How can I tell irritated skin from dry skin?

Which signs are most useful?

Flaking and cracking alone cannot separate the two: an irritated rash can also be dry and scaly. Look at the discomfort, visible changes and recent exposures together. Irritated patches can look red or darker than your usual skin tone; hand eczema can appear dark brown, purple or gray.23

Did something change before the symptoms started?

Check for new soaps, lotions, cosmetics, household products or contact with chemicals at work. A new bottle is worth putting on the suspect list, rather than automatically giving it the benefit of its packaging. Irritant contact dermatitis, a rash caused by direct irritation, usually develops quickly and is more painful than itchy. Allergic contact dermatitis usually itches more than it hurts and can appear several days after exposure, including after repeated use of a product.2

Repeated flares with strong itching, swelling or crusting need a different approach from occasional dryness. Eczema is a group of conditions that cause dry, itchy, inflamed skin; atopic dermatitis is one type and can begin at any age. Dry skin can worsen eczema in someone prone to it, but dryness does not mean you have eczema. Scratching can increase redness, swelling and itching.145

What should I do first?

Start with gentle cleansing, regular moisturising and avoiding suspected triggers. The useful routine here has fewer moving parts, not an ensemble cast of bathroom bottles.56

1. 1Avoid a suspected irritating product or substance. Use a gentle cleanser without fragrance or added dyes instead of harsh or perfumed soap.
2. 2Keep baths and showers short, using cool or lukewarm water rather than hot water.
3. 3Apply moisturiser immediately after bathing, then regularly as needed. Creams suit moderate dryness; ointments retain more moisture and suit very dry, scaly areas. For eczema, choose a mild, fragrance free cream or ointment.
4. 4For itching, hold a cool, damp towel against the area and pat or tap instead of scratching. Keep nails short and smooth.

Improvement with moisturiser is useful, but does not identify the cause: moisturisers also help mild irritant dermatitis and eczema. Moisturisers themselves can cause burning or stinging. Urea and lactic acid preparations often sting scratched, cracked or inflamed skin, so avoid treating a painful patch as a cue for stronger exfoliation.46

For hands, rinse cleanser off thoroughly, including between fingers, and pat dry. Apply a fragrance free cream or ointment often throughout the day. Extremely dry, painful hands that do not improve with moisturiser need assessment for hand eczema.3

When should I get medical help?

Arrange an appointment if regular moisturising does not help, itching keeps returning or disrupts sleep, or a rash remains after a week of treatment. Get medical advice for severe pain, fever, warmth, yellow or green fluid, red streaks, or blisters around the eyes, mouth or genitals. During pregnancy, report itching to your doctor or midwife, even without an obvious rash.127

Seek emergency care for a sudden rash that spreads quickly, trouble breathing or facial swelling.2