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Skin Care Update

As we deal with the tail end of the winter season, and all of the dramatic temperature changes we have been experiencing lately, including going back and forth between our warm homes to the frigid outdoor temperatures, our skin needs to adjust to all of these changes. Our skin, being the outermost layer of the body, is the first line of defense, confronting all physical, chemical, and biological insults we face (i.e. temperatures, irritants, and bugs of all kinds).

All of the above factors contribute to making our skin dry during the winter season. Dryness makes the skin less defensive. In order to minimize the negative effects on our skin we are advised to protect our skin in a balanced way.

  • Layering clothing starting with soft white cotton undergarments because they are gentle and are effective for warmth and sweat absorption (minimize colors and scents)

  • Trying to avoid wool and nylon when choosing a sweater.

  • Wearing a heavy coat which can be removed when warm

  • Wearing hats and scarves to protect the head, neck, and face from both wind burn and ultraviolet rays hiding behind clouds are all excellent ways to help protect our skin during winter months.

  • When it comes to showering, the recommendation is a short shower, with warm water.

  • Gently pat your self-dry and lock in moisture by immediately using a mild neutral moisturizer.

  • Body washes that are colorless and odorless can be more helpful in minimizing irritation, and are preferred over bar soap, which can sit and collect bacteria.

  • Bottles of body wash can also be shared among family members without touching each family member’s skin like bar soaps may. Squeezing a small amount of liquid body wash into a washcloth or synthetic poof for gentle exfoliation is best.

  • Remember not to use water that is too hot as it makes the skin red, itchy, and pulls moisture out of the skin.

  • Taking a warm bath once weekly in order to relax muscles would not be harmful but keep in mind that sitting in a hot tub for extended periods of time should be avoided.

Now, with regard to skincare products, we have seen significant progress in the new era. As for moisturizers, we recommend the same neutral (colorless and odorless) gentle types just like the body wash. Finding a moisturizer with a good balance is best. Try to find one that isn’t too thick or greasy, but also not too runny. The best are generally creams found in a container or lotions from a pump dispensing bottle. Moisturizers are most effective when applied after the shower in the morning and again before bed. Most moisturizers have been like the icing on the cake, helping to lock in moisture and prevent water loss from the surface of the skin.

Recent technology has produced what we call “biologic” or “functional” moisturizers. This concept means that the newer moisturizers penetrate the skin and build up moisture within the skin. This is done by using ceramides, i.e. amino acids that penetrate in between epidermal cells and contribute to natural moisture, similar to the cement which holds bricks together; these ceramides bind together to prevent trans-epidermal water loss.

Now, let us address the topic of extremely dry skin conditions, which present more often during winter months, inflammation of the skin. The two most common inflammatory skin conditions are eczema and psoriasis. These conditions can be improved and maintained by practicing good skin care; however, medical attention is needed in order to treat them. Dermatologists are the most experienced professionals to help with both of these tough chronic conditions.

There are many topical steroids (cortisones), both old and new that are used to help treat inflammatory skin conditions. The difference between the old and new steroid creams is the advanced vehicles (or inactive ingredients) used to help deliver the active medicine to the correct target areas in the skin. These new products are more elegant and more effective than the old ones, and this enhances compliance as well. We also have new topical medicines (non-cortisones) to use in conjunction with or to maintain and replace the steroids after being used for a period of time (i.e. after controlling the flare of the disease). These products are safe and they spare the skin from potential negative side effects of steroid use. Steroid use is a double edged sword; they are good for controlling flare ups, but should only be used for the period of time needed to control the flare, and no more.

The newest advancement made within this field is the invention of biologic medicines. These are injectable or oral medications that are safer than the old generations of chemotherapy drugs. Biologics have better control and much less side effects for both eczema and psoriasis. They have very specific targets within our immune system but they do not destroy our immune defenses as the older medications did. Most biologic medicines are injected under the skin by the patients themselves with easy to use devices and are only needed every few weeks, which again enhances patient compliance. Some of these newest biologic medicines are extremely effective, causing the disease to appear cured.

Having reviewed the above, we can never forget the vital role that oral or injectable steroids, antibiotics, and antihistamines play in controlling these diseases when needed. After all, we cannot emphasize enough how important it is to be compliant with treatment, and regular follow up appointments with your doctor to monitor progress and potential side effects.

Throughout this article I have focused mainly on skin care issues during the tough winter season, but I would also like to touch on the issue of skin cancer since the sunny season is (hopefully) right around the corner. Soon enough we will all be tired of being cooped up and have cabin fever, anxiously awaiting the sun and outdoors. The sun’s rays have detrimental effects on the skin which leads to potential skin cancers, and solar aging.

There are numerous recommendations we would like followed in order to protect our skin from those harmful effects caused by the sun. Avoiding the sun at mid-day when it is strongest, using a sun block lotion, and protective clothing treated with SPF, as well as seeking shade whenever possible (especially in areas with high light reflection such as the sand and water and in high altitude or latitude areas) are all protective measures that should be taken while outdoors. When it comes to SPF products, there are more advanced formulas that contain protection against UVA and UVB rays, and products containing combinations of chemical and physical ingredients. These products now come in very attractive, appealing formulas such as sprays and foams. SPF spray and foams will increase compliance; since they are easy to apply and then re-apply every 2.5-3 hours as recommended (even the best SPF will break down after 2.5-3 hours). These protective foams and sprays don’t heat the skin or cause greasiness, especially when the skin is wet or sweating, which makes application during athletic or physical activity ideal. The magic number recommended for SPF is 50, but frequency of application is also very important, possibly even more so than the higher numbers of SPF.

The use of sun glasses and protective eyewear is also very important to prevent vision damage caused by the sun.

Lastly, always remember to have a baseline skin examination done in order to evaluate moles, and prevent skin cancers, especially those individuals with high genetic predisposition and professional risks. Never forget that your dermatologist is your safe guard against skin cancer!

By: Mounir Botrous, M.D.

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