Healthy Skin Care

skin careSkin care is a daily battle for some of us. Your skin has healthy oils being naturally produced at all times.  These healthy oils are important in order to maintain a healthy skin barrier.  Many routine daily activities actually damage this healthy skin barrier and normal oils.  For instance, when washing your hands soap does not discriminate between dirt and healthy oils; therefore, washing your hands actually removes healthy oils.  This simple fact is why restoring the oils is so important when battling skin conditions.

Common medications:

Steroid creams such as hydrocortisone, triamcinolone (Westcort), and clobetasol (Clobex) may be used by your healthcare provider.  Using these creams is of utmost importance because they may have deleterious effects if used incorrectly.  Steroid creams may be used for a variety of different indications, but they should not be used more frequently than twice per day for 2 weeks.  Then, discontinue use for 2 weeks before attempting another round.  Your healthcare provider may give you a more intensive regimen, but it should only be done with physician supervision.  Steroid cream overuse can lead to thinning of the skin, loss of pigmentation, new stretch marks, easy bruising, enlarged blood vessels, and susceptibility to infections.  It is important to avoid steroid use on the face, armpit, and genitals because of their sensitivity to the side effects.  Use of steroid creams in these areas should only be done by the recommendation of your healthcare provider.

Anti-inflammatory creams such as pimecrolimus (Elidel) and tacrolimus (Protopic) are creams that decrease inflammatory mediators from T-cells (an immune fighting cell).  These immune modulating creams may be used for longer periods of time without longterm skin side effects.  The most frequent side effect of the medication is burning, stinging, or itching at the application site.  Similar to steroid creams, it should not be used on the face or genitals unless recommended by your physician.

Topical retinoids such as tretinoin (Retin-A) or tazarotene (Tazorac) are Vitamin A derivatives.  They have proven effective in many different skin conditions.  In fact, retinoids are used in many anti-aging creams since they have shown to improve wrinkles amongst other benefits.  Appropriate use of retinoid creams are important.  Do not use on damaged or open wounds (including sunburn).  Do not use around mucous membranes or thin skin such as around the eyes, lips, mouth, or nose.  Common side effects including stinging or burning around application site and redness or flaking afterwards.  Applying the correct amount can be tricky.  A pea-sized amount should cover the entire face – there should not be white residue left after application.  If visible residue is evident, you have applied too much.  If you are having trouble tolerating side effects, make an appointment with your healthcare provider to discuss ways to improve tolerance.

Skin Care:

Water actually damages the skin.  It dries the skin by removing healthy oils that were discussed previously.  It is important to apply lotion after wetting the skin to restore healthy oils.  This is especially true when washing with soap because soap speeds up the oil removal process.  When drying skin, pat the skin dry instead of vigorously rubbing which removes extra layers of skin that are protective.  As you can see by the picture, skin cells are loosely held together at the outer edges.  Vigorously rubbing scrapes off these protective layers.  Hot water washes more oil away than lukewarm water, and hot water is more irritating to skin.  If you have dry or itchy skin, it is very important to limit time in the shower as well as the temperature of the water.

Lotions are the cornerstone to skin care.  Lotions act to restore healthy oils and hydrate the skin by trapping moisture inside the deep layers.  The better a lotion is at moisturizing, the more likely it is to be oily.  Water is trapped into deep skin layers by oil which is why thick, oily lotions are actually the best for moisturizing.  Each person has varying levels of dry skin and oily skin.  It is important to match your skin with the correct lotion.  This may take several products before you find the right one for you.  If you suffer from very dry skin and lack oils, you will prefer an oily lotion.  Vaseline is the ultimate lotion because of it is petroleum (oil).  It is usually too oily for most people, so reserve Vaseline for those difficult to control dry spots or at night before bedtime when oily skin may not bother you.  If you have mild dry skin and have excess oil, you will prefer a lighter, thinner lotion without the oil content.  Generally, the thicker the lotion the more likely it is to be oily.  If you are using lotion on your face, make sure to look for non-comedogenic lotions which tend to be oil-free.  Lotions when used should be used at least twice daily but apply lotion more frequently if areas are exposed to water, soap, or chemicals.  If you have a skin disease, it is important to apply lotion to the affected areas multiple times per day in order to maintain a healthy skin barrier that prevents microscopic bacterial invasions.  Avoid lotions that contain dyes or fragrance if you suffer from skin irritation.  Remember:  The better it smells the more likely it is to irritate your skin.  Look for a white, fragrance-free lotion.  Frequently recommended lotions are (in no particular order):  Cetaphil, Lubriderm, Eucerin, Aveeno.

Your laundering routine may be the source of your skin condition.  Detergents, fabric softeners, and dry sheets / bars are some of the most potent skin irritants.  If you think about it, the objects you are in contact with the most are your clothes and bedding (pillows and sheets).  If irritating chemicals are in your laundry, you will be exposed to those chemicals 24 hours per day because you wear those irritants on your clothes, and you sleep on those irritants in your bed.  For many people, changing your laundering routine will resolve many skin problems.  Detergents that have dye or fragrances are more irritating to skin than the new lines of “Free and Clear” detergents.  Americans associate smelling good with being clean, but “smelling clean” may be wreaking havoc on your skin.  Similar to lotions, seek out a detergent that is clear and lacks fragrance.  Fabric softeners and dryer sheets also fall into the same category, especially since they are usually heavily fragranced.  Try a dryer bar instead of dryer sheets and stop adding fabric softener to your laundry to see if your skin condition improves.

Nails need to be trimmed and clean when you have skin irritation.  Bacteria hides in the recesses of your nails and scratching provides the perfect opportunity to damage the skin then inoculate with bacteria.  Clean under your nails with a spare toothbrush or nailbrush similar to surgeons before operating.  If you have longer nails, you must refrain from scratching at your skin and damaging the healthy skin barrier.  When itching occurs, apply moisturizer and massage the area instead of harsh scratching that causes excoriations and superficial infections.

Soaps can be harmful to the skin barrier.  They are designed to remove dirt and oil by creating micelles.  In addition to dirt and oil they remove healthy layers of skin.  Frequent washing can lead to a broken skin barrier and dry skin which predispose you to skin irritation and skin diseases.  It is important to find mild soaps that are not anti-bacterial; the anti-bacterial soaps are harsh on the skin.  Similar to your detergents, you want a soap that is free of dye (colorless or white) and does not have fragrances.  Liquid soaps are better than bar soaps for sensitive skin.

Always consult your healthcare provider if you have any questions or concerns about your skin care regimen.