Eczema vs. Dry Skin: What’s the Difference?

Sometimes, dry, itchy skin just needs a little more moisture to regain its strength. But when the irritation keeps coming back — or starts to burn, swell or become intensely itchy — you may wonder if it could be something else, like eczema.

Dermatology resident Angela Wei, MD, explains how to tell the difference between these two conditions, and which treatments may help.

Differences between eczema and dry skin

Dry skin is usually a temporary condition that occurs when your skin doesn’t have enough moisture, like in the middle of winter.

Eczema (atopic dermatitis) is also common. But it’s a chronic inflammatory condition involving a weakened skin barrier and activation of the immune system.

There’s some overlap between the two, but they’re also very different. Let’s break down some of those differences.

Symptoms

Dry skin is a common condition that causes:

• Mild, temporary itching
• Flaking or cracking
• Dull or ashy-looking skin
• Tight, rough skin
• Mild irritation or sensitivity

Eczema, on the other hand, tends to have more severe symptoms like:

• Inflamed, irritated skin
• Discoloration or rashes
• Swelling
• Thickened, crusted, cracked or sometimes oozing skin
• Intense, persistent itching

Timing is a key difference, too. Eczema usually starts in childhood, but it can develop at any point in your life. It also tends to flare up in response to different triggers over time.

“The biggest complaint people have with eczema is itchiness,” shares Dr. Wei. “It can be intense and can interfere with daily activities. The itching also tends to get worse at night and can disrupt your ability to sleep, too.”

Causes

A lack of moisture causes dry skin. As you get older, your skin tends to dry out naturally. But you can also get dry skin from:

• Cold, dry weather
• Low humidity
• Sun exposure
• Over-washing
• Harsh soaps or skin care products

Some skin conditions, like psoriasis and eczema, can also lead to dry skin when they cause lasting inflammation and skin damage.

Eczema happens when your skin’s natural defenses break down and your immune system overreacts. Genetics plays a role in that.

“If you have a family history of eczema, asthma or environmental allergies, you’re at higher risk for eczema,” explains Dr. Wei.

Eczema flares can also be triggered by:

• Allergies
• Extreme temperatures
• Irritants, like soaps, detergents and fragrances
• Hormonal changes
• Infections
• Stress and anxiety

Can dry skin cause eczema?

“Dry skin can lead to eczema flares or make existing symptoms worse for people prone to eczema,” warns Dr. Wei. “This is because dry skin causes cracks in your skin barrier, which makes it easier for irritants, allergens and germs to penetrate the skin and trigger inflammation.”

But having dry skin doesn’t mean you’ll get eczema. While we don’t know exactly why some people get eczema, it’s likely due to many factors, including:

• Genetics
• Immune function
• Environmental exposures

Location

Dry skin can occur anywhere on your body, but it’s most common on areas exposed to the elements, like your:

• Hands
• Face
• Arms
• Shins and lower legs

Eczema can also occur anywhere on your body, but common areas in adults include:

• Inner elbows
• Backs of your knees
• Hands
• Face
• Neck

Treatments

If you have dry, cracked skin, try these solutions:

• Hydrate your skin. Moisturize right after you get out of the shower or bath to lock in that water content, and drink plenty of water throughout the day.
• Avoid irritants. “Use fragrance-free cleansers without added dyes,” advises Dr. Wei. “These tend to be gentler on your skin and are less likely to cause inflammation or irritation.”
• Make adjustments. Use a humidifier in cold, dry environments, and avoid hot showers to avoid drying out your skin. It also helps to keep showers short.

As these lifestyle changes can help keep your skin healthy and strong, they can help soothe eczema flares, too. More specific treatments for eczema include:

• Topical steroids and nonsteroid anti-inflammatory creams
• Phototherapy (light therapy)
• Systemic treatments, including oral medications and injectable biologic therapies, like dupilumab (Dupixent®)

“Taking care of your physical and mental health also goes a long way to reducing the likelihood of a future flare,” says Dr. Wei.

When should you see a doctor?

Both dry skin and eczema can be uncomfortable and frustrating. Plus, it’s not always easy to tell what type of skin condition you’re dealing with.

Dr. Wei recommends making an appointment if:

• Your symptoms don’t improve with regular moisturizer and hydration.
• You’ve got signs of an infection like oozing, crusting, increasing redness, fever or pain.
• Itching is constant, keeps coming back and/or disrupts daily activities, like sleep.

“If symptoms are affecting your quality of life and over-the-counter options aren’t helping, make an appointment with a dermatologist,” advises Dr. Wei. “We can help you find relief and figure out if it’s eczema or something else.”