Flaky skin in older adults is extremely common, affecting more than half of people over 65. A cross-sectional study in primary care found that 55.6% of elderly patients had xerosis, the clinical term for chronically dry, flaking skin. The causes range from basic biological changes in aging skin to medications, environmental factors, and underlying health conditions.
How Aging Changes the Skin Itself
The most fundamental cause of flaky skin in older adults is that the skin’s structure and chemistry shift with age. The outermost layer of skin, the stratum corneum, loses more than 30% of its total lipid content compared to younger skin. These lipids, especially ceramides and cholesterol, act as the mortar between skin cells, holding in moisture and keeping the barrier intact. When they decline, water escapes more easily and the skin dries out.
Sebum production also drops significantly. Sebum is the oily substance your skin produces to keep itself lubricated and slightly acidic. Less sebum means the skin surface becomes drier and its pH rises, which disrupts the normal chemical environment that keeps the barrier healthy.
At the cellular level, skin cell turnover slows down. Growth signals that tell skin cells to reproduce decrease with age, while cell death increases. The result is a thinner epidermis and a thinner stratum corneum, both of which are less capable of retaining water. These changes happen to everyone as they age, which is why dry, flaky skin is nearly universal in older adults rather than a sign that something is necessarily wrong.
Winter Weather and Indoor Heating
Environmental conditions are one of the biggest triggers for flaking, especially in colder months. Heated indoor air in winter often drops below 40% relative humidity, and research on elderly residents found that even the 30% minimum humidity recommended by some building standards is not high enough to prevent dry skin in older people. Cold, dry outdoor air compounds the problem.
Air conditioning in summer can have a similar drying effect. If you spend most of your time indoors with forced air running, your skin loses moisture to the surrounding air faster than it can replenish it. A simple plug-in humidifier in the bedroom can make a noticeable difference, particularly during winter.
Bathing Habits That Strip the Skin
Long, hot showers feel good but are one of the most controllable causes of flaky skin. Hot water dissolves the natural oils on the skin surface, and the longer the exposure, the more oil is lost. Soap-based products are particularly damaging because they raise the pH of the skin’s outer layer, which activates enzymes that break down the lipid barrier and inhibits the production of new protective fats. Synthetic detergent-based cleansers (often labeled “syndet” or “soap-free”) are gentler than traditional soap. Look for fragrance-free products with a pH between 5 and 6, which matches the skin’s natural acidity.
Shorter showers with warm (not hot) water, and limiting full-body soaping to areas that actually need it, can preserve the oils your skin still produces.
Medications That Dry the Skin
Several common medications prescribed to older adults contribute to skin dryness. Diuretics, widely used for high blood pressure and heart failure, work by pulling water out of the body, and the skin feels the effects. Antiandrogen therapies, sometimes used in prostate cancer treatment, reduce the hormonal signals that drive oil production in the skin. If you’ve noticed your skin becoming significantly drier after starting a new medication, it’s worth mentioning to your prescriber, as switching to an alternative or adjusting the dose may help.
When Flaky Skin Becomes Asteatotic Eczema
In many older adults, ordinary dryness progresses to a condition called asteatotic eczema (also known as eczema craquelé). This is not a separate disease so much as a more advanced stage of dry skin. It appears as red, inflamed patches with a distinctive cracked pattern that resembles dried mud or cracked pavement. The cracks run in curving, polygonal lines across the skin surface, and the areas are typically itchy.
The shins are the most common location, but it can appear anywhere. It tends to flare in winter when humidity drops. The diagnosis is made just by looking at the skin; no lab tests are needed. The underlying mechanism is the same as general dryness: loss of water from the skin’s outer layer, compounded by decreased oil and sweat gland activity. Scratching the itchy skin creates further damage, opening up fissures that can become irritated or infected.
Underlying Health Conditions
Flaky skin can also be a visible sign of an internal problem. Hypothyroidism (an underactive thyroid) slows down many body processes, including skin cell turnover and oil production, leading to rough, dry skin. Chronic kidney disease causes waste products to build up in the blood, which can trigger widespread itching and flaking. Liver disease and diabetes are also associated with skin dryness and itching in older adults.
Nutritional deficiencies play a role as well, though they’re less common as a primary cause in well-nourished populations. Zinc deficiency can cause sharply defined scaly patches around the mouth, hands, and groin. Deficiencies in essential fatty acids impair the skin’s ability to maintain its lipid barrier. Vitamin A deficiency produces rough, bumpy skin on the arms and legs, though this presentation has also been linked to deficiencies in B vitamins, vitamin C, and vitamin E. Older adults are at particular risk for vitamin D deficiency, especially in winter, though vitamin D deficiency alone doesn’t directly cause flaky skin.
Choosing the Right Moisturizer
Moisturizers work through three basic mechanisms, and understanding them helps you pick the right product. Humectants (like glycerin and hyaluronic acid) pull water into the outer skin layer. Emollients (like squalane and fatty acids) fill in the gaps between skin cells, smoothing rough texture and repairing the barrier. Occlusives (like petrolatum and dimethicone) form a physical seal over the skin surface to prevent moisture from evaporating. For aging skin that has lost its natural lipids, a product combining all three types is ideal, but the occlusive layer is especially important for people with extremely dry or sensitive skin because it physically locks moisture in.
Urea-based creams deserve special mention. At low concentrations (2% to 10%), urea acts as a moisturizer that boosts hydration. At medium concentrations (10% to 30%), it also works as a keratolytic, meaning it gently dissolves the bonds holding dead, flaky skin cells together. In studies of adults over 60 with dry skin, both 5% and 10% urea creams produced clear improvements in hydration and visible flaking. For thick, scaly patches, concentrations of 30% or higher can soften stubborn buildup, though these are best reserved for localized problem areas rather than all-over use.
Apply moisturizer within a few minutes of bathing, while the skin is still slightly damp. This traps surface water before it evaporates. Twice-daily application, morning and after bathing, provides the most consistent results.
Restoring the Skin’s Lipid Barrier
Because aging skin has lost a significant portion of its ceramides and cholesterol, products that specifically replace these lipids can address the root cause rather than just managing symptoms. Topical ceramide-containing creams have been shown to increase hydration and improve barrier function in aged skin. Plant oil blends that are rich in fatty acids can similarly boost ceramide content in the outer skin layer. Look for moisturizers that list ceramides, cholesterol, or fatty acids among their active ingredients, as these mimic the natural composition of healthy skin.