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Dry Skin: Causes, and Do Ceramides Really Help?

Dry skin (xerosis) is in most cases a problem of the skin barrier: too little water and lipids in the stratum corneum, made worse by dry air, hot water and detergents. A Cochrane review of 77 trials and 6,603 people shows that emollients reduce disease severity and the number of flares, but there is no reliable evidence that one product is better than another, and studies comparing ceramide creams with simple emollients showed no clear advantage. We explain where dry skin comes from, when ceramides make sense, how urea and glycerin work, and how to build an effective, inexpensive routine.

Redakcja VitMode — Sen i neurobiologiathe VitMode editorial team, no individual bylinesPublishedOctober 22, 202612 min readAbout 12 min left

How this article was made

Author: Redakcja VitMode — Sen i neurobiologia — the VitMode editorial team, no individual bylines
Method: Prepared from primary sources: clinical trials, meta-analyses and guidelines. We describe study findings separately from our interpretation.
Source verification: Cited PubMed papers are automatically checked for a matching identifier, title and publication year.
Medical review: none — this article has not been reviewed by a physician
Last updated: October 22, 2026

The content is educational and does not replace medical advice. Read the full editorial process

Table of contents

TL;DR — key takeaways

→Why does skin get dry? The short answer
→How does the skin barrier work? Bricks and mortar
→What dries out the skin? Environment, age, drugs and diseases
→Do emollients really work? What Cochrane shows
→Ceramides in creams: what do we know from studies?
→Urea, glycerin and other ingredients: when to reach for them?
→How to build an effective routine: a practical plan
→Myth: it is enough to drink more water
→When is it not ordinary dryness? Warning signs
→Our editorial recommendation

Why does skin get dry? The short answer

Dry skin is one of the most common reasons for buying cosmetics, and the market for ceramide creams has grown to a size that suggests skin cannot be rescued without them. It is therefore worth checking what studies say. The answer is less spectacular than the advertising but practical: what matters most is moisturising the skin regularly and protecting it from the things that dry it out, and the exact composition of the cream is of secondary importance.

This text deals with dry skin in healthy people and dryness as an accompanying symptom. Atopic dermatitis, psoriasis and acne are covered in separate articles, and we write separately about the effect of omega-3 fatty acids on atopic dermatitis; here we mention them only where they help distinguish ordinary dryness from a disease needing treatment.

How does the skin barrier work? Bricks and mortar

The stratum corneum is often described with a 'bricks and mortar' model. The bricks are flattened horny cells (corneocytes), and the mortar is the multilayered lipid structures between them, built mainly from ceramides, cholesterol and free fatty acids. This mortar works like a seal: it keeps water in and irritants out. The second element is the natural moisturising factor (NMF), a mixture of amino acids, lactic acid and urea, among other things, which binds water within corneocytes.

When ceramides and other lipids are too few, or their arrangement is disturbed, the barrier becomes leaky: transepidermal water loss (TEWL) rises, and the skin becomes rough, tight, flaky and itchy. The review by Kono et al. (2021) recalls that a reduction in ceramide content of the stratum corneum is linked to dry skin and a damaged barrier. This is the basis of the idea that replacing ceramides from the outside may help, except that from a logical idea to a proven clinical advantage is a long way, as we describe below.

A good complement to this model is dividing cosmetic ingredients into three types of action. Humectants (glycerin, urea, hyaluronic acid) bind water. Occlusive substances (petrolatum, paraffin, oils, waxes) form a film that limits evaporation. Emollients in the broad sense smooth and replenish lipids. Most effective creams combine these mechanisms, and ceramides are one of the lipid ingredients, not a separate category.

What dries out the skin? Environment, age, drugs and diseases

External factors include low air humidity, heating and air conditioning, long hot baths, frequent washing with soap and detergents, and the use of alcohol-based products. The review by White-Chu and Reddy (2011) on dry skin in older people stresses that dryness is multifactorial: changes in keratinisation and lipid content, the use of diuretics and similar drugs, and overuse of heaters and air conditioning all play a part. The authors also note that dry skin is not a normal part of ageing, although it is common in older age.

Dryness also often accompanies diseases: atopic dermatitis and ichthyosis (genetically based barrier disorders), hypothyroidism, diabetes, chronic kidney disease and some nutritional disorders. Many drugs (retinoids, diuretics and others) can worsen dryness. New, worsening or unusually widespread dryness in a person who did not have it before is therefore a reason to talk to a doctor and possibly have tests, not just to buy another cream.

Group	Examples	What to do
Environment	Dry air, heating, air conditioning, winter	Humidifier, emollient, skin protection
Habits	Long hot baths, soaps, detergents, frequent hand washing	Lukewarm water, short showers, gentle cleansers, hand cream
Age	Changes in lipid composition and keratinisation of the skin	Regular emollients, low-concentration urea
Drugs	Diuretics, retinoids and others	Discuss with a doctor; do not stop a drug on your own
Diseases	Atopic dermatitis, ichthyosis, hypothyroidism, diabetes, chronic kidney disease	Treat the underlying disease and test as indicated

The most common causes of dry skin

Do emollients really work? What Cochrane shows

What does the research say?

Emollients and moisturisers for eczema

van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM · Cochrane Database of Systematic Reviews · 2017

Study findings

A systematic review with meta-analysis of 77 randomised trials (6,603 participants; mean age 18.6 years, mean duration 6.7 weeks) on emollients in eczema. Thirty-six trials were judged at high risk of bias and seven at low risk. Moisturisers compared with placebo, vehicle or no treatment gave lower disease severity assessed by the investigator (12 trials, 1,281 people; SMD -1.04; high-quality evidence) and fewer flares (six trials, 607 people; RR 0.33; moderate-quality evidence), with no difference in adverse events. Compared with no moisturising there were fewer flares (RR 0.40), a longer time to flare (median 180 versus 30 days) and less use of topical corticosteroids, although the difference in SCORAD did not reach the minimal clinically important difference. Active treatment combined with moisturising was more effective than active treatment alone. The authors conclude that most moisturisers had a beneficial effect, but no reliable evidence was found that one is better than another.

Strong evidenceView the study on PubMed

This describes what the study found. Editorial interpretation follows in the text below.

An important caveat: this review concerns people with eczema (atopic dermatitis), that is, a disease in which dryness is one of the main symptoms, not people with ordinary dry skin. The mechanism and the direction of the conclusion are consistent, however: regular moisturising improves the skin, prolongs the time to flare and lets you use less steroid. For ordinary dry skin there are far fewer direct randomised trials, so we infer partly from eczema studies and partly from studies of dry skin in older people.

The most important practical conclusion is, however, the opposite of the marketing one. Since no evidence was found for one emollient being better than another, effectiveness is decided by whether the product is used regularly, in sufficient amounts, and is well tolerated, not by how much it costs or whether it has ceramides in its name. The best emollient is the one your skin tolerates, that you use daily and that you can afford.

Ceramides in creams: what do we know from studies?

What does the research say?

Evaluation of a paraffin-based moisturizer compared to a ceramide-based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial

Gupta S, Ramam M, Sharma VK, Sethuraman G, Pandey RM, Bhari N · Pediatric Dermatology · 2023

Study findings

A double-blind randomised trial in children with mild to moderate atopic dermatitis: 53 participants (27 in the ceramide cream group, 26 in the paraffin-based cream group, mean age 8.2 years) applied the products twice daily, with assessments at 1, 3 and 6 months. The mean change in SCORAD at 3 months was 22.1 in the ceramide group and 21.4 in the paraffin group (p=0.37); quality of life, transepidermal water loss, steroid use and time to remission were also similar. Equivalence was formally not proven because the confidence interval of the difference exceeded the predefined margin, but the authors conclude that both products were comparable in improving disease activity. The trial is small and concerns children with eczema, not ordinary dry skin.

Moderate evidenceView the study on PubMed

This describes what the study found. Editorial interpretation follows in the text below.

This trial illustrates the state of knowledge well: when a ceramide cream was compared with a simple paraffin cream, clinical results were similar. The review by Kono et al. (J Dermatol, 2021), in turn, covered 12 papers that indicated external ceramide-containing preparations can improve dry skin and barrier function in people with atopic dermatitis, although the authors stress that double-blind comparative studies in large groups are needed to define their proper place in practice.

There is also an argument for ceramides from mechanistic studies. A double-blind, intra-individual controlled study (Andrew et al., Br J Dermatol, 2025) in 58 adults with a history of eczema compared an emulsion containing physiological lipids and glycerin with a popular glycerin emulsion without such lipids. After 28 days the skin barrier (transepidermal water loss after removing 20 tape strips) improved significantly only after the lipid preparation, skin sensitivity to sodium lauryl sulfate also decreased, and levels of certain ceramides rose by 19–24%. The glycerin-only preparation reduced dryness but did not improve barrier function. This is an interesting signal that lipid composition matters for the barrier, but it was a short study on laboratory parameters, not on how skin feels day to day, and the comparison concerned a specific product.

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Urea, glycerin and other ingredients: when to reach for them?

Urea is a component of the natural moisturising factor and a humectant; at higher concentrations it also acts as a keratolytic, that is, promotes shedding. In the Cochrane review cited above, a urea-containing cream improved dryness assessed by the investigator more often than (one trial, 128 people; 1.40; moderate-quality evidence) and reduced the number of flares, but participants in this group more often reported adverse events (RR 1.65; moderate-quality evidence), which usually means burning or irritation, especially on damaged skin. A small uncontrolled study of 20 older people with dry skin (Lacarrubba et al., 2021) showed that a cream with 10% urea over 2 weeks improved dryness and itching, but such a design does not allow conclusions about superiority over other products.

Glycerin is a classic humectant: in the Cochrane review, glycerin-containing products compared with vehicle improved the investigator-assessed SCORAD (one trial, 249 people; high-quality evidence), although the difference was smaller than the minimal clinically important one. In practice glycerin is mild and often well tolerated, and urea at low concentrations (a few percent) works for many people, whereas urea at higher concentrations and acids can be irritating on cracked skin.

It is worth being careful with additives that sensitise. The review by White-Chu and Reddy advises avoiding sensitising substances often found in emollients, such as lanolin, aloe vera and parabens, which may cause a delayed hypersensitivity reaction. If after switching creams your skin starts to burn, itch or redden, that is a signal to stop using it, not to 'wait it out'.

How to build an effective routine: a practical plan

What you can do

Dry skin care step by step

Wash in lukewarm, not hot, water and shorten your shower: hot water and long baths strip lipids from the skin, and reviews list modifying bathing technique as part of management
Replace soap with a gentle, fragrance-free cleanser and wash only the places that need it (underarms, groin, feet)
Apply an emollient once or twice a day to the whole body, ideally right after drying, when the skin is still slightly damp
Choose a texture suited to the dryness: a light lotion for summer, a richer cream or ointment for winter and very dry spots
Use enough product: a thin layer once every few days is not enough, and the effect depends on regularity
Raise the humidity in your bedroom if heating dries the air a lot
Use hand cream after every wash; gloves for housework protect against detergents
Avoid lanolin, aloe, strong fragrances and dyes if your skin is sensitive, and do not combine many new cosmetics at once
If there is no improvement after 2–3 weeks of regular care, or the skin is red and itchy, see a doctor

Cost is worth thinking about too. Since there is no evidence that premium creams are better, you can choose a simple pharmacy product or a paraffin and petrolatum emollient and spend the savings on quantity, that is, on applying it daily and generously. Ceramides may be a pleasant extra, but they are not a condition for effectiveness.

Myth: it is enough to drink more water

Myth

Dry skin is a sign that you drink too little water, so it is enough to drink more to moisturise it from the inside.

Fact

The systematic review by Akdeniz et al. (Skin Res Technol, 2018), covering six studies in healthy adults, rated the evidence as weak in quantity and quality: a slight increase in stratum corneum hydration was seen after extra water intake, especially in people who previously drank little, but the mechanism is unknown, and the authors note that studies are needed to show whether increased drinking reduces the signs of dry skin. Extra water will therefore do no harm to someone who drinks little, but it will not replace external care and avoiding drying factors.

Promises that supplements 'from the inside' will repair the skin barrier are similarly doubtful. For some of them, for instance omega-3, studies concern diseases such as atopic dermatitis, which we cover in a separate article, but for ordinary dry skin reliable evidence is far scarcer. First take care of what has a documented effect: lukewarm water, an emollient and air humidity.

When is it not ordinary dryness? Warning signs

When to see a doctor

When to see a doctor, and the limits of this article

See a doctor if the skin is strongly red, itchy, cracked, oozing or painful, if the changes lie in typical eczema sites (creases of the elbows and knees, neck, eyelids), if dryness appears suddenly and covers the whole body, if it comes with strong itching without a rash, or if the changes do not improve after a few weeks of correct care. Such symptoms may mean eczema, contact dermatitis, a fungal infection, scabies or a general disease (for example of the thyroid, liver or kidneys) and need assessment. In atopic dermatitis an emollient complements treatment rather than replacing it. The studies described here concern mainly eczema and short periods, and evidence for ordinary dry skin is indirect; ceramide preparations have not been shown to be better than simple emollients, but there is also no evidence of harm. The article does not replace medical advice.

Question	Short answer
Do emollients work?	Yes: in the Cochrane review they reduced eczema severity and the number of flares (evidence mainly from eczema studies)
Are ceramides better than ordinary creams?	No clear clinical advantage has been shown; in a study of children a ceramide cream and a paraffin cream were comparable
Do ceramides improve the barrier?	Mechanistic studies suggest improved barrier function, but these are short laboratory studies
Does urea help?	It improved dryness but more often caused irritation, especially on damaged skin
Does drinking water cure dryness?	Weak evidence: slight improvement in hydration, mostly in people who drink little
When is it not ordinary dryness?	With strong itching, redness, cracking, oozing or sudden widespread dryness

Dry skin, emollients and ceramides at a glance

Our editorial recommendation

Dry skin is one of those problems in which humble habits beat trendy ingredients. Lukewarm water, gentle washing, a generous and regular emollient and a little moisture in the air deliver most of the possible benefit. Ceramides are a valuable and safe extra, but the data do not justify paying more for them if a simpler cream works and is well tolerated. When dryness comes with itching, redness or general symptoms, it is time to stop experimenting with cosmetics and ask a doctor.

The best cream for dry skin is the one you use every day. Price and fashionable ingredients matter less than regularity, quantity and lukewarm water.

VitMode editorial team

Frequently asked questions

Most often because the skin barrier loses water faster than it retains it: dry air, heating, long hot baths, soaps and detergents, age and certain drugs and diseases (atopic dermatitis, hypothyroidism, diabetes, kidney disease) all play a part. A regular emollient and lukewarm water usually ease the problem. If dryness is sudden, widespread or comes with strong itching, it is worth consulting a doctor.

They can help, but they have not been shown to work better than simple emollients. In a study of children with atopic dermatitis a ceramide cream and a paraffin cream produced similar improvement, and a review of papers suggests ceramide preparations improve dryness and the barrier, though the authors point to the need for larger studies. Choose a cream you tolerate well and use regularly.

There is no evidence that one is clearly better than the others. Urea improved dryness but more often caused irritation, especially on damaged skin, glycerin is usually mild, and ceramides are a reasonable addition to the lipid barrier. Often the best are products that combine a humectant and an occlusive in a texture you like.

Usually once or twice a day, and more often with very dry skin, ideally right after bathing on slightly damp skin and after each hand wash. The effect depends on regularity and amount, not on the brand. In atopic dermatitis the emollient is used together with the treatment your doctor recommends.

The evidence is weak. A review of six studies found a slight increase in stratum corneum hydration after extra water intake, mainly in people who drank little, but the authors stress there are not enough studies on the effect on the symptoms of dryness. Drinking water does not replace an emollient or avoiding hot baths.

Yes. Dryness accompanies atopic dermatitis, ichthyosis, hypothyroidism, diabetes and chronic kidney disease, among others, and some drugs, such as diuretics or retinoids, can worsen it. New, worsening or very widespread dryness, especially with strong itching or other symptoms, is a reason for consultation and tests.

When the skin is red, strongly itchy, cracked, oozing or painful, when the changes affect the creases of elbows and knees, the neck or the eyelids, when they appear in a child, or when there is no improvement after 2–3 weeks of regular care. In eczema an emollient complements prescription treatment rather than replacing it.

Sources (7)

Sources are numbered. PubMed items are automatically verified (identifier, title, year).

Redakcja VitMode — Sen i neurobiologia

VitMode editorial team — no individual bylines; content based on primary sources

VitMode Editorial — Sleep and Neurobiology is the VitMode editorial team responsible for: sleep, circadian rhythm, cognition and recovery. The team has no individual bylines — texts are prepared by VitMode editors from primary sources (clinical trials, meta-analyses, guidelines). Every cited PubMed paper is automatically checked for a matching identifier, title and publication year. The content is educational and does not replace medical advice. Factual errors can be reported in a comment under the post or through the contact form; corrections are made by the editorial team.