Dry, Crusty Skin: What to Know

Flaking and fine scale often occur when dry skin loses water and sheds unevenly. A cracked, net-like pattern on the legs may fit asteatotic eczema, while itchy red patches may fit atopic dermatitis. Thick, sharply defined scale can occur with psoriasis. Crust over a scratch may be dried serum or blood, but honey-coloured crust, warmth, tenderness, pus or expanding redness raises concern for infection. The location, colour, itch and speed of change help guide diagnosis.

Wash gently with lukewarm water and a non-perfumed cleanser, pat dry and apply an emollient while the skin is still slightly damp. Repeat regularly and avoid scratching, scrubbing, hot showers and fragranced products. Do not peel off attached crust or cover a weeping area with an occlusive product without advice. If a new medicine or product preceded the rash, stop it when safe and record the timing for your clinician.

Seek prompt medical care for rapidly spreading redness, increasing warmth or pain, pus, fever, red streaks, facial or eye involvement, or a wound that will not heal. Arrange a routine review when crusting persists, returns in the same place, affects a large area, or does not improve with gentle moisturising. A clinician may need to distinguish dry skin from eczema, psoriasis, infection or a sun-related lesion.

Does the colour and texture suggest eczema, psoriasis, infection or another cause? Which emollient should I use, and should any product be avoided? What changes would require prompt review or treatment?