What is causing the rough patches on my skin?

What Is Causing the Rough Patch on Your Skin?

Rough patches on the skin are common and usually harmless, but they can be annoying or even painful. Understanding the possible causes can help you decide whether simple home care will do—or if you need to see a doctor. Below is a guide to what might be behind that rough patch on your skin, how it's diagnosed, and when professional help is needed.

Common Causes of Rough Patches on Skin

1. Dry Skin (Xerosis)

• Often appears in winter or dry climates.
• Skin feels tight, flaky or scaly.
• Usually improves with regular moisturizing.

2. Eczema (Atopic Dermatitis)

• Chronic inflammation that causes itchy, red, scaly patches.
• Often starts in childhood but can affect adults.
• Triggers include stress, allergens, irritants (soaps, detergents).

3. Psoriasis

• Immune-mediated condition causing well-defined, silvery scales.
• Common on elbows, knees, scalp.
• Can be related to stress, infections, certain medications.

4. Keratosis Pilaris

• Small, rough bumps (often on upper arms, thighs, cheeks).
• Caused by buildup of keratin around hair follicles.
• Tends to improve with exfoliation and moisturizers.

5. Ichthyosis

• Group of genetic disorders leading to widespread scaling.
• Skin looks fish-scale–like and may crack.
• Requires specialized creams and sometimes systemic treatment.

6. Actinic (Solar) Keratosis

• Rough, scaly patches from long-term sun exposure.
• Can be precancerous; commonly on face, ears, hands.
• Should be evaluated by a dermatologist.

7. Contact Dermatitis

• Local reaction to irritants/allergens (nickel, fragrances).
• Skin becomes red, itchy, sometimes blistered.
• Avoiding triggers and topical steroids help.

Systemic and Less Common Causes

1. Nutritional Deficiencies

• Vitamin A, zinc or essential fatty acid deficiency can lead to rough, scaly skin.
• Often accompanied by other signs (poor wound healing, acne, hair loss).

2. Diabetes

• High blood sugar damages small blood vessels and nerves.
• Can cause dry, rough patches—especially on legs and feet.

3. Thyroid Disorders

• Hypothyroidism often leads to dry, rough skin.
• May also have cold intolerance, weight gain, fatigue.

4. Cholestatic Liver Disease
   When bile flow from the liver is impaired, certain substances build up in the body and can cause intense itching (pruritus) and rough, thickened skin. Key points:

• Pathogenesis: Bile acids, endogenous opioids, and autotaxin-mediated lysophosphatidic acid (LPA) accumulation irritate nerve endings in the skin (Bergasa & Jones, 2006).
• Presentation: Persistent itching, often worse at night, with scratching leading to rough, scaly or even bruised patches.
• Diagnosis:
  • Blood tests (liver enzymes, bilirubin)
  • Transient elastography ("FibroScan") to assess liver stiffness and fibrosis stage (Friedrich-Rust et al., 2008).
• Management (EASL Guidelines, 2017):
  • First-line: Ursodeoxycholic acid to improve bile flow.
  • Bile acid sequestrants (cholestyramine) to bind excess bile acids.
  • Rifampicin or naltrexone for refractory itching.
  • Consider liver biopsy or referral to hepatology for advanced disease.

Diagnosing a Rough Patch on Skin

A thorough evaluation starts with a skin exam and history:

• Duration, location, triggers (soap, sun, climate).
• Associated symptoms (itching, pain, systemic signs).
• Personal or family history of skin or autoimmune diseases.

When necessary, your doctor may order:

• Skin scraping or biopsy to check for fungal infection or psoriasis.
• Blood tests for diabetes, thyroid or liver function.
• Imaging (ultrasound or elastography) if liver disease is suspected.

Home Care and Over-the-Counter Treatments

For many rough patches, you can start with simple measures:

• Gentle cleansing: Use soap-free, fragrance-free cleansers.
• Regular moisturizers: Look for ceramides, urea or lactic acid.
• Exfoliation: Mild chemical exfoliants (alpha-hydroxy acids) for keratosis pilaris.
• Avoid hot water and harsh scrubs that strip natural oils.

If you're noticing hard, thickened areas on your skin and aren't sure what's causing them, Ubie's free AI symptom checker can help you identify possible causes and determine if you need medical attention.

Professional Treatments

If home care isn't enough, a healthcare provider may recommend:

• Prescription topical steroids or calcineurin inhibitors (for eczema).
• Vitamin D analogues or phototherapy (for psoriasis).
• Laser or cryotherapy (for actinic keratosis).
• Systemic medications (for severe psoriasis, cholestatic pruritus).

When to See a Doctor

Seek medical attention if your rough patch on skin is:

• Rapidly expanding or bleeding.
• Painful, oozing, or infected (red streaks, pus).
• Associated with systemic symptoms (jaundice, unexplained weight loss, fever).
• Suspected to be sun-damaged or precancerous.

Speak to a doctor promptly about anything that could be life-threatening or serious.

Key Takeaways

• Rough patches on skin have many causes: common ones include dry skin, eczema, psoriasis, keratosis pilaris and actinic keratosis.
• Systemic conditions like diabetes, thyroid disorders and cholestatic liver disease can also lead to rough, itchy skin.
• Home care (gentle cleansers, moisturizers, mild exfoliation) helps most cases.
• Persistent, painful, rapidly changing, or widespread patches should be evaluated by a healthcare provider.
• For a quick assessment of your symptoms, Ubie's free AI symptom checker can provide guidance on next steps.

Always remember: if you have concerns about your skin—especially changes that are new, worsening or causing significant discomfort—it's best to speak to a doctor.