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Diseases and Conditions Tips and Tricks

How to Care for Your Oral Health with Sjogren’s Syndrome

February 6, 2024

Today we’re going to learn about Sjogren’s syndrome oral health and steps you can take to protect your teeth and gums. But before we delve into the matter, let’s talk about Sjogren’s Syndrome.

Introduction to Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disorder that affects the body’s moisture-producing glands like the salivary and tear glands. This causes symptoms of dry eyes and dry mouth and can negatively affect your oral health. Sjögren’s syndrome mostly affects middle-aged women, with 9 out of 10 Sjögren’s patients being female. The condition can occur at any age though, including childhood.

Sjögren’s syndrome is considered a systemic disease because it can affect organs and body systems beyond the eyes and mouth. However, the hallmark symptoms remain dry eyes and dry mouth due to impaired gland function. According to a 2014 study, the prevalence of primary Sjögren’s syndrome ranges from 0.01 to 0.72% of the population).

How Sjögren’s Syndrome Affects Saliva Production

Sjögren’s syndrome is an autoimmune disease that attacks the body’s exocrine glands, including the salivary glands. This leads to significant reductions in saliva and tear production. The hallmark symptom of Sjögren’s is dry mouth, also known as xerostomia. With Sjögren’s, the salivary glands become inflamed and damaged, impairing their ability to produce saliva. This results in chronic feelings of dry mouth.

Saliva plays a critical protective role in oral health. Having minimal saliva in the mouth due to Sjögren’s syndrome can allow bacteria to grow, leading to increased risk of tooth decay and fungal infections. Lack of saliva also makes chewing and swallowing food more difficult. According to the National Institutes of Health, nearly all patients with primary Sjögren’s syndrome report symptoms of dry mouth.

Without adequate saliva to lubricate and rinse the teeth and gums, Sjögren’s patients face heightened risk of cavities, gum disease, mouth sores, and other dental problems. Ensuring proper oral hygiene is especially important for Sjögren’s patients due to reduced saliva production.

Dry Mouth and Sjogren’s Syndrome Oral Health Complications

Sjögren’s syndrome dramatically reduces saliva production, resulting in a chronic dry mouth condition known as xerostomia. Saliva is critical for oral health, and without adequate saliva flow, Sjögren’s patients experience uncomfortable dry mouth symptoms and an increased risk of dental problems.

Common dry mouth symptoms caused by Sjögren’s syndrome include:

  • Chapped or cracked lips
  • Burning or tingling sensation in the mouth
  • Difficulty chewing, speaking, and swallowing
  • Dry, sticky, or burning tongue
  • Mouth sores or infections
  • Bad breath

With decreased saliva production, Sjögren’s patients are also at higher risk for complications like gum disease, tooth decay, and oral fungal infections. Dry mouth creates an environment favorable to bacteria growth, acid damage, and irritation.

Specifically, Sjögren’s patients may experience:

  • Increased dental cavities due to lack of saliva’s buffering capacity and remineralization properties
  • Gingivitis and periodontitis as saliva is not present to wash away plaque and acids
  • Oral thrush or candidiasis fungal infections in the mouth

Left untreated, dry mouth can seriously impact oral health over time. That’s why managing symptoms and dental care are so important for Sjögren’s patients.

Other Sjogren’s Syndrome Oral Health Problems

In addition to dry mouth, Sjögren’s syndrome can lead to several other oral health issues including:

Tooth decay – With less saliva to wash away food and neutralize acids, cavities can develop more frequently (https://pearlypros.com/category/cosmetic-dentistry/oral-health-tips/).

Gum disease/infections – Dry mouth allows bacteria to grow, increasing risk of gingivitis, periodontitis and other infections (https://m.facebook.com/kabanidental/posts/4169354456419345/).

Fungal infections – Candida fungus thrives in the dry mouth environment.

Mouth sores – Lack of protective saliva causes sensitive tissue in mouth to crack and ulcerate.

Loss of taste – Saliva helps stimulate taste buds. Reduced saliva flow can diminish the sense of taste.

Importance of Saliva for Oral Health

Saliva is critical for maintaining good oral health. It serves several key functions:

Lubricates and Protects Tissues – Saliva acts as a lubricant for the mucous membranes in the mouth and throat. This helps protect against friction that can cause irritation or damage. The lubricating properties of saliva also keep the mouth comfortable and aid in functions like talking and swallowing.

Neutralizes Acids – Saliva contains minerals like calcium and phosphate that help neutralize acids in the mouth. Acids are produced when plaque bacteria metabolize sugars and attack tooth enamel. Saliva helps restore a neutral pH balance to prevent acid erosion of enamel.

Contains Minerals That Strengthen Enamel – Saliva provides a constant source of calcium, phosphate, and fluoride ions that are essential for re-mineralizing and strengthening tooth enamel. Minerals in saliva help protect teeth from bacterial acids and also aid in repairing early tooth decay.

With reduced saliva production, these protective factors are diminished. This puts Sjögren’s patients at a much higher risk of gum disease, tooth decay, and other problems.

Managing Dry Mouth

There are several methods Sjögren’s syndrome patients can use to help manage dry mouth symptoms and increase comfort:

  • Sipping cool water – Keeping hydrated by frequently sipping cool water can help provide relief and moisture.
  • Saliva substitutes – Artificial saliva sprays or gels can serve as saliva substitutes to coat and lubricate the mouth. Some examples are Biotene, Oasis, and Xerolube.
  • Alcohol-free mouth rinses – Swishing with alcohol-free oral rinses without irritating ingredients can help moisten the mouth. Some options are Biotene, ACT Total Care, and Crest Pro-Health rinses.
  • Chewing gum – Chewing sugar-free gum stimulates saliva production and can help keep the mouth moist. Look for brands containing xylitol.
  • Moisturizing sprays and gels – Moisturizing oral sprays and gels provide quick, temporary relief. Products like Mouth Kote and Oasis moisturizing gels can coat and hydrate the mouth.

Patients should work with their dentist to determine the best dry mouth remedies based on their symptoms. Using a combination of methods throughout the day provides the most effective relief.

Source: https://sjogrens.org/sites/default/files/inline-files/Sjogrens-DryMouth.pdf

Daily Sjogren’s Syndrome Oral Health Recommendations

Maintaining good oral hygiene is essential for Sjögren’s patients to prevent cavities, gum disease, and other dental problems. Here are some tips for keeping your mouth healthy on a daily basis:

Brush gently with a soft-bristled toothbrush. Use gentle, circular motions when brushing and avoid scrubbing aggressively on your teeth and gums. This helps prevent abrasions or irritation of the soft tissues.

Use a fluoride toothpaste. Fluoride helps strengthen enamel and prevent cavities, which is very important for those with dry mouth. If your mouth is very dry, look for toothpastes specially formulated for dry mouth.

Floss once daily. Flossing removes plaque and food particles between teeth that brushing misses. Be very gentle when flossing if you have inflamed gums.

Ask your dentist about fluoride treatments. In-office fluoride treatments or prescription high-concentration fluoride gels can help protect your teeth by strengthening weakened enamel.

Don’t forget to brush your tongue to help freshen breath. End each day with a thorough brushing and flossing to keep your mouth clean while sleeping.

Seeing the Dentist Regularly

It is critical for Sjögren’s patients to see their dentist regularly, every 6 months, so they can monitor symptoms and get preventive treatments.

During dental checkups, patients should discuss any dry mouth symptoms, cavities, tooth sensitivity, gum recession, and other issues with their dentist. Getting exams twice a year allows dentists to track changes in oral health over time.

The dentist may recommend more frequent cleanings or fluoride treatments to help prevent cavities in Sjögren’s patients. They can also advise patients on proper brushing techniques for sensitive teeth and receding gums.

Other preventive dental treatments that may help Sjögren’s patients include dental sealants to protect teeth from decay and prescription strength fluoride toothpaste or varnish.

Finding a dentist experienced in treating Sjögren’s patients can provide specialized care and advice. Research local dentists to find one familiar with dry mouth management and preventive dental care.

With routine exams and treatments, Sjögren’s patients can minimize oral health issues despite reduced saliva. Seeing the dentist regularly is key to maintaining dental health.

Sjogrens Syndrome Oral Health Considerations

There are some special dental considerations for Sjögren’s syndrome patients to be aware of.

Toothpaste for Dry Mouth

Using a toothpaste made specifically for dry mouth can help Sjögren’s patients protect their teeth. These toothpastes are formulated to be extra gentle and to help stimulate saliva production. They also contain ingredients like xylitol and calcium to help strengthen tooth enamel and neutralize mouth acids.

Finding Support for Oral Health

Living with Sjögren’s syndrome and dealing with the oral health complications can feel overwhelming at times. However, there are excellent resources and support systems available to help you manage your oral health:

  • Connect with national and local patient foundations like the Sjögren’s Syndrome Foundation (SSF). The SSF provides education, awareness, and support programs to empower patients. Joining local support groups can also help you connect with other patients facing similar challenges.
  • Build a collaborative relationship with your dentist so you can work as a team to protect your oral health. Make sure to discuss all your symptoms openly and get specialized guidance for your unique needs.
  • Ask your dentist to coordinate with your rheumatologist for a more integrated treatment approach.
  • Consider getting a second opinion if you feel your oral health needs are not being adequately addressed.
  • Stay on top of regular dental visits and cleanings every 6 months.

You don’t have to manage Sjögren’s oral health complications alone. By utilizing available resources and being your own advocate, you can maintain better dental and gum health.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

Overcoming Inflammation When to see a rheumatologist

How to prepare for your rheumatology consultation

October 3, 2017
How to prepare for your rheumatology consultation

Rheumatologists treat well over 100 different types of diseases.  These diseases are complex and affect many organ systems.  Diagnosing a rheumatic disease is like solving a complex puzzle.  Every first consultation includes a detailed history, a physical examination, and a review of past blood work, x-rays, and documentation from your other doctors.  All these help your rheumatologist solve the puzzle.

Preparing for a rheumatology consultation is a bit like preparing for a meeting with your accountant.  You want everything organized in advance: W-2, investment income statements, IRA/pensions distributions, child care costs, etc.  You want everything neatly laid out in advance, so that your consultation is as productive as possible.

Laying the groundwork

Make sure your rheumatologist has all the information at his or her disposal well before your appointment.

  • The progress note from your referring physician. What is the question that’s being asked?
  • Your primary care physician’s (PCP) last progress note.
  • The results of any blood tests.
  • The results of any x-rays or any other imaging.
  • If you had a biopsy that relates to your symptoms (e.g., skin biopsy, kidney biopsy, lung biopsy), your rheumatologist will want to see the pathologist’s interpretation.
  • If you are transferring care from another rheumatologist, your current rheumatologist will definitely want to see that information.

Bring an updated list of your medications and allergies

It’s always a good idea to have a written updated list of all your medications and allergies.  Make sure you bring this along to your first consultation.  Do not assume that your PCP’s updated medication list is up-to-date. Some people see more than one doctor and they’re all making changes independently.

Anticipate questions your doctor may ask

Rheumatologists certainly have access to high specialized blood tests and imaging, but the medical history is by far the most important part of the consultation.  Before your visit, try to expect some questions your doctor may ask and then write them down.  Here are a few that may help you get started.

  • When did you first notice something was wrong or had changed?
  • Describe your symptoms.
  • Has this ever happened before? If so when?
  • Do the symptoms come and go or are they continuous?
  • Is there a particular time of day where they are worse?
  • What makes your symptoms worse? What makes them better?
  • Have you taken any over-the-counter medications for your symptoms? If so, which ones and did they help?
  • Do you think you have other symptoms besides joint or muscle pain that seem connected?
  • Have your symptoms caused you to make changes to your daily routine?

Anticipate questions you may have for your doctor

  • Based on what you know, what could be causing my symptoms?
  • What tests do I need to have done to help decide what my diagnosis is?
  • Are there any symptoms that I should be looking out for?
  • What kind of interventions could I do now, to help ease some of my symptoms?
  • What kind of activities should I avoid at this time? (e.g, get pregnant, run a marathon, prolonged travel, etc.)

Actively listen and participate

You may feel overwhelmed when your doctor is giving you a new diagnosis, let alone giving you a complex set of recommendations.  You’re not alone.  A study looked at how much information (when prescribing a new medication) patients retained after their doctor’s appointment.  They found that only 64% of people were able to recall all the information that they discussed during the visit[1].  Not bad, but not great.

We know that recall of information improves health outcomes in people suffering from chronic diseases like rheumatoid arthritis and lupus.  Another study looked at aspects of doctor-patient communication that lead to higher recall.  They found that active patient engagement and explicit conversations about medications improved recall.[2]  Here are a few tips about becoming a better active listener.

  • Pay attention
  • Show that you’re listening
  • Provide feedback
  • Defer judgement
  • Be candid, open, and honest in your response.

You may also want to write things down in a journal (highly recommended) or maybe you may want to bring an advocate to your consultation.  This could be a trusted friend or family member.

Conclusion

Being ready for your appointment, active listening, and asking questions to understand your symptoms is central to not only making the most of your rheumatology consultation but also, becoming an empowered patient.

Please follow this link to request a rheumatology consultation.

[1] Tarn DM, Flocke SA, New prescriptions: How well do patients remember important information? Fam Med. 2011 Apr; 43(4): 254–259.

[2] Richard C, Glaser E, Lussier MT. Communication and patient participation influencing patient recall of treatment discussions. Health Expect. 2017 Aug; 20(4): 760–770.

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Diseases and Conditions

Tocilizumab: the new wonder drug for giant cell arteritis

June 7, 2017
People aged 50 years and above can develop giant cell arteritis

On May 22nd 2017 the FDA approved weekly subcutaneous tocilizumab (trade name Actemra®) to treat giant cell arteritis, a type of vasculitis that can cause blindness and in some cases death.  Why is this so important and how does this change everything?  The answer is simple.  Previously there were no effective treatments.  Rheumatologists used steroids like prednisone at high doses for months on end.  Many people would get lot’s of side effects due to the steroids and even this did not guarantee success.  Typically it takes many years for a medication to get FDA approval.  Although it did take more than a year to get approval, the process in this particular situation was fast-tracked.  Before I get into how we got to where we are today, let’s start with some background.

What is giant cell arteritis?

Giant cell arteritis is a type of large vessel vasculitis that tends to affect people aged 50 years and above.

Pay attention to the spelling, a-r-T-E-r-i-t-i-s. This is completely different from a-r-T-H-r-i-t-i-s.

Giant cell arteritis is an autoimmune disease that inflames blood vessels not joints.  More specifically, it inflames the aorta and the branches of the aorta.  Sometimes it’s also called temporal arteritis, but that’s not a good name for it because the temporal arteries are one type of artery that giant cell arteritis can affect.  We call this autoimmune disease giant cell arteritis because if you biopsy an artery you will find “giant cells” also called “granulomatous inflammation”, when you look at it under a microscope.  In fact, this is one way rheumatologists make the diagnosis.

This is an image of the human arterial system. Giant cell arteritis can affect any artery coming off the aorta

By LadyofHats, Mariana Ruiz Villarreal [Public domain], via Wikimedia Commons

What are the symptoms of giant cell arteritis?

Giant cell arteritis can present in many ways.  It really depends on the affected blood vessel(s).  If there is vasculitis in a temporal artery, then people tend to have a bad headache and a cramping pain when chewing food.  Maybe the blood vessels supplying the ears has vasculitis? This can cause a change in hearing and vertigo.  If the blood vessels supplying the eyes is affected, then it can cause blindness.  In some cases, people aren’t even aware of it.  They get a CT scan for some unrelated issue and the radiologist finds a large aortic aneurysm.  Giant cell arteritis is a condition that causes inflammation throughout the body, so many people present with fevers, drenching night sweats, and weight loss.

One of the most common presentations of giant cell arteritis is polymyalgia rheumatica.  Sometimes doctors simply call it “PMR”.  While 40% of people with giant cell arteritis have polymyalgia rheumatica, 10-20% of people with polymyalgia rheumatic develop giant cell arteritis.  Polymyalgia rheumatica is an autoimmune disease that causes muscle pain and stiffness in the shoulders, neck, hips, and thighs.  Finally, like giant cell arteritis, it affects people aged 50 years and above.

How do you diagnose giant cell arteritis?

There are many ways to diagnose giant cell arteritis.  First of all, blood tests like the CRP and the sed rate are usually very high.  These are tests that measure the amount of inflammation in your body.   Ideally you want to have a biopsy of the affected blood vessel but sometimes that’s not possible.  The biopsy should show giant cells but this only occurs in about 50% of cases so having a negative biopsy does not necessarily completely exclude disease.  When a biopsy is not possible, certain imaging studies can help like ultrasound, CT angiography, and PET scans.

How is giant cell arteritis treated?

Steroids, steroids, and more steroids.  If a doctor suspects that someone has giant cell arteritis, they immediately start treatment with high doses of steroids.  This happens even before the workup!  Once the diagnosis is firmly made the steroids are slowly tapered.  This happens over months.  It’s not uncommon to still be on steroids for YEARS after the diagnosis.  In many cases, the vasculitis returns.  This can be very frustrating and upsetting.  Rheumatologists have tried to treat people with medications like methotrexate in addition to steroids, but these haven’t really worked.

That is until now…

How it began

In 1990 researchers tested the blood of 15 people who had untreated giant cell arteritis.  They found high levels of a cytokine called interleukin 6 (IL-6) in their blood.  After treatment with steroids, their interleukin 6 levels decreased except for a few people.  Which is unsurprising since many people with giant cell arteritis relapse.

At that time, we didn’t have any medications that specifically blocked interleukin 6.

Flash forward to 1997.  A company based in Japan called Chugai Pharmaceuticals began research on tocilizumab to treat rheumatoid arthritis.  Tocilizumab is biologic humanized monoclonal antibody that blocks interleukin 6. Then in 2003 Genentech co-developed the medication.  Genentech’s tocilizumab is called Actemra®. Finally in 2010 the FDA approved Actemra® for to treat moderate to severe rheumatoid arthritis.

Giant cell arteritis and tocilizumab

Now remember how researchers found high levels of interleukin 6 in the blood of people with giant cell arteritis? What would happen if you treated someone who has giant cell arteritis with tocilizumab?  Would they go into remission?  Maybe you could taper off steroids more quickly?  That’s exactly what some Swiss scientists showed in 2011.  They treated 5 people with giant cell arteritis with tocilizumab.  All of them went into remission and all of them were able to taper off the steroids quickly.  The elevation and blockade of interleukin 6 appeared to be especially relevant for the treatment of giant cell arteritis.  But this was a case series with a very short follow-up time.  Was this a fluke or were they onto something?

In 2012, researchers started a larger phase 2 study.  This time they studied 30 people and they randomized them to either receive tocilizumab+prednisone or placebo+prednisone. The results were favorable:

  • 85% of the people who received tocilizumab and 40% of the people who received placebo went into remission by week 12.
  • 15 % of the people who received tocilizumab relapsed, where 80% of the people who received placebo relapsed by week 52.
  • People who received tocilizumab on average stopped prednisone 12 weeks in advance compared to people who received placebo.
  • 35% of people who received tocilizumab had a serious side effect, where 50% of people who received placebo had a serious side effect.

The last act

At last year’s American College of Rheumatology conference, Dr. John Stone presented data from the GiACTA trial, which was a randomized, double-blind, placebo-controlled trial.  This was a phase 3 study.  So they looked at more people from various locations.  There were 251 people placed into 4 different groups.

  • A short course of prednisone (26 weeks) + a weekly subcutaneous placebo
  • A long course of prednisone (52 weeks) + a weekly subcutaneous placebo
  • A short course of prednisone + weekly subcutaneous tocilizumab
  • A short course of prednisone + every other week subcutaneous tocilizumab

The results

  • 56% of people who received weekly tocilizumab achieved and stayed in remission after 12 months.
  • 53.1% of people who received every other week tocilizumab achieved and stayed in remission after 12 months.
  • 14% of people who received a short course prednisone + placebo were in remission after 12 months (p <0.0001).
  • 17.6% of people who received a long course of prednisone + placebo were in remission after 12 months (p ≤ 0.0002).
  • People who received tocilizumab received about half as much prednisone overall.
  • Adverse events were about the same in all groups and there were no deaths or vision loss.

The conclusion

Due to these extraordinary results and the dire need for effective treatment for giant cell arteritis, the FDA approved weekly subcutaneous tocilizumab.  I don’t know about you, but I’m very excited about this!  Finally a medication that works!  Mind you, it doesn’t work in every single case but this is definitely is a step forward.  And to add icing on the cake, although tocilizumab doesn’t eliminate the need for steroids, it does drastically decrease the total amount people get…another big plus.

To continue learning more about rheumatology and how to read research articles from their original source, please read on!

References

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm559791.htm

Rheumatology Secrets, 3rd edition

Dasgupta B, Panayi GS. Interleukin-6 in serum of patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol. 1990 Dec;29(6):456-8.

https://www.drugs.com/history/actemra.html

Seitz M, Reichenbach S, Bonel HM, Adler S, Wermelinger F, Villiger PM. Rapid induction of remission in large vessel vasculitis by IL-6 blockade. A case series.Swiss Med Wkly. 2011 Jan 17;141:w13156. doi: 10.4414/smw.2011.13156.

Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, Bütikofer L, Seitz M, Reichenbach. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.Lancet. 2016 May 7;387(10031):1921-7. doi: 10.1016/S0140-6736(16)00560-2. Epub 2016 Mar 4.

Stone JH, Tuckwell K, Dimonaco S, Klearman M, Aringer M, Blockmans D, Brouwer E, Cid MC, Dasgupta B, Rech J, Salvarani C, Spiera RF, Unizony SH, Collinson N. Efficacy and Safety of Tocilizumab in Patients with Giant Cell Arteritis: Primary and Secondary Outcomes from a Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). http://acrabstracts.org/abstract/efficacy-and-safety-of-tocilizumab-in-patients-with-giant-cell-arteritis-primary-and-secondary-outcomes-from-a-phase-3-randomized-double-blind-placebo-controlled-trial/. Accessed May 29, 2017.

Tips and Tricks

Simple and easy ways to hydrate your skin

January 23, 2017
Hydrate dry skin

Introduction

Dry, flaky skin got you down? A lack of proper hydration is often the culprit behind dull, lackluster skin. Hydrated skin is essential for maintaining a glowing, radiant complexion. Read on to learn the science-backed methods to restore moisture, bounce, and a healthy glow to your skin.

What is Skin Hydration?

Skin hydration refers to the process of delivering moisture to the skin cells and retaining it in the epidermis (the outermost layer of skin). Hydrated skin has enough water content for the skin to look and feel soft, plump, and supple. Skin that lacks sufficient hydration becomes dry, flaky, and tight. Properly hydrated skin is better able to withstand damage from environmental stresses like pollution, sun exposure, and harsh weather. It also has a more youthful, healthy appearance with fewer visible fine lines and wrinkles. Hydration is essential for proper skin function and homeostasis [1].

When the skin is hydrated, the cells become engorged with water, causing them to plump up. This provides structural stability and resilience to the skin. Hydration also allows skin cells to carry out normal physiological functions like tissue repair, barrier function, and shedding of dead skin cells. Skin that lacks hydration becomes less efficient at protecting against irritants, bacteria, and the early signs of aging. Furthermore, water makes up the base of the skin’s surface layer – without adequate hydration, this surface layer dries out and cracks, which can accelerate aging. Properly hydrating your skin is key to maintaining healthy, youthful skin over time [2].

Why Skin Hydration Matters

Keeping your skin properly hydrated provides many benefits for a youthful, healthy appearance. Hydrated skin is plump and supple, with a dewy, radiant glow. The skin barrier is strong to lock in moisture and keep out irritants when it has enough water content. As we age, skin naturally loses the ability to retain moisture, so it’s especially important for women over 25 to focus on hydration.

The best thing about keeping your skin hydrated is that it can help reduce the look of fine lines and wrinkles. Water makes the skin fuller, smoothing out dryness and crepey texture. By staying hydrated regularly, you can improve the elasticity and firmness of your skin, which can reduce sagging and wrinkles. Proper hydration can also help fight flakiness, tightness, and roughness.

In contrast, the consequences of dehydrated skin are amplified signs of aging. Research shows that insufficient hydration leads to up to 50% more fine lines and wrinkles by age 40. Without adequate moisture, the complexion looks dull, skin feels irritated, and makeup applies unevenly. Long term, extreme dehydration can even cause the skin to crack and become prone to infection.

By making skin hydration a priority with high quality moisturizers, humectant serums, and hydrating skin care routines, women can maintain a youthful complexion with fewer wrinkles and a healthy, radiant glow.

Causes of Dehydrated Skin

There are several factors that can cause the skin to become dehydrated and lacking in moisture. Environmental exposures like sunlight, heat, and cold temperatures can strip moisture from the skin [1]. As we age, the skin’s natural ability to retain moisture decreases leading to increased dryness [2]. Using harsh soaps, over-exfoliating, and excessive hot water can disrupt the skin barrier and deplete natural moisturizing factors [3]. Certain medical conditions like eczema, psoriasis, diabetes, and thyroid disorders can also contribute to dehydrated skin [1].

[1] https://www.medicalnewstoday.com/articles/dehydrated-skin
[2] https://bodewellskin.com/blog/dehydrated-skin/
[3] https://www.theskinsmith.co.uk/what-is-the-cause-of-dehydrated-skin/

Hydrating Ingredients

There are several ingredients that help hydrate skin in different ways:

Humectants

Humectants are ingredients that attract and bind moisture to the skin. They pull water from the dermis and the air into the epidermis. Common humectants include:

  • Glycerin – a natural humectant that draws moisture into the skin (https://www.paulaschoice.com/ingredient-dictionary/ingredient-skin-conditioning-ingredients.html)
  • Hyaluronic acid – attracts and binds up to 1000x its weight in water for plump, hydrated skin

Occlusives

Occlusives create a protective barrier on the skin to prevent moisture loss. They seal hydration into the skin. Examples include:

  • Petrolatum – provides an occlusive layer to lock in moisture
  • Dimethicone – seals hydration and smooths the skin

Emollients

Emollients fill in cracks between skin cells and smooth the skin. They help skin retain moisture. Common emollients:

  • Ceramides – naturally found in skin, supplementing them prevents moisture loss
  • Plant oils like jojoba, almond, and olive oil – nourish skin and provide fatty acids

Using a combination of humectants, occlusives, and emollients is ideal for hydrating different layers of the skin.

Maximizing Absorption

To get the most out of your hydrating skin care products, it’s important to maximize absorption. Here are some research-backed tips:

Apply products to damp skin after cleansing. Damp skin acts like a sponge, quickly absorbing serums, lotions and creams compared to dry skin [1]. Be sure to pat your face dry with a towel instead of rubbing.

Use gentle, circular motions when applying products. Massaging products into the skin in smooth, circular motions can increase penetration compared to simply smoothing products on [2].

Apply products from thinnest to thickest texture. Starting with lightweight serums and ending with richer moisturizers allows each layer to fully absorb before applying the next.

Finish with a protective layer like petroleum jelly. Applying an occlusive layer like petroleum jelly over hydrating products seals in moisture and prevents evaporation from the skin’s surface [3].

Signs of Properly Hydrated Skin

When your skin is properly hydrated, you’ll notice some clear signs. Hydrated skin appears plump, smooth, and dewy rather than tight or flaky. Here are the main signs your skin is getting the moisture it needs:

Plump, smooth skin texture. Hydrated skin will lack wrinkles and feel supple to the touch, rather than dry and rough.

Minimal flaking or tightness. If your skin is properly hydrated, it won’t peel, crack, or feel uncomfortably tight, especially after cleansing.

Healthy, natural glow. With adequate moisture levels, your skin will exhibit a radiant, illuminated sheen rather than looking dull.

According to experts at First Impressions Clinic https://firstimpressionsclinic.ca/2023/03/06/how-to-hydrate-your-skin-this-winter/, properly hydrated skin also does not appear thin or sunken in. The right moisture balance keeps skin looking full and firm.

Lifestyle Tips for Hydrated Skin

In addition to using topical skincare products, there are several daily habits that can help maintain well-hydrated skin:

Drink plenty of water. Getting adequate water intake helps your body stay hydrated from the inside out. Aim for the recommended 8-10 glasses per day.

Eat foods rich in omega-3 fatty acids. Foods like salmon, walnuts, and chia seeds help strengthen the skin barrier and lock in moisture. Omega-3s also help reduce inflammation that can lead to dryness.

Limit hot showers. Extremely hot water can strip the skin of oils. Keep showers warm, not steaming hot, and avoid excessive showering.

Use gentle cleansers. Harsh soaps and cleansers disrupt the skin barrier, causing moisture loss. Opt for gentle, hydrating cleansers without sulfates. Use hypoallergenic products when possible.

Protect skin from sun damage. UV exposure can dehydrate and thin the skin over time. Wear SPF 30+ sunscreen daily.

Adapting these simple lifestyle habits into your daily routine can keep your complexion hydrated, healthy and glowing.

Conclusion

Properly hydrating your skin is key to maintaining a youthful, healthy glow. By understanding what dehydrates skin and how to counteract it with both topical products and lifestyle habits, you can get your complexion looking plump and radiant. Be sure to drink plenty of water, eat omega-3 rich foods, limit hot showers, and apply hydrating serums and occlusive moisturizers. Implement a gentle but thorough skincare routine with ingredients like hyaluronic acid and glycerin to draw moisture into the skin and seal it in. With some discipline and the right products, dry, flaky skin doesn’t stand a chance. Get started today on your journey towards maximizing hydration for smooth, supple skin.

Final Topic Callouts

When your epidermis lacks water and lipids, the many essential functions of the skin become compromised. However, with knowledge of the causes, targeted ingredients, and smart skin care techniques, you can get your skin glowing again. Some key takeaways from our discussion on hydrating your skin:

  • Applying products to damp skin ensures better absorption of hydrating ingredients like glycerin and hyaluronic acid into the deeper layers of the skin.
  • Exfoliating aids hydrating products by removing dead cells that can prevent effective penetration.
  • Occlusive ingredients like petrolatum seal in existing moisture and prevent water loss through the skin’s outer barrier.
  • Limiting hot showers, staying hydrated, and eating omega-3 rich foods can support your topical routine.
  • Look for plumpness and a dewy glow, instead of flakiness and tightness, to assess proper hydration.

With some diligence to your skin care regimen and lifestyle, you can achieve a supple, quenched complexion.

Diseases and Conditions When to see a rheumatologist

8 important warning signs of scleroderma

November 28, 2016
Scleroderma is an autoimmune disease that can cause fibrosis of skin and internal organs. Early diagnosis is very important. Read on to learn more!

If I had to pick one autoimmune condition, which causes chills to run down one’s spine, I pick scleroderma.  The medical name for this condition is systemic sclerosis.  In a nutshell, systemic sclerosis is an autoimmune disease which causes inflammation in small blood vessels, which eventually can cause hardening of the skin and other major organs.

I quick Google search of scleroderma will inevitably present you with a horror show of images and stories from sufferers of this condition.

Yes, scleroderma is a terrible disease, but it’s also a terribly heterogeneous disease meaning that no two cases of scleroderma are the same.  There are mild cases and there are life-threatening cases.

Identification of early disease is probably one of the most important determinants of prognosis.  Well actually, it’s a little more complicated than that, but it is the one aspect that you can control:  The knowledge to know when to ask.

Types of Scleroderma

This is how rheumatologists breakdown scleroderma:

Classification of scleroderma

 

Basically, systemic sclerosis is when the disease affects the skin and internal organs and localized scleroderma is when it only involves the skin.  A lot of rheumatologists, included yours truly, believe that localized scleroderma and systemic sclerosis are actually two completely different diseases.

I’m going to concentrate on systemic sclerosis going forward.

Now we’re left with scleroderma sine scleroderma, limited systemic sclerosis, and diffuse systemic sclerosis.  Scleroderma sine scleroderma is systemic sclerosis involving the organs but not involving the skin.  This is super rare.

People that have limited systemic sclerosis have hardening of the skin that does not go past the elbows or knees.  They also tend to NOT have kidney involvement or inflammation of the lungs.  The disease course usually is insidious and sometimes is very difficult to detect, particularly during a 15 minute doctor’s appointment.

The last type is called diffuse systemic sclerosis.  It’s important to detect REALLY fast because it can progress quickly, because it can be deadly, and people simply do better when they’re treated early. People suffering from this type of scleroderma can have whole body hardening and are more prone to develop lung inflammation and kidney involvement.

Raynaud’s phenomenon

Almost everyone with any form of systemic sclerosis has something called Raynaud’s and esophageal reflux.  They also tend to appear early during the disease process, so these two symptoms are important to watch out for.

They say a picture is worth a thousand words.  Here’s an example of Raynaud’s… not the most dramatic example but that’s kind of the point.

This is a nice example of Raynaud's phenomenon. Sometimes the finger can be white, like the pinky, and sometimes it can look dusky

 

Raynaud’s can involve your fingers and your toes.  Exposure to cold can cause it as well as a rapid change in temperature, and stress.  Raynaud’s is very common in women and for the most part is annoying but nothing serious.  The picture above is actually my hand.  This has been going on since my teens.  Let me tell you, I grew up in Canada.  Shoveling snow was kind of brutal.

About 15% of women have primary Raynaud’s (i.e., Raynaud’s without any underlying autoimmune condition).  Primary Raynaud’s typically first appears during one’s teens or early adulthood.  People with scleroderma tend to develop it later in life and  the intensity is A LOT more severe.  Sometimes the skin can become so ischemic (poor circulation) that it can cause an ulcer.  I have a lot of patients whom I’ve diagnosed with systemic sclerosis that told me that they thought that they had purple fingers because they were getting old…  This is NOT part of the normal aging process.

  1. Onset of Raynaud’s at a later stage in life.
  2. Raynaud’s complicated by ulcers.

Heartburn

Another symptom found in almost all people suffering from systemic sclerosis is heartburn.  This can present as chest pain, burning pain up your esophagus, nighttime cough, an acid taste in your mouth in the morning.  Sometimes people may have difficulty swallowing food and water.  Now, a lot of people have heartburn.  Just because you have heartburn, does not mean you have scleroderma.  You have to look at the entire picture.

  1. Heartburn
  2. Difficulty swallowing

Other common symptoms

Here is a list of other symptoms to watch out for:

  1. Puffy fingers, VERY high yield symptom
  2. Red spots all over your face, chest, and/or palms
  3. Hardening of the skin
  4. Shortness of breath with exercise

 

Conclusion

There are a lot more symptoms that I haven’t gone over.  But sometimes less is more.  If you can remember these 8 warning signs, you have a really good chance of detecting early disease on your own, and maybe even save your life or the life of a loved one.  Having more than one of these symptoms should prompt you to consult a rheumatologist for further evaluation and testing.

For more information, I highly urge you to visit the Scleroderma Foundation website. They provide useful information about scleroderma for both the newly diagnosed and those that have had the disease for a long time.  They’re also involved research and patient advocacy.  Needless to say, I highly recommend them!

If you want to learn more about Raynaud’s phenomenon and ways how to treat it, read on.

References

Rheumatology Secrets 3rd edition

van den Hoogen F, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013 Nov;72(11):1747-55.

Minier T, et al. Preliminary analysis of the very early diagnosis of systemic sclerosis (VEDOSS) EUSTAR multicenter study: evidence for puffy fingers as a pivotal sign for suspicion of systemic sclerosis. Ann Rheum Dis. 2014 Dec;73(12):2087-93.

Scleroderma Foundation: http://www.scleroderma.org/site/PageServer#.WTC56WjytPY

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