Rethinking Clean with Dr. Skotnicki
Eczema, psoriasis and dermatitis - three of the most common yet most mysterious skin conditions - are all related to inflammation and skin sensitivity. You hear about it all the time: “anti-inflammatory” foods, skincare and diets. We know inflammation is bad, but why and how do we avoid it?
‘Sensitive skin’ is a term used by professionals and consumers alike - we use it to describe skin that is easily reactionary to outside factors (wool, skincare products, climate, etc.). Dr. Sandy Skotnicki, a renowned Toronto dermatologist who specializes in allergic contact dermatitis and skin disease, believes 80% of skin sensitivity comes from either pre-existing conditions (psoriasis, eczema, dermatitis) or invisible inflammation. Dr. Skotnicki states that three factors can cause those without preexisting conditions to get sensitive skin: using too many products, using them too frequently, and washing too often - these practices can alter the skin’s microbiome and comprise the skin’s ability to function as a barrier.
Excess Washing & Our Microbiome
The cleanser we use to wash our face has a lipophilic end of the molecule - this part of the molecule attaches to fatty substances (grease on the skin) and removes it. But, its also attaching to and removing the lipid molecules that form our stratum corneum’s strong wall. This leaves holes in the wall, compromising the skins barrier function. Dr. Skotnicki says: “soap can wash the skin into a situation similar to genetic eczema”. This has also now damaged the skins microbiome. Our microbiome is comprised of microbes that develop on our skin since birth, and they’re there to help it function at optimal levels. With a damaged microbiome and a skin surface that is wiped of its ‘good’ and ‘bad’ germs, we are now inviting bad bacteria in. One study did an entire body scan of a man and woman who had not used any beauty or cleansing products for three days. The scan showed that the single largest source of molecules found on the skin was not skin cells, bacteria, or virus, it was residue from beauty and hygiene products. Showing our lifestyles leave lasting, physical traces on our skin.
Multiple studies have shown that the skin of a healthy person has a more diverse microbiome, compared to someone with sensitized skin who has a less diverse microbiome. A lot of this comes down to exposure as well - if you aren’t exposed to many elements as a child, you wont have developed defences to them (very similar to our immune system function). As a result, our bodies not only attacked the bad bacteria, but also the benign factors like house dust, pollen, and food allergens.
Using too many products: the average adult uses 9 products per day, with 126 different ingredients. The average woman uses 12 products per day, which contain 168 different ingredients. Doesn’t sound like you? 25% of women use 15 products per day... This makes it very difficult to discern what is causing a reaction in your skin. Dr. Skotnicki tests for allergens to determine which could be causing the reaction - and she has found methylisothiasolinone (MI) to be one of the largest culprits of extreme reactions. This ingredient was introduced after consumers became outraged at the possible link of parabens and cancer, which drove companies to slap a ‘paraben-free’ sticker on everything, and replace parabens with another preservative. Unfortunately, the replacement has been found to cause extreme reactions in many people, including children. So, if you’re finding your skin is reactive, look for MI on your ingredient lists (more likely to be in rinse-off products, like shampoo, body wash and laundry detergents).
Allergen or Irritant?
Let’s talk about food - many of us immediately look for a food allergen that is causing issues with our skin. We can all agree that what we eat and how we treat our bodies greatly impacts our skin. Putting that notion aside, a food allergen reflected in the skin would look more like a typical hive. Dr. Skotnicki says: “If the reaction is scaly, weepy and red, and lasts for days of weeks, the trigger is likely contact in nature”.
Next, we need to determine whether we’re having an allergic reaction or an irritant reaction. Dr. Skotnicki says this will determine how we treat it. Allergic reactions to beauty products are actually much less common than we think - what happens is the ingredient wrongly triggers the body’s immune system. It actually takes repeated exposure to the allergen for you to develop an allergic reaction to it, and can take a few days to appear. In comparison, an irritation usually appears immediately and at the site of contact. Irritations are cumulative - the more yourself exposed, the more likely the reaction is to occur. This can happen when we’re using too many beauty products, and after a while of over using too many products, we get an irritation as the damage builds up daily. This irritation might look like dry, flakey, sore skin. One way to easily decipher if you’re suffering from an allergy or irritant is to think where you applied the product and where your body reacted. If you applied it all over your body, but only had a reaction on your face, then it is likely an irritant. If its an allergy your whole body would react. A patch test can confirm whether its an allergy or irritant.
Dr. Skotnicki says that water is her largest problem for skin health because it dissolves the fats in our skin’s stratum corneum — the skin’s outer brick wall. Limiting bath and shower time to 10-15 minutes and avoiding hot water temperatures can help ease discomfort. She also suggests limiting overly washing with soap - avoid washing your limbs unless they’re dirty - this will help prevent soap from removing too much of the fats from our skin barrier and causing sensitive skin. Another cause of disruption is over exfoliating - so avoid abrasive scrubs (anything with shells in it) or tools - but gentle exfoliation is great to reveal smoother skin and as the skins natural processes slow down with age. A hidden culprit is actually shampoo! Because the scalp doesn’t show immediate irritation, the back of the neck, ears and eyelids are likely to be irritated and indicate an issue with your shampoo. To avoid this, look for shampoos that don’t contain MI or avoid over washing with shampoo, and trying to rinse your hair away from your body as much as possible so as to limit your skin’s exposure. Dr. Skotnicki has a detailed Product Elimination Diet that has you stop all the products you’re currently using, switch to very gentle approved products, then slowly reintroduce your products one at a time, once per week. She emphasizes that you must stop using all products, as some that are used on other parts can actually cause irritation in others (nail polish and irritation around the mouth for example). Dr. Skotnicki stresses that just because something is a known allergen or potential irritant (some essential oils, for example) doesn’t mean you will have a reaction. Its about finding what does and does not work for you.
Cleansing Amidst COVID
Learning about how harsh over cleansing can be is a little troubling given the current need to cleanse our hands constantly. Dr. Skotnicki suggests these gentle cleansing products for the hands too, like these brilliant hydrating Cerave wipes which are perfecting for right now! Or, this bar soap from Aveeno - I’ll be swapping this at every sink in my home! Here are some more of the products ill be trying from her suggestions:
Dr. Skotnicki’s book Beyond Soap contains so much information about how and why our skin is sensitive and how we can treat it. Her preferred method is often a product elimination diet - is anyone ready to try it?