Dry skin, or eczema, is a problem that I see in my family practice all the time, so I know that this is a common problem for many of you.
Eczema is actually a British term for what Americans call dermatitis, and these terms are a bit “loaded” because they don’t mean the same thing to everyone. But, if you have skin that is regularly, even on-and-off, dry and itchy, you’re watching the right video.
Whether we’re talking about a small patch on one part of your body or a widespread dry and itchy rash, I think it’s essential to first understand how important it is for your skin to be healthy.
When I see someone in the office with dry and itchy skin, it’s always tempting to give them a steroid cream to “make it go away.” Steroid creams come in all different strengths, and they are generally quite effective at helping damaged skin recover. Still, you cannot keep using steroid creams for the rest of your life, as long-term use of steroids is actually quite dangerous for the skin and can lead to permanent and irreversible damage.
So, what can you do to maintain healthier skin going forward?
The most important consideration is your skin’s natural oily “barrier”. Disruptions in this healthy barrier can lead to moisture loss and chemical irritants getting into the skin. One of the most common ways you will experience this is your skin becoming dry and itchy.
In fact, the easiest way to think about good skin health is to think about dryness. Being in a dry environment – whether you live in a dry climate or your home environment is not humidified enough – is often a common trigger for eczema or dermatitis. Where I live, winter is the dry season, and we see many more skin issues then. Another common contributing factor is regular exposure to powders and other chemicals that can dry out the skin. But, the most common contributor to this dryness is soap.
I learned about soaps and how they contribute to eczema and dermatitis while training in Toronto as a family medicine resident. A lecture from Dr. Bernice Krafchik, which has always stuck with me, taught me that while we do need to use some soap, some of the time, to keep ourselves clean, a lot of us use way too much soap, and often even the wrong types of soap.
Healthy skin will always have some bacteria that permanently hang around and help everything work smoothly. That’s natural, and promoting these organisms is a big part of skin health. If you wash away your skin’s oily barrier with too much soap, you risk damaging these essential bacteria, not to mention preventing your skin from hanging onto moisture, causing dryness and irritation.
So, let’s start by discussing the worst soap strategies.
First of all, some soaps on the market are simply too drying to be recommended for anybody who experiences dry and itchy skin. The worst offenders, in my experience, would be soaps like Ivory, Irish Spring, and Zest. A milder bar soap like Dove would be a better choice.
But another big problem that has become more common over the last couple of decades is the increased use of liquid soaps and body washes. You have probably all experienced using liquid soap, accidentally getting too much on your skin, and needing to spend extra time to wash it off. Liquid soaps and body washes are often simply too much soap, much more than you need, and the best way to limit the amount of soap you use is to switch to a mild bar soap.
In fact, for those people in the know, it can be overkill to wash your whole body with soap every day. Many people use soap very minimally on all of their skin, limiting soap use to their armpits and bums when they shower and simply rinsing off the rest of the body. Babies and infants, in particular, really do not need soap at all, especially since you are regularly cleaning the dirtiest spot after every bowel movement.
I cannot tell you how common it is to see parents of newborns and little infants expressing surprise that the liquid soap they have been using on their child is actually the reason they have dry and irritated skin. Most kids do just fine being bathed in water alone. And please do not forget about bubble baths, as this is another source of excessive soap for some kids. And I will quickly mention here that bathing kids too often is also drying to the skin: once or twice a week, especially for babies and infants, is absolutely often enough.
Now that we’ve discussed how to prevent healthy oils in your skin from getting washed out, we should also talk about another practice humans have used for millennia to help rejuvenate their skin and protect it from the outside world.
Rubbing oils into the skin is a worldwide practice that can help prevent and manage eczema and dermatitis, and many of us turn to moisturizing creams and lotions available at pharmacies and health food stores. But any lotion, by definition, has a high water content and will therefore have a drying effect on the skin. How can something with a high water content cause dryness? Well, Dr. Krafchik also taught me that the water component of lotion evaporates pretty quickly after application, leaving whatever chemicals and other components are in the lotion to sit on your skin. So, why are so many of these products sold as moisturizers, whether lotions or creams? Well, because they feel wet and therefore feel like they would be moisturizing. But, because they do not work in the long run, you have to keep applying them repeatedly. In other words, companies make a lot of money from selling these products.
What would be a better moisturizer? Something that feels oily to the touch, even a bit greasy: for example, Vaseline, or petroleum jelly. But, of course, that would get messy, particularly if you are applying that to various parts of your body. Much more reasonable options that humans have used for ages would be oils such as coconut oil or Shea butter. Rubbing these oils into your skin can help rejuvenate that oily barrier and keep your skin moist and protected from the external environment. For some people, coconut oil is irritating, and Shea butter is expensive, so you may look at other products containing lanolin or urea, which are available at pharmacies.
Managing skin health by respecting your body’s natural defenses can be very satisfying over the years, limiting discomfort and irritation and keeping your skin healthy and happy throughout your life. So, please limit that soap use, and respect the healthy, oily barrier that protects your skin, and you’ll be off to a great start!
