Dry skin, winter itch – includes related articles
The commonest causes of winter itchiness are centrally heated homes and workplaces, lack of room moisture, cold, dry air and too much bathing or showering. The best antidotes to dry skin are to humidify the indoor surroundings well and, as one dermatologist puts it, “to moisturize, moisturize, moisturize.” John, a radio technician who lived in a small, stuffy apartment, proves the point. He rarely opened the windows and his “sealed” office was over-heated. He habitually took two daily showers — one every morning, the other after his evening work-out. Every year, come November, he’d become very itchy, particularly on his shoulders and arms, sometimes scratching to draw blood. Finally a colleague aersuaded him to get medical advice. The doctor took a careful history to determine whether there were any chemical irritants at work — none, except perhaps the photocopier fluids — then told him to buy a humidifier for the apartment, to shower only once daily, to wash with mild, superfatted soap (such as Dove, Petro-Phylic or Neutrogena) and to apply moisturizer to his damp skin right after showering. The dermatologist also prescribed a menthol/camphor lotion for the itchy areas. The itch soon vanished and John keeps it at bay by repeating the same treatment when needed. Others who suffer from dry skin or winter itch can adopt similar measures. Those most susceptible to dry, flaking skin are the fair-skinned, the elderly, people prone to allergies and those who take too many showers or baths. Anyone with severely scaling, itchy skin should seek medical advice.
Dehydration often the culprit
While the combination of oil and sweat normally keeps human skin soft and supple, various factors — such as lack of humidity, over-exposure to water, sun, chemicals and soaps — can dehydrate it. If the skin loses water more rapidly than the deeper cells can replenish it, the upper layer dries out. Given the right conditions, dry skin can occur not only in winter but at any time of year and may be linked to dermatitis (skin irritation due to specific substances) and skin diseases involving abnormal skin turnover. Dry skin or xerosis characteristically starts out as small, whitish scales possibly with some reddening and cracking. Many sufferers complain that their faces feel taut to the point of cracking. Dehydrated, dry skin tends to become itchy and, although scratching may momentarily alleviate the irritation, the friction can lead to further breakdown. Untreated, it can develop into eczema, with soreness, inflammation, perhaps bleeding and in some cases swollen, oozing and crusty patches. (Dermatologists use the terms “dermatitis” and “eczema” almost interchangeably to denote badly inflamed, scaling, weepy skin.) Wind and cold may stimulate further cracking, discomfort and rawness. Once inflammation develops, it may be difficult to reverse except by applying topical steroids (such as hydrocortisone) or the arrival of warmer weather and higher humidity. In tracing the causes of skin itching, physicians consider not only indoor dryness but also other common and not-so-common triggers, such as: contact dermatitis (due to poison ivy or other plants, insect bites or exposure to chemical irritants such as dyes, metals, rubber, drugs), allergic reactions, cosmetic irritation, certai skin diseases (such as ichthyosis and psoriasis) and disorders such as kidney or liver disease.
Prevention is best: moisturize, moisturize, moisturize
The trick for itchy, dry skin is to keep it and the environment as moist as possible and to stop water loss from its surface. Avoid extreme temperatures, humidify the indoor air, apply moisturizers to damp skin and protect it from excessive exposure to sun, water, winter’s cold and harsh cleansers. Steering a sensible course through the quagmire of conflicting opinions about skin care is no easy matter. One young woman recently complained that she can’t decide on the “Right way to clean her skin” nor on the merits of “soaps versus cleansing creams” because everyone offered different advice. Her esthetician warned her never to touch her face with soap, to clean it with cleansing creams and astringent lotions, and to apply special “day” and “night” creams, especially under the eyes. Her dermatologist told her the opposite: “to wash her face once daily with bland soap and warm water, to use creams sparingly on her oily skin and not to lather on anything under the eyes.” Some dermatologists oppose the application of eye creams at bedtime, warning that they can cause eye puffiness if left on overnight. (If used at all, they’re best applied for 10 or so minutes and then wiped off.) And they warn that those prone to it may develop “cosmetic-induced” acne from certain face creams or moisturizers.
Each life-stage requires a slightly different skin care routine. During childhood, adolescence and young adulthood, most dermatologists recommend washing with gentle soap and warm — not hot or cold — water and a clean washcloth for about half a minute, rinsing well to remove all the soap. (Hot water isn’t advised because it’s very drying.) Soaps should be used more sparingly and washing done less frequently in very young infants and the elderly who have more sensitive skins. Overwashing makes the skin dry and flaky. Choosing the right skin cleanser depends on the skin type. A 1991 evaluation found that cleansing creams were not uniformly less drying to the skin than soaps. Mild soaps, although possibly less drying, don’t clean the skin as well as more alkaline types. The addition of agents such as cocoa butter, glycerin, and mineral oil does not significantly reduce soap irritation. Overall, people should choose any soap they like unless they have dry skin problems in which case mild, superfatted types may be best (such as Neutrogena, Dove, Caress, Petro-Phylic, Allenbury’s and Lowilla). One University of Toronto dermatologist recommends avoidance of deodorant and antiseptic soaps, unless medically prescribed.
Baths are generally more drying than showers
Many experts suggest replacing tub baths with showers, as they are less drying and more hygienic, removing dirt and bacteria more efficiently with the constant stream of clean water. However, as a relaxant after a hard day or to soothe aching muscles, warm (not hot and drying) baths can do wonders. Keep washcloths for the face separate from those for the body. Pumice stone can be used while showering or bathing to remove tough, dead skin from the soles of the feet and elbows, but rub gently to avoid abrading/harming the skin. Bubble baths and bath oils should be used with caution. While dry, itchy skin may benefit from bath oils, they make the tub slippery and increase the risk of falling. It is safer to apply creams or oils directly to damp skin after showering than adding them to the bath water. And always remember to use a bath mat! Bubble baths may appear harmless but can trigger a skin irritation and may provoke urinary tract infections in children (especially girls). When used, they should be well dispersed by pouring under a running tap. Above all, always moisturize the damp skin.
Choosing moisturizers wisely
The right cream or moisturizer is a matter of cost and personal preference. One dermatologist calls the choice simple: “never pay for the name.” Moisturizers coat the skin with oil, block evaporation of the skin’s natural moisture and trap water in its surface. While they can’t cure dry skin, moisturizes provide protection, relieve the dry, itchy feeling and reduce the tendency to crack. Although most of the water in the cream or moisturizer evaporates, the oil stays on as a lubricant, enabling the skin to retain moisture. The typical North American woman uses as many as 10 to 15 cosmetic and cleansing products. But it’s quite unnecessary to buy “special” creams for good moisturizing results. Most dermatologists consider expensive creams hardly worth the cost as cheaper ones, even plain petroleum jelly or mineral oil, do an equally good or better job. Whatever their price, moisturizers, hand and body creams, face, eye or night creams all have one thing in common — they trap water and provide a protective layer between the skin and the outer environment. All are basically oil and water mixtures with emulsifiers added to keep them well mixed and sometimes perfumes for a pleasing scent. Despite their various forms — ointments, creams, lotions, foams, gels and oils — all moisturizers contain similar ingredients: occlusives (which block the evaporation of water), humectants (which attract water) and emollients (oils such as mineral oil) that smoothe the skin by filling in the spaces between dry skin flakes. The thickness of moisturizing creams varies according to their oil-water ratio. The heavier or greasier it is, the greater the lubricating qualities. The thicker the product, the more oil it contains; the thinner the cream, the more water it contains. “Vanishing” or day creams have more water than night creams. As a rule, the drier the skin, the thicker the cream to use.
For dry or sensitive skins, choose any affordable moisturizer that is rich in oil and pleasant to use. One inexpensive way to moisturize is simply to soak the skin in warm water for a few minutes, pat off the excess and apply any oil to the damp skin, such as mineral oil, cocoa butter and petroleum jelly. Light mineral oil is just as effective as costly commercial products and because it contains no perfume is unlikely to irritate the skin or cause allergies. Fancy ingredients don’t guarantee better results. Although many modern skin care products are promoted as “wonder materials,” few live up to the touted claims. Some ingredients commonly found in moisturizers, including solvents, fragrances and preservatives, can cause irritation if present in high concentrations, or allergies if the user is sensitive to them. Recent consumer studies report that price, advertisers’ promises and “designer” labels bear no relationship to moisturizer efficacy. In fact, of dozens tested by U.S. Consumer Reports, the most expensive moisturizers turned out to be the least effective and fell in the bottom half of their ratings. Relatively inexpensive products, such as Nivea and Sea Breeze (by Clairol) came out on top of the moisturizer listings. Oil of Olay, Arden’s Visible Difference and other popular products scored low. No moisturizer proved any more effective than white petroleum jelly. Moisturizers should be easy to apply, relatively cheap and free of substances that trigger an allergic response. Also critical is the moisturizer’s cosmetic appeal — does it feel, look and smell pleasant? After all, to be effective, it must be frequently applied on clean, damp skin. A product that feels too greasy or smells bad won’t be used. The type of lubricant chosen should reflect the skin type and degree of dryness. For mildly dry skin, almost any lubricant will provide sufficient relief. For greater dryness, moisturizers with humectants such as glycerin (10 per cent) sorbitol, urea, alpha-hydroxy acids (four to eight per cent) are best. For very dry skin, products rich in petroleum jelly will likely provide the most relief. However, while petroleum jelly is one of the best and cheapest of moisturizers, it is sticky, so many prefer less greasy, even if less effective products.
For the face, products recommended by dermatologists include: Aquarelle Lotion, Moisturel Face Lotion, Neutrogena Facial Lotion, Aquaderm and Complex 15. For the hands and body, suggestions include: Lactimol, Aquatain, Lacthydrin, Nivea, Neutrogena norwegian formula, Neutrogena Rain Bath and Neutroderm. Oily skins prone to acne usually don’t need any moisturizer at all.
Astringents containing alcohol may be useful for the oily-skinned but will further dehydrate dry skin. If used at all, astringents should be dabbed on lightly with cotton balls (not paper tissue as it irritates the skin). Despite claims that various astringents “close the skin’s pores,” none fulfil this promise.
Watching for allergic reactions to skincare products
Plain face creams rarely cause allergic reactions, but certain ingredients in them can act as irritants or provoke allergies, particularly perfumes, salicylic acid, resorcinol, oxidizing agents and lanolin, sometimes because they’re used on parts of the body for which they were not intended. A body cream suitable for the arms or legs might induce puffiness if used under the eyes. Skin bleaching creams are among those most likely to cause allergic reactions. They should not be used by dark-skinned people except with medical supervision as they often cause an inflammatory reaction and patches of lighter skin. Hair products also frequently cause skin allergies, especially those containing paraphenylene diamine or thioglycolates. Hair removers containing barium or calcium sulfide or calcium thioglycolate can also cause allergic skin reactions. Nail polish can produce not only nail splintering and yellowing, but also allergic reactions if it touches the skin. A trace of nail polish on the eyelids can make them red and swollen. (Yet many of those with an allergic eyelid reaction don’t realize that nail polish was to blame.)
Wintertime hand care
Dry, cracked, chapped hands are a particular problem among mechanics, outdoor workers, cleaning personnel, nurses, surgeons, those who do housework and anyone whose hands are often wet. Since hand irritation might be due to skin diseases such as psoriasis, herpes, contact dermatitis, impetigo or other disorders, it’s wise to seek medical advice before assuming that everyday chores are to blame! The best way to avoid chapped hands is to keep them well dried, protected from the cold and wind, to wear cotton-lined vinyl gloves for wet work (rubber can cause allergies) and frequently apply hand creams to moist skin. Dry, brittle nails that easily break are another common wintertime problem, or sometimes due to illness, exposure to chemicals, strong detergents and nail polish removers. Soaking brittle nails in warm water for a few minutes and then applying olive oil or petroleum jelly at night can strengthen and make them more flexible. Most nail creams are no better than ordinary moisturizers. Nail hardeners will harden the nails, but may provoke a condition where the nail plate lifts from the nail bed. They can also discolour the nails or cause bleeding under them, so should be used with caution. The adhesive used to apply artificial nails can cause allergic reactions. Contrary to folklore, gelatin usually does nothing for dry or brittle nails, unless the person is suffering from a protein deficiency, in which case it will take three to six months to get noticeable results!
Help for aging skin
Aging skin normally becomes thinner and is drier than younger skin, hence the need to moisturize extra well with advancing years. Avoiding the sun’s harmful rays goes a long way towards preserving the skin’s suppleness. The best advice is to stay out of the sun as much as possible and apply sunscreens. Since older skin tears and gets injured more easily, it needs more vigilance. The renewal of the outer stratum corneum layer slows down as we age, making older people more prone to dry skin problems. The diminution in both sweating and sebum production among the elderly accentuates the need for regular moisturizers. Avoid abrasive washcloths, rough towels and grainy cleansers. A good face massage can increase the blood flow and reduce dryness, but without lasting benefits. The central message for those with dry, aging skin is to avoid harsh soaps, wash less often and above all to moisturize consistently. Cleansers for the over-65s should be mild (e.g., Cetaphil, Aquanil or Dove), omitting astringents. In using makeup for older skins, “less is often more.” A light or no foundation may be best to avoid caking in the wrinkle grooves. Powders are also best avoided as they often stick in the fine lines. For eye makeup, subtle rather than loud colours are advised. (Frosted products often accentuate a crepy look.) Brown mascara may be softer than black.
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