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Q: My skin has become very dry and itchy over the past year. Could it be some other skin problem, not just dry skin?

A:

Our skin’s top layer, or epidermis, is normally thick with naturally occurring fats and oils that act as a barrier to help retain moisture and prevent irritants from entering the skin.

But as we age, the skin thins, and we lose some of those fats and oils. This allows vital moisture to escape from the skin, allowing it to become dry and cracked.

While dry skin in itself is the most common cause of itchy skin, sometimes it’s tough to tell if the symptoms are caused by a different condition, such as contact dermatitis, eczema or psoriasis.

People with contact dermatitis are more vulnerable to allergens and irritants such as fragrances that could cause inflammation. When they come in contact with something that causes a reaction, they develop a red, cracked, itchy rash.

Eczema is another term for atopic dermatitis, a condition that is mostly diagnosed in children. In older adults, eczema is a more general term for skin that’s chronically dry, cracked and itchy despite the use of moisturizers.

Psoriasis causes thick, raised, red or silvery patches of scaly skin on the elbows, knees, scalp and trunk. This skin condition isn’t as itchy as eczema.

Psoriasis is the result of an overactive immune system that causes a rapid turnover of skin cells and leads to cells piling up on the surface.

Over-the-counter remedy

For simple dry skin, a concerted effort to moisturize the skin throughout the day may be all it takes to get rid of itching and dryness.

But most people don’t moisturize often enough, or they use lotions that contain too much water to be effective on very dry skin.

Instead of liquid lotion, look for an oil-based cream that’s so thick it comes in a jar, not a pump bottle. If moisturizing alone isn’t working, it’s time to make an appointment with your doctor or a dermatologist.

Q: My cholesterol level has remained about the same for many years, but now my doctor suggests that I start taking a statin drug. What has changed?

A: There are two major reasons why your doctor could now be recommending a statin — the cholesterol guidelines continue to evolve and/or you have developed other heart disease risk factors, such as Type 2 diabetes or hypertension.

In the past, the decision to start a statin or other drug was based primarily on the level of low-density lipoprotein cholesterol (LDL), the so-called “bad cholesterol.”

New guidelines have removed this “target-driven” approach. They don’t focus on the LDL numbers. Instead, they recommend using risk to decide when people should take a statin drug to lower LDL cholesterol.

Statins are best because they do more than just lower a number. They reduce risk of developing heart disease and having a stroke.

New evidence suggests that an LDL cholesterol level much lower than 70 mg/dL is probably beneficial for some people. So, even if you have an excellent LDL blood level, you likely should take a statin if you have:

—Artery disease, including angina, a previous heart attack or stroke, or other related conditions

—A very high level of harmful LDL cholesterol (generally at or above 190 mg/dL)

—Diabetes, if you are also 40 or older

For everyone else it’s a decision that you make with your doctor, depending on risk factors that include:

—A parent, brother or sister who had coronary artery disease or stroke at an early age (a man before age 55 or a woman before age 65)

—Tobacco use

—High blood pressure

—A low HDL (“good cholesterol”) level (under 40 milligrams per deciliter)

A statin dose tailored to the individual is more important than reaching a particular target number.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit www.health.harvard.edu.

© 2020 President and Fellows of Harvard College. Distributed by Tribune Content Agency, LLC.