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Understanding skin conditions · survey 04
Dryness & flakiness

Losing water

Dry skin is a water problem. The surface loses water faster than the skin underneath replaces it, so it tightens, flakes, and stings when you put things on it. Fixing that is mostly two moves: get water in, then stop it leaving.

The skin barrier holding water, and losing it Two panels side by side. On the left, plenty of lipid glue between the skin cells keeps water in the layers below and only a little rises into the wall. On the right the glue has thinned with gaps missing, the surface is cracked and a flake is lifting, and arrows carry water up through the wall and out into the air. HOLDING WATER LOSING WATER DEEPER SKIN · STILL HYDRATED
Diagram · the same wall, holding water and losing it

Holding water — plenty of glue between the cells

Losing water — the glue thins, and water walks out

Deeper skin — still hydrated

Two things get called dry · 01

Dry, or dried out

Getting this wrong is the most common reason a moisturiser does not work. Dry is a skin type you have. Dried out is something that happens to you, and it happens to every skin type, oily included.

Dry · a type
Not enough oil, more or less permanently
·Feels tight most days, not only after washing.
·Flakes and rough patches, with fine cracks on the cheeks, shins and hands.
·Rarely shiny, and makeup clings and lifts rather than sitting flat.
·Can be made worse by age, by long hot showers and by a week somewhere cold.
Needs a richer texture, lipids and something that seals. This one is managed rather than fixed.
Dried out · a state
Enough oil, not enough water
·Happens to any skin type, and oily skin gets it too.
·Water passes out through the surface all the time — transepidermal water loss. When the barrier is worn down that loss rises, faster than the skin can replace it.
·Can be made worse by overnight aircon, by a flight, by a new acid or by a fortnight of hot showers.
·Skin can be shiny by midday and tight and flaky at the same time.
·Fine lines look deeper and most things sting. It settles once the cause stops, though more slowly than it arrived.
Needs water-binding ingredients and a week or two with fewer actives, rather than a heavier cream.
How it happens · 02

Where the water goes

01
The glue runs low
Your skin cells are stacked like bricks, and the lipids between them are the glue. Lose glue and the wall stops being watertight.
02
Dry air pulls the water out
Aircon is the big one here. Cooling the air dries it, and dry air takes water off your skin for as long as you sit in it. A plane cabin, wind and cold weather all do the same job.
03
Flakes are unglued cells
Skin sheds all the time and you never notice. Short of glue, the cells come away in clumps instead, and that is the bit you see in the mirror. Scrub at them and you take good skin with them.
04
Then it itches
Gaps in the glue let irritants down to the nerve endings, so the skin itches. Scratching costs you more glue, which is how a patch that would have settled on its own turns into one that lingers.
How moisturisers work · 03

Three layers, in order

Moisturisers do three different jobs, and most people are only buying one of them. Turn each layer on and see what changes.

Cross-section of the skin with each moisturiser layer switched on or off Skin cells drawn as bricks with glue between them, over a hydrated deeper layer. With the emollient on, the gaps between the bricks are filled; with it off they are dark voids and the surface is cracked. With the humectant on, arrows draw water down from the air and up from the deeper skin into the wall. With the occlusive on, a sealing band covers the surface and the escaping-water arrows stop underneath it. WATER IN WATER OUT OCCLUSIVE · SEALED IN CELLS, AND THE GLUE BETWEEN THEM DEEPER SKIN
IllustrativeWater loss high
Causes · 04

What is drying you out

Climate
Hot, long showers
Heat and time strip the lipids you need, so keep it lukewarm and brief, then moisturise while the skin is still damp.
Climate
Aircon, most of the day
The one that catches people in Singapore. Cooling air dries it, so an air-conditioned office and a bedroom unit overnight can mean twelve hours a day in air far drier than the street outside. Nothing feels wrong until it flakes.
Products
Foaming and soap cleansers
If your face still feels tight a minute after washing, change the cleanser before you buy anything else.
Products
Over-exfoliation
Acids and scrubs several times a week thin the barrier. If you flake after exfoliating, that is damage.
Products
Ramping actives too fast
Retinoids and strong acids started nightly will flake you for weeks. Two nights a week, buffered with moisturiser, gets you to the same place with far less of it.
Other
Age, weather and medication
Lipid production falls with age, and some prescriptions dry the skin as a known side effect. If this is you, it is not that you are doing it wrong.
Daily routine · 05

Habits that hold water

01
Moisturise on damp skin
Do it within about three minutes of a shower, before your skin has dried off. It is worth more than a more expensive cream.
02
Downgrade the cleanser
Use a cream or a gel rather than a foam, once in the evening, with water alone in the morning if you are very dry.
03
Shorter, cooler showers
Hot and long is the combination that strips lipids, so keep the water warm and get out sooner.
04
Occlusive at night
Put a thin layer of something sealing over your moisturiser, on the driest patches only.
05
Pause the actives
Take two weeks off acids and retinoids while things settle, then bring one of them back slowly.
06
Add humidity
If you sleep with the aircon on, a humidifier in that room does more than most products will.
Give any of this time before deciding it has not worked. The glue between the cells rebuilds slowly, and the early days rarely look like progress.
Not just dry skin

Several conditions arrive dressed as dryness

→If the itch wakes you up, or the skin cracks and bleeds, you are past what a moisturiser can do.
→Thick silvery scale on sharply edged plaques points to psoriasis. Itchy, poorly defined patches, often in the elbow or knee creases, point to eczema. Both still need a moisturiser, but they need treatment as well, so get them looked at.
→Greasy yellowish flakes along the scalp, the brows or the folds beside the nose are usually seborrhoeic dermatitis rather than dryness.
→Sudden dryness all over, or dryness alongside fatigue, hair thinning or feeling cold, is worth a blood test.
→You have given it a decent stretch of gentle, consistent care and have nothing to show for it.
Next stop

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