Dry and itchy skin conditions

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Eczema and dermatitis 1

The terms eczema and dermatitis are often used interchangeably.

Clinical features may include some of the following:

  • Itching
  • Redness
  • Dry skin with areas of fine scale (scale does not normally develop in flexures due to friction) 
  • Excoriations (scratch marks)
  • Lichenification (thickened areas of skin)
  • In darker skin, prominent follicular involvement is common
  • During flare ups the skin will appear red, sometimes with vesicles and weepy/crusted patches
Eczema and dermatitis on the cubital fossa (inside of elbow)

Eczema and dermatitis on the cubital fossa (inside of elbow)

The distribution of eczema or dermatitis:

  • Can potentially affect any body site
  • In infants, it’s common on the face
  • Can include flexural involvement e.g. at elbows and knees
  • Can become widespread, affecting many different areas of the body
  • Can also commonly be found on the hands, feet and scalp
  • The genitalia can be affected

Common examples:

  • Atopic eczema
  • Discoid eczema
  • Gravitational eczema
  • Asteatotic eczema
  • Hand/foot eczema
  • Contact allergic dermatitis

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Psoriasis 2

Clinical features may include some of the following:

  • Lesions consisting of chronic, sharply-demarcated, red, scaly plaques
  • Plaques which are red and well-defined with a silvery surface scale
  • Most cases of chronic plaque psoriasis are described as large plaque psoriasis or small plaque psoriasis
Psoriasis on the elbow

Psoriasis on the elbow

The distribution of plaques can:

  • Be symmetrical
  • Be on extensor surfaces or can be widespread
  • Merge to cover very extensive areas of the skin, particularly on the trunk and limbs

Common sites affected include:

  • Scalp
  • Ears
  • Elbows
  • Umbilicus (belly button)
  • Genitalia
  • Gluteal cleft
  • Knees
  • Fingernails and toenails

Common examples:

  • Large plaque psoriasis
  • Small plaque psoriasis

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Ichthyosis 3

Ichthyoses are a group of skin conditions characterised by a generally uniform and persistent pattern of scaling. There are at least 20 varieties of ichthyosis: the most common one is ichthyosis vulgaris, which can occur in conjunction with atopic eczema, and many have keratosis pilaris.

Clinical features of ichthyosis vulgaris may include some of the following:

  • Small, fine, irregular scales, often curling up at the edges. The scaling, which is semi-adherent, is often much more pronounced on the shins. The scale is usually white-grey, although dark-skinned individuals often have darker scales 

While the skin may appear dry or normal at birth, fine scaling is usually apparent by two months of age, although occasionally the diagnosis does not become apparent until the age of five years. The distribution of ichthyosis can be as follows:

  • It can often be found on the outer parts of the arms and legs and less frequently on the flexural creases or the nappy area (in babies)
  • The trunk, and in particular the abdomen, is mildly affected. The forehead and cheeks may be involved early on, but scaling usually diminishes in these areas with age

Other types of ichthyosis, besides ichthyosis vulgaris, include X-linked recessive ichthyosis (XLRI), lamellar ichthyosis (LI) and harlequin ichthyosis – these are very rare.

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More information

To read more about the dry and itchy skin conditions featured on this page, or for more information about other skin conditions, visit the Primary Care Dermatology Society’s website. This has an A–Z list of a wide range of skin conditions, as well as a list of common conditions

Next: A stepwise approach to treating dry and itchy skin >

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References

  1. Primary Care Dermatology Society (PCDS). (2017a). Eczema (Atopic eczema). [accessed April 2017] via http://www.pcds.org.uk/clinical-guidance/atopic-eczema
  2. Primary Care Dermatology Society (PCDS). (2017b). Psoriasis: an overview and chronic plaque psoriasis. [accessed April 2017] via http://www.pcds.org.uk/clinical-guidance/psoriasis-an-overview
  3. Primary Care Dermatology Society (PCDS). (2017c). Ichthyosis. [accessed April 2017] via http://www.pcds.org.uk/clinical-guidance/ichthyosis

Thank you to Dr Tim Cunliffe (GPwSI Dermatology and Skin Surgery, South Tees NHS Foundation Trust, Middlesbrough) for his help in recognising the most prevalent conditions discussed in this section.

UK/E45-NHS/0317/0004a