Itchy Skin In Winter - How To Treat?

Posted by Dr. Natasha Ryz on

Itchy skin in winter is frustrating and painful.

Itchy skin in winter is caused by dry skin and skin barrier disruption.

Topical therapy is the backbone of treatment for dry itchy skin and includes emollients, glycerol, urea, zinc oxide, colloidal oatmeal, and cannabis.

Treatment of itchy skin should include prevention by emollients and aim for a quick disruption of the itch-scratch cycle.

 This article will discuss:

    • What is winter dry skin?
    • What is itch or pruritus?
    • What causes dry skin to itch?
    • How to treat dry itchy skin
    • Tips for treating dry itchy skin
    • How to protect your skin barrier
      • What is the skin barrier?
      • How to protect your moisture barrier
      • How to protect your lipid barrier 
      • How to protect your acid mantle 
    • Things to try for dry itchy skin in winter
      • Emollients for itch relief
      • Omega 3 fatty acids for itch relief
      • Cannabis for itch relief
      • Glycerol for itch relief
      • Urea for itch relief
      • Zinc oxide for itch relief
      • Colloidal oatmeal for itch relief
      • Cold exposure for itch relief
      • Peppermint and menthol for itch relief
      • Vinegar for itch relief
      • Summary
      • References

      Itchy Skin In Winter - How To Treat Dry Skin Itch

      What is winter dry skin?

      'Winter dry skin' is dry skin that develops during the cold winter season.

      Winter dry skin can have a wide spectrum of symptoms - from mild dryness and flaking to severe itching, redness and pain.

      Winter dry skin symptoms are painful and frustrating, and often associated with skin conditions such as eczema or atopic dermatitis. 

      Symptoms of winter dry skin include:

      • Loss of skin elasticity.
      • Skin feels tight, dehydrated.
      • Skin appears dull, rough and blotchy.
      • Slight to severe flaking, scaling or peeling.
      • Fine lines and wrinkles are more pronounced.
      • May have irritation and a burning sensation.
      • Mild to severe itching.

      Learn more: What is Dry Skin Pain?

      Winter dry skin has been reported to involve scaling, defects in water holding and barrier functions, and decreased lipid levels in the stratum corneum (Ishikawa et al, 2013).

      The following contribute to winter dry skin:

      • lack of water in skin
      • lack of water-holding substances called humectants (glycerin, hyaluronic acid, natural moisturizing factors)
      • lack of epidermal lipids (ceramides, fatty acids, cholesterol)
      • lack of sebum (triglycerides, wax esters, squalene)

      Learn more: Winter Dry Skin - What is it?

      What causes winter dry skin?

      Exposure to winter weather can weaken your skin barrier and its protective functions.

      It is broadly accepted that skin barrier functions may be negatively affected by winter conditions, including:

      1. cold temperature
      2. low humidity
      3. wind exposure
      4. sun exposure 

      Cold to freezing temperatures can damage your dry skin. Furthermore, cold temperatures often mean low humidity, which also dries out your skin. Bitterly cold winds can also strip moisture from exposed skin. And during the winter there is also potential for UV damage from sun exposure.

      Learn more: Winter Dry Skin - What Causes It?

      Itchy Skin In Winter - How To Treat Dry Skin Itch

      What is itch or pruritus?

      Itch, also known as pruritus, is an unpleasant skin sensation, which induces an impulse to scratch (Stephen et al, 1941; Ikoma et al, 2013).

      The sensation of itch is caused by itch-inducing substances, called pruritogens, that bind to receptors in your skin, resulting in the perception of itch (Kamo et al, 2017).

      What causes dry skin to itch?

      The main cause of dry skin induced itch is thought to be due to a decline in skin barrier function (Kamo et al, 2017).

      Histamine is one of the major itch mediators, but studies show histamine-dependent and histamine-independent pathways in transmitting itch (Toyama et al, 2022).

      Because histamine is a well-known pruritogen, antihistamines are the first line of treatment against itch. However, antihistamines are not fully effective in some dermatological conditions, such as xerosis, atopic dermatitis and psoriasis. Therefore, dry skin is thought to be an important feature of antihistamine-resistant (histamine-independent) itch (Kamo et al, 2017).

      Itch sensation is usually increased at night due to higher skin temperature, heat under the blanket, circadian rhythms of neuropeptides and cytokines, and fewer distractive thoughts (Patel et al, 2007; Lavery et al, 2016).

      Itchy Skin In Winter - How To Treat Dry Skin Itch

      How to treat dry itchy skin?

      Dry itchy skin can be complex, and difficult to treat.

      Dry itchy skin in winter is often relieved with the use of moisturizers, emollients, and some lifestyle modifications, such as using a humidifier, avoiding harsh cleansers, and supplementing the diet with essential fatty acids. 

      In addition, nutrient-rich oils, balms and barrier creams are required to improve dry skin and protect against further damage.

      Active ingredients, including vitamins, humectants, lipids and fatty acids can help repair the skin barrier, calm redness, and sooth irritation and itch.

      Treatment options for dry itchy skin include a combination of emollients and moisturizers, fatty acids, zinc oxide, colloidal oatmeal, cannabinoids, peppermint oil and menthol, capsaicin and UV therapy (Weisshaar et al, 2019).

      Some people with dry itchy skin may also require medications to control symptoms, including antimicrobial agents, antihistamines, anti-inflammatory agents, anesthetics, immunotherapy, biologicals, and others (Weisshaar et al, 2019).

      No treatments can claim consistent or complete efficacy, and often a combination of treatments is required (Weisshaar et al, 2019).

      Talk to your doctor about treatments for dry itchy skin in winter.

      Itchy Skin In Winter - How To Treat Dry Skin Itch

      Tips for treating dry itchy skin

      General tips for treating dry itchy skin in winter include:

        • Use a skin moisturizer daily, especially after showering and bathing.
        • Use a mild cleanser, low pH soaps and syndets.
        • Try a luke-warm water, bath (max 20 min), possibly adding colloidal oatmeal, dabbing the skin dry after bathing.
        • Avoid frequent washing and bathing.
        • Avoid chlorine exposure in pools and hot tubs.
        • Wear soft, lightweight clothing such as silk, linen, and muslin.
        • Avoid irritating fabrics like flannel and wool, which can exacerbate symptoms of winter itch.
        • Dress in layers to avoid sweating.
        • Keep room temperature cool at night while you sleep
        • Avoid contact with allergenic and irritant substances (e.g., certain fragrances, preservatives and surfactants).
        • Keep fingernails short and trimmed.

      (Adapted from Weisshaar et al, 2019).

      Itchy Skin In Winter - How To Treat Dry Skin Itch

      Protect your skin barrier

      To treat dry itchy skin in winter, you must protect your skin barrier, including your moisture barrier, lipid barrier and acid mantle.

      What is the skin barrier?

      Your skin barrier includes the outermost layers of skin, called the stratum corneum.

      The stratum corneum can be thought of as a brick wall that protects you.

      On a weight basis, the stratum corneum contains approximately 70% protein, 15-25% water and 15% lipids (Ananthapadmanabhan et al, 2013).

      The structure of the stratum corneum can be described as a ‘brick and mortar’ model, in which the protein-rich corneocytes are the bricks, and the mortar is the lipid‐rich matrix containing ceramides, cholesterol, and fatty acids.

      When your skin barrier is healthy, it feels and appears smooth, soft, and plump.

      In contrast, a damaged skin barrier looks dry, rough, dull, and dehydrated, and may become irritated, inflamed and itchy.

      The skin barrier includes:

      • The moisture barrier
      • The lipid barrier
      • The acid mantle

        Learn More: What is The Skin Barrier

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Protect your moisture barrier

          The moisture barrier is a part of your skin barrier. 

          The skin moisture barrier ensures your skin is hydrated by trapping and holding water into your skin.

          The skin moisture barrier is composed of water, natural moisturizing factors (NMFs) and other humectants, such as glycerol and hyaluronic acid to attract and hold onto moisture.

          There are several ways to protect your moisture barrier:

          1. Drink water.
          2. Use a humidifier.
          3. Use a moisturizer with humectants.
          4. Limit exposure to cold weather.
          5. Protect your skin from the elements.

          Learn more: Winter Dry Skin - How To Prevent Dry Skin

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Normal skin hydration

          Water is essential for the normal functioning of the skin. 

          The water content of skin is remarkably high - the epidermis (the outer skin layer) contains more than 70% water, while its outermost layer, the stratum corneum has been shown to contain ~15 - 25% water (Warner et al, 1988; Caspers et al, 2001; Caspers et al, 2003).

          Adequate hydration of the stratum corneum serves three major functions (Fowler, 2012):
          1. it maintains plasticity of the skin, protecting it from damage
          2. it contributes to optimum stratum corneum barrier function
          3. it allows hydrolytic enzymes to function in the process of desquamation
          When the water content of the stratum corneum falls below 10%, scaling on the skin surface becomes visible (Rycroft, 1985).
          The retention of water in the skin is dependent on:
          1. Natural moisturizing factors (NMFs) and other humectants (such as glycerol and hyaluronic acid) to attract and hold onto moisture
          2. Intercellular lipids (fats) that form a barrier to prevent transepidermal water loss (TEWL) (Verdier-Sévrain et al, 2007). 

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Protect your lipid barrier

          The lipid barrier is a part of your skin barrier. 

          The surface of your skin is covered by a layer of protective lipids (fats), including epidermal lipids and sebum.

          Epidermal lipids are released from keratinocytes (skin cells), and are a mixture of ceramides, free fatty acids and cholesterol. These lipids are released from skin cells and fill the spaces between the cells, like mortar or cement (Pappas, 2007).

          Learn more: Beneficial Fats Found Naturally in Your Skin Barrier

          There are several ingredients that can protect your lipid barrier:

          1. Emollients
          2. Linoleic acid
          3. Occlusives

          Emollients can protect your lipid barrier

          The word emollient derives from the present participle of the Latin verb emollire, which means "to soften or soothe." Emollire, in turn, derives ultimately from mollis, meaning "soft." 

          Skincare ingredients that function as emollients include plant butters, vegetable and fruit oils, animal fats, and esters.

          Products that function as emollients include moisturizers, creams, oils, serums, and balms.

          An emollient is an ingredient in a moisturizer. The job of the emollient is to soften skin.

          Learn more: What are Emollients? Best Emollients for Dry Skin.

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          What are the benefits of emollients?

          The function of emollients in skincare is to soften the skin, help the skin retain its moisture and to support the skin’s barrier function.

          Skin that does not have sufficient lipid content on its surface can appear dull, dry and rough. Emollients "fill in the gaps" in the skin barrier and soften it along with giving it a healthier look

          The role of emollients in the treatment of dry skin conditions is often underestimated. Emollients promote optimal skin health and prevent skin breakdown, and their use can improve quality of life (Moncrieff et al, 2013; Newton et al, 2021).

          Emollients are skin conditioning – the give skin a soft and smooth appearance, restoring suppleness and improving elasticity (Brown et al, 2005).

          Emollients:

          • Make your skin feel soft and smooth.
          • Help reduce flaking and roughness from dry skin.
          • Help assist the skin barrier by filling in gaps between cells.

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          What is linoleic acid?

          Linoleic acid is an essential fatty acid found naturally in healthy skin.

          Linoleic acid is the most abundant polyunsaturated fatty acid in the skin barrier (Ansari et al, 1970).

          Linoleic acid is also the precursor to ceramide synthesis (Breiden et al, 2014).

          As an essential component of ceramides, linoleic acid is involved in the maintenance of the transdermal water barrier of the epidermis (Whelan et al, 2013). 

          Linoleic acid can relieve symptoms of dry skin.

          Most of the free fatty acids can by synthesized by your skin cells and are released into the outer stratum corneum.

          However, linoleic acid is an essential fatty acid that must be provided externally through diet, supplements or topically through skincare products (Lin at al, 2017).

          Learn more: Linoleic Acid Omega 6 Fatty Acid - Benefits for Dry Skin

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          What are occlusives?

          Occlusives are skincare ingredients or products that form a protective film that prevents moisture loss from the skin.

          They are usually oily or waxy. 

          Occlusives include:

          • Mineral oil
          • Petrolatum
          • Lanolin - from sheep's wool
          • Beeswax
          • Cocoa Butter
          • Jojoba oil

          Mineral oil and petrolatum are two of the most effective occlusive ingredients.

          Some ingredients that are emollients also have occlusive properties.

          For instance, cocoa butter is an emollient because it softens skin, and cocoa butter is also an occlusive because it forms protective barrier on your skin.

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Protect your acid mantle

          The acid mantle is a part of your skin barrier.

          The term "acid mantle" describes the inherent acidic nature of the outer skin barrier, or stratum corneum.

          Maintaining skin pH is important, as skin pH influences skin barrier homeostasis, stratum corneum integrity and cohesion, and antimicrobial defense mechanisms. 

          Many factors can affect the pH of the skin, including age, sebum, sweat, detergents, cosmetics, and irritation (Ali et al, 2013; Yosipovitch et al, 1996).

          Even rinsing your skin with water alone produces an immediate but transient increase in its pH (Gfatter et al, 1997). 

          Learn more: What is The Acid Mantle of The Skin Barrier? 

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Avoid high pH soap

          The high pH of soap can disrupt the skin barrier.

          Soaps typically have a high pH of 9-10, and soap can disrupt the skin barrier.

          The pH of the skin is generally in the range 4.5 to 6.5.

          The high pH of soap causes swelling of the stratum corneum, which allows unwanted deeper penetration of the soap into the skin possibly causing irritation and itching (Prottey et al, 1975).

          Soap can also binds to stratum corneum proteins further inducing swelling and hyper hydration of the skin. Following the completion of washing, the excess water evaporates leading to skin tightness and dryness because the soap binding reduces the ability of the skin proteins to hold water. This explains the reduction in skin hydration and elasticity following soap cleansing (Draelos et al, 2018).

          To protect your skin's acid mantle, ditch the alkaline soaps.

          Try using a gentle cleanser such as an oil cleanser or an oil to milk cleanser.

          Learn More: 8 Types of Face Cleansers - Which Are Best for Cleansing Your Dry Skin?

          Itchy Skin In Winter - How To Treat Dry Skin Itch

          Things to try for dry itchy skin

          There are several treatment options for dry itchy skin in winter:

              1. Emollients for itch relief
              2. Omega 3 fatty acids for itch relief
              3. Cannabis for itch relief
              4. Glycerol for itch relief
              5. Urea for itch relief
              6. Colloidal oatmeal for itch relief
              7. Zinc oxide for itch relief
              8. Cold exposure for itch relief
              9. Peppermint and menthol for itch relief
              10. Vinegar for itch relief

            Talk to your doctor about treatments for dry itchy skin in winter.

            Itchy Skin In Winter - How To Treat Dry Skin Itch

              1. Emollients for itch relief

              Emollients and barrier-improving creams are the first-line therapy for the treatment of all skin barrier related itch (Pavlis et al, 2018; Moncrieff et al, 2013).

              Emollients are a broad category of skincare ingredients and products.

              Skincare ingredients that function as emollients include plant butters, vegetable and fruit oils, animal fats, petrolatum, mineral oil, and esters.

              Products that function as emollients include moisturizers, creams, oils, serums, and balms.

              An emollient is an ingredient in a moisturizer. The job of the emollient is to soften skin.

              Learn more: What Are Emollients? Best Emollients for Dry Skin 

              Moisturizers and oils rich such as mineral oil and sweet almond oil can relieve itching. Furthermore, individual fatty acids such a gamma-linolenic acid can also relieve itching.

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Moisturizers for itch relief

              A moisturizer is a skincare product, such as a cream or a lotion, that is used to prevent dryness in the skin.

              Moisturizers contain water and add moisture to the skin.

              Moisturizers also contain emollients, humectants and occlusives.

              • Emollients soften, smooth, and condition the skin.
              • Humectants attract and hold moisture to the skin.
              • Occlusives form a protective film that prevents moisture loss from the skin.

              The balance of these ingredients determines whether a moisturizer is better for dry skin or oily skin. For instance, a moisturizer for dry skin would contain a high percentage of emollients and occlusives.

              Moisturizers have been shown to improve skin barrier function, by preventing excess transepidermal water loss (TEWL) and the entry of external pruritogens, which may help alleviate itching (Kamo et al, 2016).

              As the composition of moisturizers varies, the effectiveness of moisturizers can differ depending on the base ingredients and actives.

              For instance, using emollients with anti-itch ingredients, e.g., urea (5–10%), glycerol (20%), menthol (1%), zinc oxide (10%) has shown to be effective against pruritus (Weisshaar et al, 2019).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Mineral oil for itch relief

              Mineral oil (baby oil) has been shown to relieve itching in patients with uremic pruritus (Lin et l, 2012; Karadag et al, 2014; Singh et al, 2021). 

              For instance, topically applied mineral oil soothed itching briefly and improved sleep quality and quality of life in a randomized clinical trial of 70 hemodialysis patients with pruritus (Karadag et al, 2014).

              Applying baby oil is a simple, safe, inexpensive and easily administered treatment for itchy skin in haemodialysis patients (Lin et al, 2012). 

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Sweet almond oil for itch relief

              Sweet almond oil is an excellent emollient and is known for its ability to soften the skin. Topical sweet almond oil has been shown to reduce itch, and significantly improved the itch-related quality of life of patients with uremic pruritis (Afrasiabifar et al, 2017; Mehri et al, 2018).

              Sweet almond oil contains approximately 60 - 75% oleic acid, 15 - 30% linoleic acid, 3 - 9% palmitic acid. Interestingly, oleic acid and linoleic acid have both been shown to inhibit TRPV1, a receptor that plays a role in itch and pain responses (Morales-Lázaro et al, 2016).

              Gamma-linolenic acid for itch relief

              In a study in which topical 2.2% gamma-linolenic acid cream was applied to patients with refractory uremic pruritis, the treatment alleviated itch more than a placebo-based cream did (Chen et al, 2006). 

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              2. Omega 3 fatty acids for itch relief

              What are omega-3 fatty acids?

              Omega 3 fatty acids consist of alpha-linolenic acid (ALA), and its two active metabolites, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

              • alpha-linolenic acid (ALA)
              • docosahexaenoic acid (DHA)
              • eicosapentaenoic acid (EPA)

              Alpha-linolenic acid (ALA) is found in green leafy vegetables, flaxseed, walnuts, soybean, and canola oils. 

              The body has a minimal ability to convert ALA into DHA and EPA.

              Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are found in fish oils, marine algae and phytoplankton that naturally produce them.

              Fish oil supplements and omega-3 fatty acid supplements contain oil derived from the tissues of oily fish rich in omega-3 fatty acids, such as salmon, mackerel, sardine, and anchovy. 

              Fish oil supplements contain a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—the two main types of omega-3 fatty acids that provide health benefits.

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Can omega 3 fatty acids help with itching?

              Supplemental omega 3 fatty acids have been shown to help with itching in patients with atopic dermatitis (eczema), hemodialysis and end-stage renal disease.

              In 3 clinical trials, patients with atopic dermatitis took daily omega 3 fatty acid doses ranging from 5000 to 8200 mg and found improvement in disease symptoms including itching (Søyland et al, 1994; Koch et al, 2008; Mayser et al, 2002).

              In a clinical trial of 47 hemodialysis patients who had chronic itching, there was a significant improvement in pruritus and xerosis at 8 weeks of treatment with 6000 mg/d omega 3 fatty acid (Peck et al, 1996).

              Dry skin is an extremely common symptom found in end-stage renal disease patients and has been suggested to be a contributor to pruritis (Shirazian et al, 2017).

              Patients with chronic kidney disease consumed 1000 mg fish oil once daily for 3 months found significantly improved skin hydration on both the face and arms, as well as disease-related symptoms of pruritus (Lin et al, 2022).

              These results suggest a potential promising therapeutic of omega-3 supplementation for improving skin conditions and consequent pruritus symptoms.

              Currently, no study exists recommending the optimal therapeutic dosing of omega 3 fatty acid supplementation for improved skin health. However, significant outcomes were reported with doses ranging from 1200 mg/d EPA + DHA to 18 000 mg/d EPA + DHA (Thomsen et al, 2020).

              Given its high safety profile, low cost, and ease of supplementation, omega 3 fatty acids and fish oils are a reasonable supplement that may benefit patients wishing to improve inflammatory skin conditions through diet (Thomsen et al, 2020).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              3. Cannabis for itch relief

              Topical cannabinoids show great promise for the treatment of itch, including difficult to treat itch.

              Topical cannabinoids are of interest in skin disease because of the high safety profile and direct, local application to involved areas, and recent years have brought an assortment of cannabinoid-containing topicals specifically advertised for use on the skin, such as oils, lotions, emollients, creams, and patches (Avila et al, 2020).

              Cannabinoids include:

              • Phytocannabinoids derived from the Cannabis sativa plant (e.g., D(9)- tetrahydrocannabinol [THC], cannabidiol [CBD])
              • Endocannabinoids (e.g., anandamide and 2-arachidonoylglycerol [2-AG])
              • Synthetic cannabinoids

              (Gaoni et al, 1971; Merchoulam et al, 2014).

              Human studies, although limited, have consistently shown significant reductions in both scratching and symptoms in chronic pruritus (reviewed by Avila et al, 2020).

              Clinical studies have shown a reduction in pruritus (itching) in several skin diseases, including atopic dermatitis, psoriasis, asteatotic eczema, prurigo nodularis, and allergic contact dermatitis, as well as systemic diseases, including uremic pruritus and cholestatic pruritus (Avila et al, 2020; Szepietowski et al, 2005; Yuan et al, 2014; Visse et al, 2017; Dvorak et al, 2003).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Dietary hemp seed oil for itch relief

              Dietary supplementation with hemp seed oil has been shown to improve the skin barrier and significantly alleviate symptoms of eczema, including dry skin and
              itchiness (Callaway et al, 2005).

              Hemp seed oil is obtained by pressing hemp seeds from the hemp plant and extracting the oil. 

              Cold-pressed, unrefined hemp seed oil is a vibrant green color, with a nutty flavor. 

              Hemp seed oil should not be confused with hash oil or cannabis oil, which also comes from the cannabis plant, and contain psychoactive cannabinoids THC and/or CBD.

              Because hemp seed oil is derived from the seeds of hemp plants, rather than the stalks and leaves, it contains only trace amounts of cannabinoids. 

              Hemp seed oil has a long history of safe and effective use.

              Learn more: 5 Benefits of Hemp Oil for Skin - Soften and Strengthen Your Skin Barrier

              More research is required to develop treatment regimens and indications for treating itchy skin with cannabinoids.

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              4. Glycerol for itch relief

              Glycerol is also known as glycerin.

              The beneficial effects of glycerol on the skin have been recognized for over 75 years, and glycerol has been widely used as an ingredient of skincare formulations for its moisturizing and smoothing effects (Fluhr et al, 2008). 

              Glycerol is made by your skin, and endogenous glycerol plays a role in skin hydration, cutaneous elasticity and epidermal barrier repair (Fluhr et al, 2008).

              Interestingly, glycerol is decreased in the stratum corneum of patients with uremic xerosis, and a decrease in glycerol is correlated to an increase in severity of itching and skin barrier alteration (Yosipovitch et al, 2007).

              Topically applied glycerol is known to increase stratum corneum hydration, improve epidermal barrier function and decrease clinical signs of inflammation (Breternitz et al, 2008). 

              Topically applied glycerol has a rapid hydrating and smoothing effect that can be achieved at concentrations ranging from 10 to 15% (Loden et al, 2000).

              In patients with uremic xerosis, treatment with a skin protective product combining 15% glycerol and 10% paraffin was associated with a substantial improvement of the uremic pruritus and quality of life (Balaskas et al, 2011).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              5. Urea for dry itchy skin

              Urea is a hygroscopic molecule, meaning it can attract and hold onto moisture.

              Urea is naturally present on the skin as a component of the complex mixture of natural moisturizing factors (NMFs) that contributes to skin hydration (Verzi et al, 2020; Lacarrubba et al, 2020).

              Urea represents a very useful molecule in dermatology due to its unique moisturizing and keratolytic properties that are exerted in a dose‐dependent manner (Lacarrubba et al, 2020, Celleno et al, 2018; Dall'Oglio et al, 2020).

              In particular, at low concentrations (2–12%), urea acts as an emollient (filling the gaps between desquamating corneocytes thus contrasting dehydration) and a humectant (attracting water from dermis into epidermis and also from the external environment in humid conditions) (Micali et al, 2020; Friedman et al, 2016).

              Moreover, some studies suggest that urea may regulate filaggrin gene expression necessary for proper barrier function maintenance (Friedman et al, 2016; Benintende et al, 2017; Danby et al, 2016). 

              Based on these properties, urea has been topically used for the treatment and prevention of senile xerosis or xerosis associated with skin diseases such as ichthyosis, atopic dermatitis and psoriasis, at concentrations ranging from 2 to 12% in different formulations (Lacarrubba et al, 2020; Pan et al, 2013; Micali et al, 2018).

              Clinical studies have demonstrated that urea‐based topical formulations restore the stratum corneum ability to attract and maintain hydration (Benintende et al, 2017).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              6. Zinc oxide for itch relief

              Zinc has been used as a skin treatment for centuries.

              Topical preparations like zinc oxide, calamine lotion, or zinc pyrithione have been used as soothing agents and anti-itch relief (Gupta et al, 2014).

              Calamine lotion contains zinc oxide or zinc carbonate and is used frequently for symptomatic relief of itch because of its soothing properties (Gupta et al, 2014).

              Zinc oxide paste and zinc sulphate are effective in diaper dermatitis and hand eczemas (Baldwin et al, 2001; Faghihi et al, 2008).

              Although zinc is less effective as compared to other treatment modalities like topical corticosteroids, it is a useful soothing and anti-itch agent (Landsdown et al, 1996; Baldwin et al, 2001).

              Topical zinc oxide has strong antioxidant and antibacterial action and is used to treat atopic dermatitis or eczema (Gupta et al, 2014).

              Zinc inhibits mast cell degranulation and reduces the secretion of histamine, an important mediator of inflammatory response and an inducer of itch, thereby making it a useful treatment option for itch relief (Marone et al, 1986).

              Interestingly, zinc oxide infused textiles have been tried for the management of atopic dermatitis in a study and a significant improvement was observed in the disease severity, pruritus, and subjective sleep, in patients who wore zinc oxide infused textiles (Wiegand et al, 2013).

              Topical zinc oxide is available in various concentrations - from 10% to 40%, and in a variety of forms including creams, ointments, pastes, powders and sprays.

              Zinc oxide creams are generally safe for long term use.

              Itchy Skin In Winter - How To Treat Dry Skin Itch 

              7. Colloidal oatmeal for itch relief

              Oatmeal (Avena sativa) has been used for centuries as a soothing agent to relieve itch and irritation associated with various skin diseases. 

              Colloidal oatmeal is a natural product that is derived from the whole dehulled grain. Colloidal oatmeal is made by grinding oat grain into a very fine powder.

              Colloidal oatmeal is so finely ground, that you don't feel any grittiness when it is added to skincare products. It feels smooth and comforting on your skin.

              Colloidal oatmeal has an excellent safety record and is approved by FDA (US Food and Drug Administration) as an over-the-counter skin protectant (Kurtz et al, 2007).

              Creams containing 1% colloidal oatmeal have been shown to be effective for the management of mild to moderate atopic dermatitis in children (Lisante et al, 2017A; Lisante et al, 2017B) and hand dermatitis in adults (Sobhan et al, 2020).

              An over the counter 1% oatmeal cream was found to be equally effective and safe as the prescription barrier cream for the symptomatic treatment of mild-to-moderate atopic dermatitis in children (Lisante et al, 2017A).

              Symptoms including itch were improved after applying the 1% colloidal oatmeal cream, and improvements were maintained over the course of treatment. In some children, itch was immediately relieved after applying 1% colloidal oatmeal. Transepidermal water loss values were significantly reduced, and skin hydration was significantly increased throughout the study (Lisante et al, 2017A).

              A study on acute burn patients showed that the patients experienced less itching and requested significantly less antihistamine when using liquid paraffin with 5% colloidal oatmeal compared to liquid paraffin only (Matheson et al, 2001). 

              Colloidal oatmeal contains various active compounds that have moisturizing, protective, soothing, antioxidant and anti-inflammatory activity, including avenanthramides and beta-glucans (Fowler et al, 2012; Pazyar et al, 2012).

              The active ingredients in oatmeal consist of polysaccharides, beta-glucans, proteins, lipids, saponins, enzymes, flavonoids, vitamins, and avenanthramides.

              Avenanthramides from oats can reduce histamine release from mast cells (Cerio et al, 2010; Pazyar et al, 2012) and their topical application decreases inflammation and scratching in pruritus-induced models (Fowler et al, 2012). Oatmeal produces a protective moisturizing barrier on the skin which helps to soften and moisten the skin and heal tissue, and reducing pruritus (Fowler et al, 2012).

              Colloidal oatmeal is well tolerated in children and adults for short-term and long-term use for itch relief (Cerio et al, 2010; Fowler et al, 2012).

              Colloidal oatmeal suspensions are available in many different products, including bath soaps, shampoos, shaving gels, and moisturizing creams.

              Colloidal oatmeal can also be mixed into bathwater.  

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              8. Cold exposure for itch relief

              Topical cooling is a frequently used remedy for itch. Cooling the skin by application of ice, gel packs, cool compresses, or cold water can temporarily reduce itch in patients affected by atopic dermatitis, contact urticarial, or psoriasis (Fruhstorfer et al, 1986).

              Cooling is an effective temporary remedy for itch, and can bring welcome relief to itchy insect bites, nettle stings, poison ivy, atopic dermatitis, and psoriasis (Liu et al, 2018).

              In a nursing home, elderly people with senile pruritus reported that that a cold compress and/or cold showers could relieve the itch (Dyhre-Petersen et al, 2019).

              Senile pruritus is defined as chronic itch of unknown origin in individuals of old age. In this context, the word ‘senile’ refers to ‘one of old age’. No international agreement exists regarding an age limit for being categorized as one of old age, though commonly the limit is set to ≥60 years or ≥65 years (Clerc et al, 2017).

              Although many patients report that cold showers reduce itch, no scientific studies have been performed to confirm this observation (Weisshaar et al, 2019).

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              9. Peppermint and menthol for itch relief

              Peppermint essential oil (Mentha arvensis) and menthol can be used topically to relieve itchy skin.

              Peppermint essential oil naturally contains high amounts of l-menthol, an organic compound with local anesthetic properties that provides a cooling sensation, while it naturally alleviates skin irritation, itch and pain (Zhao et al, 2022; Li et al, 2022).

              Menthol triggers a cooling sensation through receptor TRPM8 (transient receptor potential cation channel subfamily M member 8), which is found throughout the skin.

              Low to moderate concentrations of menthol activate TRPM8 in the primary nociceptors, generating a cooling sensation, whereas menthol at higher concentration could induce pain - cold allodynia, and cold hyperalgesia mediated by TRPM8 sensitization (Li et al, 2022).

              Patients with pruritus of hepatic, renal, and diabetic origin were treated with 5% peppermint oil in petrolatum for 2 weeks and had significant improvement of itching. The topical treatment of chronic pruritus with peppermint oil was found to be effective, easy to use, safe, cheap, and had a favorable odor (Elsaie et al, 2016).

              Pregnant women with pruritus gravidarum were treated with 0.5% peppermint oil in sesame seed oil twice a day for 2 weeks and had a significant improvement in severity of itching (Akhavan et al, 2012).

              Application of a 3% menthol-containing moisturizing cream was safe in healthy individuals and participants with dermatitis. In the latter, itch scores were significantly reduced during follow-up (Tey et al, 2017).

              Peppermint oil is generally recognized as safe (Food and Drug Administration, 2014).

              Always dilute peppermint oil before use and start with low doses - such as 0.5% peppermint oil in a carrier oil.

              High doses of peppermint oil can be irritating and cause pain.

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              12. Vinegar for itch relief

              Vinegar can be used topically to treat itchy skin.

              The use of vinegar in the treatment of skin disease and wound management dates back to Hippocrates (Elhage et al, 2021).

              In preliminary studies, vinegar has been reported to be useful for the treatment of itch or pruritus (Long et al, 1985; Oh et al, 1998; Delavar et al, 1996; Lee et al, 2011; Nakhaee et al, 2015).

              Vinegar has been shown to be safe and effective in treating uremic pruritus. A 5% white vinegar solution applied to itchy areas two times a day for two weeks significantly decreased all dimensions of pruritus (Nakhaee et al, 2015).

              It is thought that by maintaining the acidic pH of the skin surface, vinegar helps to preserve skin barrier function and reduces skin irritation (Yosipovitch et al, 2008).

              However, use vinegar with caution if you have eczema.

              The application of 0.5% apple cider vinegar soak increased transepidermal water loss in patients with eczema, although it decreased skin pH.

              Unfortunately, the beneficial acidification of the skin did not last more than 60 minutes, and the majority of eczema patients suffered skin irritation after the vinegar application (Luu et al, 2019).

              While generally safe, inappropriate use of vinegar can result in damage to the skin. Avoid using vinegar full strength - only use diluted vinegar.

              Itchy Skin In Winter - How To Treat Dry Skin Itch

              Summary

              Dry itchy skin is common during the cold winter months.

              Dry itchy skin is often relieved with the use of moisturizers, and some lifestyle modifications, such as using a humidifier, avoiding harsh cleansers, and supplementing the diet with essential fatty acids.

              Dry itchy skin can be complex, and difficult to treat.

              In order to treat dry itchy skin in winter, you must protect your skin barrier, including the moisture barrier, lipid barrier and acid mantle.

              How to treat dry itchy skin in winter?

                • Protect your moisture barrier:
                  • Drink water
                  • Use a humidifier
                  • Use a moisturizer with humectants
                  • 10 - 15% glycerol for itch relief
                  • 5 - 10% urea for itch relief
                • Protect your lipid barrier:
                  • Emollients for barrier repair and itch relief
                  • Topical linoleic acid for barrier repair
                  • Supplement with omega 3 fatty acids
                    • 1200 mg/d EPA + DHA to 18 000 mg/d EPA + DHA
                  • Cannabis for itch relief
                • Protect your acid mantle:
                  • Avoid high pH soaps
                  • Choose a gentle cleanser
                  • 0.5 - 5% vinegar for itch relief

              Certain treatments for itch are soothing and can be used as often as desired.

              For instance, emollients, moisturizers, topical fatty acids, such as linoleic acid, zinc oxide creams, colloidal oatmeal and cannabis can help sooth irritation and itch.

              Things to try for soothing itch relief:

                • Moisturizers
                • Carrier oils and fatty acids
                • 1 - 5% Colloidal oatmeal
                • 10% zinc oxide or calamine lotion
                • Cannabis

              Other treatments for itch should be used sparingly or as spot treatments.

              Cold exposure, peppermint, menthol, and vinegar can be irritating and damage your skin barrier if overused, or in the wrong dose.

              Be careful, and always dilute menthol and peppermint essential oil. Do not use full strength essential oils on your skin.

              Things to try for quick itch relief:

                • Cold exposure - cold water, cold compress, ice cube on itchy area
                •  0.5 - 5% peppermint oil in a carrier oil or moisturizer
                • 0.5 - 5% vinegar

              No treatment can claim consistent or complete efficacy, and often a combination of treatments is required to control itch.

              Some people with itchy skin may require medications to control symptoms, including antimicrobial agents, antihistamines, anti-inflammatory agents, immunotherapy, biologicals, phototherapy and others.

              If you have dry itchy skin, you may require a dermatologist’s help, and they can prescribe medications to help with itching, redness and pain.

               

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