Q. My skin is in terrible shape. Every winter about this time my hands start cracking and peeling and they look terrible. The dryness makes my skin feel like sandpaper and the itching is unbearable. I have been a bloody mess from scratching and suffer greatly.
I have been to more than a dozen doctors, including dermatologists and allergists. They give me greasy ointments that I hate or cortisone creams. I have even taken oral prednisone, which worries me because of possible side effects. Antibiotics are prescribed if I get a skin infection from scratching. Nothing really helps for long.
I am at my wit’s end and am willing to try anything to ease the dryness and the itching. Help!

A. You are not the only person who suffers with horribly dry skin at this time of year. Low humidity dries out skin and lips and can make life miserable.
Another reader shared his own experience in this regard:

“I have spent hundreds of dollars on all types of creams and medicines for dry, itchy skin and eczema. I have more back scratchers than Carter has liver pills. I even have them in the car.
“Last December I read an article in a health magazine suggesting that an individual suffering from osteoporosis, as my sister does, take cod liver oil in order to get the necessary vitamins A and D in order to utilize the calcium she was taking. This was especially true for my sister since she was not getting very much sunshine.
“I decided that I would take some along with her, thinking it couldn’t hurt. Well lo and behold, within two weeks I received the best Christmas present I ever received. The itching and rash have entirely disappeared and I am free of this malady once and for all.
“My skin needed oil from the inside out and no one ever figured this out. I don’t think it really matters whether it is cod liver oil or flaxseed oil. I take 4 tablespoons a day, 2 in the morning and 2 in the evening. I hope you can pass this on to others who might benefit from my experience.”
Bob

We are delighted to learn that you got such amazing relief from cod liver oil, but we caution against such a high dose. It may have relieved your skin condition, but too much cod liver oil might actually weaken bones and increase the risk for osteoporosis. The reason is the vitamin A (retinol) content in cod liver oil.
We have known for more than two decades that too much vitamin A is associated with osteoporosis and an increased risk for fractures (Annals of Internal Medicine, Nov. 15, 1998. A study published in JAMA (Jan 2, 2002) found that postmenopausal women with the highest intake of vitamin A were at greatest risk for hip fractures.
Investigators who have tried to explain why women from Scandinavia (especially Sweden and Norway) have weaker bones and a higher incidence of hip fractures compared to other Europeans have hit on their high consumption of cod liver oil. They attribute the problem to the high retinol content of cod liver oil, as well as vitamin A-enriched milk and cereal.
Swedish researchers have also found that men with high vitamin A intake are at greater risk for fractures, including hip fractures. They published their findings in the New England Journal of Medicine (Jan. 23, 2003).
Part of the problem may be attributed to the fact that vitamin D levels have been reduced in many cod liver oil products. This is done in large measure to deodorize cod liver oil and make it more palatable. If the ratio of vitamin A to vitamin D is out of kilter, it can increase the risk for osteoporosis and fractures.
Some cod liver oils contain over 13,000 IU of vitamin A in a tablespoon. The maximum people should take is 10,000 IU per day. If you are swallowing 4 tablespoons every day, that could add up to almost 50,000 IU of vitamin A daily…way too much! We think 2,000 IU of vitamin D3 is essential for bone health and immune function and many cod liver oils do not have that much.
Bottom line, we think that it is essential to get a good balance of both vitamin A and D and we worry that many cod liver oil products do not provide that. A high-quality fish oil that supplies omega-3 fatty acids plus a vitamin D3 supplement might provide a good balance of nutrients and ease dry skin. Flax seed might also be beneficial. Keeping cod liver oil intake to under 1 tablespoon daily might also be safe if the vitamin A content is not excessive.
We humbly offer another solution to the dry skin dilemma. It turns out that urea is an amazing natural moisturizer for really dry skin. A study in the most prestigious dermatology journal (Journal of Investigative Dermatology, June, 2012) suggests that when an adequate amount of urea is applied to the skin in a topical cream it can strengthen the skin’s barrier function and boost its resistance to microbes. That may be why it is so helpful for conditions such as eczema (atopic dermatitis).
It is not always easy to find high-potency urea creams. The sponsor of our radio show, Redex Industries, makes a terrific product Udderly Smooth Extra Care 20 with 20% urea at an affordable price. You can find it at this link.

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  1. lee
    Reply

    How about if a person were to consume 1/8 tspn. a day (gradual increase to 1-2 tspn, CYCLED)?

  2. tll
    Reply

    As I make my own lotion, more info on urea would have been useful…

  3. fbl
    Reply

    dls, my guess is that you don’t have enough fats in your diet. Try taking two tablespoons of organic coconut oil daily. See my recipe above for one suggestion.
    Dry skin is a result of poor diet and/or nutrition and not enough fats. Natural fats please! Nobody should have to go through what you are for comfortable skin!

  4. dls
    Reply

    I have used many different creams, lotions and oils over the past 65 years. Urea is very good. However, with years of experimentation, I have found that different products are needed for different parts of the body. Keri lotion for the face and ears, aloe vera for the chest, Eucerin cream for the back and back of neck, for the limbs a 50/50 mixture of Crisco and Vaseline with a little baby lotion added for scent, and Curel for the male parts. It takes a long time to apply after a shower, but is worth it the rest of the day.

  5. fbl
    Reply

    MR, you might try adding a bit of natural fats to your diet and see if that helps your skin. It sure has helped me.
    Mine was so bad that even my heels, soles and cuticles would crack. Yes, my skin would feel like it was burning and itching too. I hear ya!
    Try some organic coconut oil, cream and/or real butter. Your body is crying out for some natural fats.

  6. MR
    Reply

    I’ve always had itchy skin during all but the summer months, and only a few commercial lotions helped. Lately I’ve been applying vegetable glycerin after my shower, and have had no itching at all. I’ve read that the skin should be a little bit wet when applying the glycerin. I rub a little rosewater on my skin first, but plain water should work just as well. Anyway, this has given me the most complete relief from itching I’ve ever had. As far as I’ve been able to find out, vegetable glycerin is completely safe, and is free from any additives. I get it at a health food store.

  7. abigail
    Reply

    The information about the proper balance of A and D3 is vague. Please be more specific so we can properly evaluate available products.

  8. fbl
    Reply

    For about the last 12 years I have made myself an afternoon treat using organic coconut oil. I use about 2 TB per mug of hot chocolate. One mug every afternoon.
    My skin is great! I’ve not been plagued with dry skin except a bit during the winter months. We are in the spa every evening after dinner so my skin soaks in hot water every day. During the winter I use a coconut based moisturizer on my skin about every other day. During the rest of the year I need it only once or twice a week. Even chemo and radiation for cervical cancer two years ago didn’t ruin my skin. Aged me a bit though.
    I am 67 and even my family Dr. has commented on my skin. He’s been my Dr. for over 20 years and so has seen me age. I don’t use cosmetics at all either by the way. Almost 30 years ago my skin became sensitive to all of them-even the really expensive hypoallergenic products. Now I stick with coconut oil.

  9. Susan
    Reply

    This is a recipe that I have made up and use.
    My substitutions are coconut oil (Luann brand at Walmart, as I am using it externally), my homemade non-petroleum jelly, and Dermasil lotion from Dollar Tree. I get the Vit E cream at Walmart, two 4-oz containers. I clean them out and use them to hold the lotion.
    Or you can make it with the baby lotion, Vaseline & Vit E cream.

  10. RHB
    Reply

    About 20 years ago I developed severe eczema on my hands. I tried various commercial moisturizers. They helped relieve the dryness, but after a few days the itching got worse.
    I went to a dermatologist who gave me some lotions and ointments to try. Same problem: the dryness improved but the itching got worse.
    I went to another dermatologist at the leading research hospital in the state. He gave me other lotions and ointments and they produced the same results: less dryness but more itching.
    I went to a third dermatologist who had a private research institute. He told me I needed to stop using all of the other products, and stop using soap to wash my hands. He had me start doing two things that worked for me: 1) Use Cetaphil Gentle Skin Cleanser (or a store-brand equivalent) to clean my hands; and 2) Use a thin layer of Cetaphil Gentle Skin Cleanser followed by a thin layer of Cetaphil Moisturizng Cream for moisturizing.
    Through trial and error I discovered that moisturizing several times a day with the Cetaphil products made my hands itch slightly. I am better off to moisturize once a day just before I go to bed.
    About 10 years after the onset of eczema on my hands, the skin on my arms and face began to look dry and scaly. I stopped using soap in the shower and use Cetaphil Gentle Skin Cleanser instead.
    I also use a steam vaporizer in my bedroom at night during the winter. These treatments have kept my skin healthy.

  11. Mariellen G.
    Reply

    Sometime in the last year, you had a letter from a woman who used olive oil on the most-girl part of her. I tried it, and found it relieved the itching at least as well as the hormone cream I’d been using wayyy too often. (I shared the suggestion with a friend, including the letter-writer’s “dosage” of five drops, using a medicine dropper, a day. My friend indicated that five drops from a turkey baster might be a more appropriate dosage for her!!) Anyway, with the onset of winter and dry indoor heat, I’ve begun rubbing the olive oil in ALL the itchy places externally. It helps a lot.

  12. MH
    Reply

    I once read, I believe in this column, that Borage Oil was effective in relieving eczema. I tried it and, lo and behold, it is! Additionally, it is helpful in relieving arthritis (such as in the knee). It comes in capsule form. It does work.
    Good luck!

  13. Karen
    Reply

    A good quality fish oil would probably give the same results without the vitamin A risk. My experience is that dry skin is often a consequence of low-fat diets.

  14. CBL
    Reply

    My husband had VERY dry skin all year, but especially during Winter. Straight Mineral Oil solves the problem. It IS messy, but soaks into the skin in about 5-10 minutes and the skin is no longer oily. Stand on a towel when you apply it to keep the oil off the floor. Wearing thermal underwear seems to help, too. AmLactin lotion (we get ours at Costco) applied immediately after drying off stings the first few times it’s applied, but it’s not messy, and it also solves the problem. Use soaps from the health-food store. Old-fashioned sponge baths and washing your hair in the sink keep water off the rest of your skin. My mother used to use Crisco, and her skin was soft and didn’t itch.

  15. aj
    Reply

    Quilters use the udderly smooth cream on their hands and it works great.

  16. H
    Reply

    Be careful about fish oils if you are on blood thinners or anticoagulants ie Plavix etc. I had a reaction which I believe was caused by taking flaxseed oil while I am on Plavix. I love natural remedies but when you are on Rx meds I think you have to be more cautious. It’s good to keep some notes when you start taking something different so you can backtrack and figure things out if you need to. My Dr. and my eye Dr. had recommended the flaxseed oil and we all learned something.

  17. Judith
    Reply

    I have suffered from dry skin year round for a long time. The one thing that helps me is Evening Primrose Oil. I take a lot – 3,000 mg per day but it is the only way to stop my skin from cracking. Walmart, surprisingly has a high quality, low cost solution.

  18. T Allyn
    Reply

    Hydrous lanolin in a jar with no water added (can be ordered by most pharms) and raw shea butter (non-processed) both heal and moisturize…and work!

  19. Rick B
    Reply

    I’m interested in finding out more about the subject as I suffer immensely from eczema.

  20. H. A. O'Connell
    Reply

    When my fingers and knuckles become dry and cracked (splitting open), and/or my hands get chapped, I am reminded that my Vitamin A is insufficient. Adding 10,00 IU/day (with food) for a few days – heals them up quicker than any cream, lotion or ointment applied externally. When my fingernails begin breaking off easily, the vitamin A again does the trick, restoring my nails to normal strength! I take this supplement is in addition to my multiple.

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