This past Christmas, I received probably one of the most bizarre gifts I have ever received. A full adult-sized onesie! Let me tell you, it hasn’t really brought out the most flattering bit of my anatomy. Last year I had lamented that my house was kind of cold in the winter and mentioned that babies had it made with their one-piece pajamas. That being said, I decided to use my family’s superhuman memory to my advantage. This year it was all about my dry skin and how wonderful it would be to have a paraffin wax machine.
I have to admit it though, that onesie does keep me nice and toasty at night!
While waiting for the paraffin wax machine that hopefully will be making its apparition Christmas 2017, hint-hint, I thought I’d do a little research about the topic of dry skin: anatomy, immunology, and basically how to keep it as moist as possible without that oily feeling. People who suffer from autoimmune diseases tend to suffer from dry skin. This really isn’t surprising. This skin is the largest organ in the human body. Because of its large surface area, it needs a large complex immune system. Autoimmune diseases = inflammation and inflammation involving the skin = dryness, irritation, and itchiness.
Anatomy and immunology
The medical term for dry skin is xerosis and the term dermatitis signifies inflammation of the skin. The skin is made up of the epidermis which is the most superficial layer followed by the dermis and then the subcutis. These layers are made up of blood vessels, hair follicles, as well as glands. One of the main functions of the skin is to protect your body from the outside world. That being said, the skin contains many immune cells such as Langerhans cells, neutrophils, eosinophils, and lymphocytes. When skin is irritated by bacteria, viruses, chemicals, the immune system kicks in to fight off the foreign invader. With autoimmune diseases, it’s the immune system that starts to attack the skin itself. In either case, when the immune system is activated it causes inflammation which = irritation + dryness.
There are many autoimmune diseases that affect the skin. Some of these include scleroderma, Sjögren’s syndrome, rheumatoid arthritis, lupus, sarcoidosis, and psoriasis.
So what can you do to keep your skin moist and healthy? Drink plenty of water, limit the amount of exposure of your skin to water, protect your skin from the sun, avoid allergens, and moisturize regularly.
Avoiding irritation and dehydration
You would think that more water equals more hydration. That may be true for ingested water, but it’s the opposite for water that makes direct contact with your skin. For example, every healthcare worker soon learns that there is a positive correlation between the dryness of their hands with the amount of times they wash their hands per day. Don’t get me wrong washing your hands is very important to prevent the spread of infection, but it certainly does a number to your skin. Some things simply cannot be avoided. That being said, if you suffer from dry skin, try to limit the amount of time you spend washing in the shower. Make it a quick 5 min instead of a long 30 min shower. Another tip is to use lukewarm water instead of hot water.
For people who shave, try to shave immediately after you shower. The hair will be much more malleable at this time. Always use a sharp razor and always shave with the line the hair grows. These will lessen the amount of irritation caused by shaving.
This may sound obvious, but it’s really important to prevent your skin from burning. Burnt skin = dehydration. If you plan on being in the sun, try to stay in the shade between 11 AM and 3 PM. The UV is at its highest during these hours. Aim to cover up with clothing made of light-colored cotton. Light colored clothing adds a few extra SPF points. Broad-brimmed hats and sunglasses are your friends. Use sunscreen liberally. At least 15 SPF. For people suffering from lupus, plan for a much high SPF as UV can actually trigger a full-fledged systemic flare.
What I mean by avoiding allergens means, try to avoid anything that may cause some form of allergic reaction. Again allergic reaction = inflammation = deterioration of skin barrier function = dehydration. Obviously, it’s impossible to avoid everything but it may be a good idea to swap perfumed household products for hypoallergenic ones: laundry detergent, softener, soap, shampoo, moisturizer etc. Anything that directly or indirectly makes contact with your skin. It’s important to note that even, “all natural” products can potentially contain allergens. For example, most people aren’t allergic to Shea butter, but some are. Learn to know your skin.
Hydrate you skin
Are you as confused as I am when it comes to moisturizers? Which ones are good? Which ones are bad? What’s the difference between a lotion, cream, and an ointment? What goes where? How much should I apply? How often?
It’s essential to moisturize daily particularly those suffering from dry skin conditions. Simply put, dry skin is determined by the amount of transepidermal water loss and this in term is determined on the integrity of the skin barrier function. The composition of the moisturizer determines whether the treatment helps skin barrier function or not. I can’t tell you which moisturizer is better than the other, because I haven’t found any blinded head-to-head evidence-based studies addressing this topic. If you do find one, let me know. I’m all ears!
Moisturizers come in various forms: lotions, creams, and ointments. Lotions are the least greasy and ointments are the greasiest. Typically, the greasier the moisturizer, the longer it lasts. The questions what goes where and how often and how much to apply, may actually be over-complicating the matter. The goal is to keep the skin nice and hydrated. When you really think about it, consistency is key. Would you wear a thick greasy ointment on your hands all day long? I wouldn’t because it’s uncomfortable and quite frankly not practical. Due to my job description, I wash my hands nearing 100 times a day. I’d rather use a cream or lotion and simply apply it more often. The ointment might be better tolerated at night before going to bed? If I’m comfortable, I’m more likely to wear the moisturize regularly. How much to apply? Apply enough so that the skin feels moist.
Like I said, there’s no need to complicate things.
One word of advice, when applying a moisturizer, try to stoke it onto the skin in the direction that the hair naturally falls. This can prevent folliculitis.
A little bit about miracle cures. They don’t exist. Any product marketing itself to be a “cure for psoriasis”, is probably a product to be avoided. A lot of these products have high doses of corticosteroids, which may initially make the skin look more hydrated and look “healthier”. If you suffer from psoriasis, it may even clear it up. But in the long run, regular application will cause permanent skin thinning, aging, and atrophy. Just like food, read the ingredients on the packaging of your moisturizer.
When it comes to diet, in general beware of any diet advocating cutting out lists of foods. For the most part, these are not founded in evidence and you actually may be doing more harm than good. Nothing beats a clean diet and plenty of water. What that actually means, is a matter up for debate. For more information regarding clean eating, I recommend visiting the Blue Zone Project by Healthways. The Blue Zone principles were derived from a National Geographic study identifying practices in cultures where people tend to live longer, i.e., greater than 100 years of age, and healthier as compared to the normal population. When you have entire populations of people living longer and healthier over thousands upon thousands of patient years, it makes me think they’re onto something.
I hope you’ve found this information useful. If you would like more information, please contact your local physician. Love your skin, keep it nice and hydrated!
Dermatology Secrets Plus, 5th edition copyright 2016 by Elsevier
American Academy of Dermatology
Loden M. Effect on moisturizers on epidermal barrier function. Clin Dermatol. 2012 May-Jun;30(3):286-96.
Penzer R. Providing patients with information on caring for skin. Nurs Stand. 2008 Nov 5;23(9):49-56.