How to tell whether it is dry skin or something more serious?

Dry skin, medically known as xerosis. Picture: Linda Prebreza/pexels

Dry skin, medically known as xerosis. Picture: Linda Prebreza/pexels

Published May 28, 2024


Dry skin, medically known as xerosis, is a common condition that can be both irritating and uncomfortable. While it is often harmless and can be caused by environmental factors, it can sometimes indicate more serious underlying health issues.

Understanding the potential causes and signs can help you identify when it's more than just a surface-level problem.

With winter in full force in South Africa, people who suffer from dry skin are getting ready. They are stocking up on oil-based creams and heavier moisturisers to fight the cold, dry weather.

Actinic keratosis is a very common pre-cancerous skin condition, especially among those with paler skin tones who are around the age of 50 and above. Picture: Karolina Grabowska/Pexels

For many, small changes in skincare routines, using a humidifier indoors and drinking more water will help improve their skin. However, these simple methods may not be enough for everyone.

Dr Bradley Wagemaker, a Medical Director at Lamelle Pharmaceuticals, points out another concern.

“Actinic keratosis is a very common precancerous skin condition, especially in people over 50 with lighter skin. Many people aren't aware of AK and how to treat it. This lack of awareness means they risk developing skin cancer later on.”

Left untreated, some AK lesions can develop into what is known as squamous cell skin cancers.

According to Harvard Health, this is the case for almost 40% of white patients older than 50, making it the most common precancerous skin condition in this age group.

How to tell the difference

Although the condition might seem alarming, telling the difference between dry skin and Actinic Keratosis (AK) is easy and can be done at home.

Dry skin usually gets better with regular treatments. Everyday creams with ceramides to hydrate and protect the skin’s moisture barrier, along with Vitamin B3 and other home remedies, should help manage dry skin.

Wagemaker advises, “If basic methods like using more moisturisers, bath oils, or shower creams don’t help, and you notice dry skin patches and lesions in sun-exposed areas persisting despite regular use of over-the-counter treatments, AK might be the cause.

“Where dry skin might simply feel ‘tight’ or itchy after cleansing or appear ashen and darkened, AK appears as dry, scaly patches on parts of the skin that are typically exposed to the sun’s UV rays — the face, neck, hands, arms, and even the ankle area.”

Treating AK

Traditional treatments for Actinic Keratosis (AK) include cryotherapy (using extreme cold) and liquid nitrogen. These methods, often used by dermatologists, can leave some people unhappy with the look of their skin after treatment.

An alternative is “field-directed therapy”, which treats entire areas of the skin and may be more effective.

Using good-quality sunscreen with at least SPF 30 is essential. Additionally, topical creams and ointments with nicotinamide offer several benefits. Nicotinamide has anti-inflammatory properties, helps prevent acne, strengthens the skin’s barrier, and reduces the appearance of skin lesions.

“Taken orally, nicotinamide is associated with a lower incidence of AK. Its benefits when used topically have also been well-established,” adds Wagemaker.

“Nicotinamide, as well as photolyase, a DNA-repair enzyme with the ability to seek out and correct DNA damage, are the main ingredients in the Nia-Sol supplement and skincare range.”

Understanding and treating skin conditions

Adding a humectant like panthenol to topical creams helps strengthen the skin’s barrier, lock in moisture, reduce inflammation, and speed up healing, says Wagemaker.

Dry skin is a common issue that many people experience, especially during colder months. However, some serious skin conditions can go unnoticed or undiagnosed because their symptoms are often mistaken for simple dryness.

Below are some conditions that frequently fall into this category:

Eczema (Atopic Dermatitis)

Eczema is a chronic condition that causes the skin to become red, inflamed, and itchy. It often appears similar to dry skin but requires more intensive treatment, such as medicated creams and lifestyle adjustments.


Psoriasis is an autoimmune condition characterised by the rapid build-up of skin cells, leading to thick, scaly patches that can be mistaken for excessively dry skin.

It’s crucial to identify psoriasis early for treatments involving topical steroids, light therapy, and systemic medications.

Contact Dermatitis

Contact dermatitis occurs when the skin reacts to an irritant or allergen, resulting in redness, itching, and peeling. While it can look like ordinary dry skin, identifying the causative agent is key for proper management and avoiding long-term issues.

Signs it’s more than just dry skin:

  • Persistent itching and discomfort. Visible thickening or scaling of the skin.
  • Rashes or patches that do not improve with regular moisturising.
  • Skin changes accompanied by other symptoms like fatigue (common in hypothyroidism).

Caring for your skin during winter can be challenging, as the cold air can worsen skin problems.

Knowing the difference between simple dry skin, which can be treated with home and over-the-counter remedies, and the more serious condition called Actinic Keratosis (AK) is crucial.

This knowledge helps you choose the best treatment for yourself and your loved ones, Wagemaker offers.