Question 1

Can I exfoliate it away?

Accepted Answer

It depends on the cause, and that is precisely the point. On xerosis gentle exfoliation can help; on active dermatitis it worsens the inflammation; on a mycosis it does not affect the cause and can spread it to other sites. Since to the naked eye the forms resemble one another, exfoliating before knowing what you are dealing with is a gamble often lost.

Question 2

Why does it only flake in winter?

Accepted Answer

Cold, wind and dry air from heating draw water from the horny layer, and the skin barrier works less well: this is the typical seasonality of xerosis and the dermatitis associated with it. Seborrhoeic dermatitis also often has a seasonal pattern. Seasonality is therefore useful information to report at the visit, because it narrows the possibilities even before looking at the skin.

Question 3

If it does not itch, is it less important?

Accepted Answer

No, itching does not measure importance. Several scaling conditions cause little or no itching, and some lesions deserving attention are completely asymptomatic. A more useful criterion is this: localised scaling that persists at the same site for weeks and does not respond to usual measures should be examined regardless of how much it bothers you.

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