phototherapy—this might be necessary if your skin doesn't get better with any other options.

Skin Cancer: Basal Cell Carcinoma and Squamous Cell Carcinoma

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types of skin cancer, with BCC being the most common. BCC is caused by years of sun exposure or indoor tanning.

Symptoms

Symptoms appear on areas of the body that get a lot of sun exposure (face, ears, neck, lips, and back of hands) and might include:

• A flesh-colored round growth
• A pearl-like bump
• A pinkish patch of skin

Superficial BCC can also look like the early stage of SCC. Symptoms of SCC can include:

• Scaly patches on areas of the body that receive a lot of sun exposure
• Spots that look like warts
• Spots that 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 BCC or SCC, but people with fair skin, light hair, and light eyes are at the highest risk.

Treatment

Dermatologists typically treat these types of skin cancer. Depending on the type and stage of cancer, treatment might include:

• Local treatment (like cryotherapy, topical chemotherapy, or laser surgery)
• Surgery
• Radiation
• Chemotherapy
• Immunotherapy

Both types of skin cancer can become disfiguring and sometimes deadly if allowed to grow, so be sure to see a healthcare provider if you notice any change in a preexisting skin growth or the development of a new one.

Hypothyroidism

An underactive thyroid, also called hypothyroidism, can affect many body parts, including the skin. The thyroid is a small gland at the base of your neck that produces hormones that help regulate your metabolism. 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.

Symptoms

Symptoms of hypothyroidism may include:

• Feeling cold
• Fatigue
• Weight gain
• Depression
• Dry skin

Treatment

If you think you have an underactive thyroid, a healthcare provider can confirm it with a series of blood tests. Treatment for hypothyroidism includes medication that can help relieve symptoms, including dry, rough, or scaly skin.

Ichthyosis Vulgaris

Ichthyosis vulgaris is an inherited skin condition that 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 gene mutation. There are more than 20 different types of ichthyosis, but 95% of people who develop it get the mildest form.

Ichthyosis vulgaris is caused by the same gene mutation that may cause eczema, resulting in too little filaggrin in your skin. Without enough of this protein, skin cells don't shed as they should and tend to pile up on the surface, Dr. Gohara explained.

Symptoms

The symptoms of this skin condition are thickened, scaly skin which often looks like it's covered in fish scales.

Treatment

There's no cure for this kind of ichthyosis, but dermatologists recommend the following treatments:

• Exfoliating and moisturizing regularly to help control the symptoms
• Try taking long soaking baths to soften the scales
• While bathing, use a washcloth, loofah, or pumice stone to gently slough away the scales.
• After bathing, apply moisturizer to damp skin to help seal in water.
• Choose 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.

Athlete's Foot

You don't have to be an athlete to get this fungal infection. Still, the warm, dark, moist environment inside shoes 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 warm, damp areas around swimming pools, showers, and locker rooms are also common places for this fungus to grow.

Symptoms

The condition is particularly common between the toes, though it often spreads to the soles, the heels, and the edges of the feet. Typical symptoms of athlete's foot include:

• Dry skin
• Itching and burning between the toes or soles of the feet
• Scaling or peeling skin
• Inflammation or swelling
• Blisters that then crack and peel

Treatment

Treatment usually includes topical antifungal creams, gels, or sprays, which typically clear the infection quickly. 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 skin conditions, including contact dermatitis, psoriasis, and dryness, may mimic athlete's foot. A dermatologist can evaluate your skin and diagnose the cause of your symptoms.

Unlike most other causes of scaly skin, athlete's foot is highly contagious and is difficult to get rid of. Ways to prevent athlete's foot include:

• Change shoes and socks regularly
• Wear light, airy shoes
• Wash your feet daily and dry them completely
• Wear flip-flops around community swimming pools, locker rooms, and showers
• Athletes should wear synthetic, moisture-wicking socks to keep feet cool and dry.

Sunburn

Sunburn is a type of radiation burn that's caused by too much unprotected exposure to UV rays that causes short-term skin damage.

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," he told Health.

Unfortunately, this process isn't perfect, and some 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.

Symptoms

Symptoms of sunburn can include:

• Inflamed skin that is hot to the touch
• Painful skin
  
• Blistering, peeling skin
• Swelling
• Itching
• Headache, fever, or chills if the sunburn is severe

Treatment

If you get burned, take quick action to treat it:

• Cool your skin with cold compresses or take a cool shower or bath
• Moisturize skin while it's still damp
• To decrease pain or inflammation take a non-steroidal anti-inflammatory drug (NSAID)
• Drink plenty of fluids

Moisturizers should not contain petroleum or oil-based ointments because they can trap heat and make the burn worse.

To avoid getting burned in the first place:

• Apply broad-spectrum sunscreen with an SPF of 30 or higher on all exposed skin
• Seek shade whenever possible
• Cover up with hats, sunglasses, and UV-protective clothing.

Pityriasis Rosea

Pityriasis rosea is a rash that follows a distinctive pattern, appearing first on the body as a single, oval, scaly patch. Known as the "herald" 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 what is known is that the condition is harmless, neither contagious nor sexually transmitted, and usually clears up on its own without treatment after one to five months.

Symptoms

Symptoms of pityriasis rosea may occur in this order:

• Feeling ill for a couple of days
• Developing a large patch on the skin
• Developing smaller patches or bumps
• Skin clears on its own

Treatment

If treatment is needed, it's usually for itchy skin, which happens about half the time. Healthcare providers may prescribe topical steroids. 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.

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

Moisturizing daily is an obvious solution to dryness, but your entire skincare regimen can help you avoid skin issues by doing the following:

• Wash with a mild cleanser
• Take shorter showers with lukewarm water
• Apply sunscreen daily, 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'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.