The following is an excerpt from the Glow Journal podcast. To listen to the full interview, subscribe now on iTunes or Spotify
How can you treat dry skin and acne simultaneously? What is the ideal shower temperature? What’s the best way to exfoliate dry skin? Why are skin conditions and sensitivities heightened in winter?
The last time we spoke to Dr Ryan De Cruz, he shared his knowledge on all things isolation skin- skin that is irritated, stressed and acting out. We took Dr Ryan’s advice and we healed our isolation skin – and then winter hit, and with it came a whole new list of skin woes.
So many listeners and glowjournal.com readers have reached out to me in recent weeks looking for winter skin salves – products to protect their skin from the winter chill and artificial heating and products to heal their sore, dry, irritated skin. As you know, I am an educated consumer and not an expert and, given how much we all learnt from Dr Ryan last time, I insisted on taking your winter skin questions back to him.
In the name of full disclosure, this story is sponsored by CeraVe, however as per all of my expert interviews, the guest doctor is never here to push specific brands and products. For this reason, Dr De Cruz recommends specific ingredients rather than products, giving you the tools you need to make your own, educated purchasing decisions.
On a personal note, given that the range has been developed with dermatologists, I do use CeraVe myself and largely credit the brand with the fact that my skin has made it through isolation and the cold snap unscathed. For me, CeraVe falls into a category that I’m particularly fussy about – the “reset” category of non-irritating products that I know my skin loves, that I can use to hit “reset” and restore balance to my skin between trials, and will deliver serious, consistent results use after use. Fortunately, Dr Ryan approves. As you’ll read, Dr De Cruz’s non-negotiables for winter skincare are minimalist products that contain skin-identical ceramides to strengthen the skin barrier, hyaluronic acid and NO fragrance – four boxes that CeraVe has been proven to tick. The range is dedicated to strengthening the skin barrier to create healthy, beautiful-looking skin… it’s simple, it delivers and it’s inexpensive.
GLOW JOURNAL: I believe that we touched on this in our isolation skin episode, but I think it’s worth revisiting, given the timeliness. Why is it that so many people suffer from dry skin in the winter?
DR RYAN DE CRUZ: It’s a really good question and absolutely very, very common. I estimate about 60 to 70% of the patients that I see every day of my career have dry skin and potentially even skin conditions that develop from dry skin.
The simple fact is that we live in an incredibly dry climate. Australia is very far south. We’re very isolated. Yes, within parts of Australia, it is quite humid, for example up north in the Northern territory and in Queensland, but in the more southern states like Tasmania, Victoria and New South Wales, our winters are very dry. As a result of that, our skin dries out naturally. Add into that fact that the temperature drops, and even a drop of one or two degrees can be quite significant for people to really feel it, we crank up the heaters, we tend to put lots of layers on and, in Melbourne, we all know that our uniform is black. so we have all of these thick woollen coats, thick scarves and jumpers, and all that does is actually dry our skin out more because we actually artificially manipulate our internal environments by cranking up the heaters and wearing all these layers. As a result of that ,water just evaporates from our skin like there’s no tomorrow.
So dry skin is very much a winter problem. If you’re unlucky enough to have the genes for dry skin anyway, and there are many people who know that they had very dry skin when they were children, and that their parents or siblings have dry skin, for genetic reasons they actually aren’t holding moisture as well, on top of that. That’s why this time of day is actually the worst [for dry skin], nd we see a lot of skin conditions appearing in winter.
That brings me to my next question, because a lot of our readers and listeners have complained of heightened irritations during the winter. Are those sensitivities linked to dry skin and the weather as well?
Definitely. What we know is that dry skin, at a cellular level, is a problem with the skin barrier. Our skin cells aren’t being held together tightly enough, we’re losing moisture, and when we lose water through evaporation, we switch on our inflammatory cascade so we actually develop inflammation simply through dryness.
But in addition to the loss of water, we have a lot of irritants entering or skin through these gaps in our skin cells. Irritants can include things like natural fibres from clothing, so wool and cotton, artifical fibres, dusts and pollen. During isolation, everyone has gone cleaning crazy. We’re cleaning our houses, we’re cleaning up our gardens- all of that is aerosolising particles that then settle on our skin. We’re also using a whole lot of harsher chemicals now. Woolworths, the other day, was completely sold out of bleach and cleaning products because people are really using all of these harsh chemicals on their environment and, of course, that directly irritates the skin as well.
We have this tenant in dermatology that dry skin is itchy skin. It’s not only itchy, but it’s also very sensitive. So there are quite a few reasons why the skin, at this time of the year, appears more sensitive.
On that harsh chemical note, this is another thing that we touched on last time but, again, is worth revisiting. We’re using sanitiser now. I, personally, have never cared for my hands more than I have in the last couple of months. Hand care does seem to be a priority. What should we be looking for in a hand cream?
The concept of hand sanitiser has really taken off. People who’ve never, ever used an alcohol based hand gel before are now buying it by the five litre bottle. We know that it is a very quick and effective way of killing off bacteria, but we also know that it will help dissolve the natural oils in our skin.
So the first principle is that, yes, it’s an important adjunct to our antibacterial and antiviral defence, but every time we use an alcohol based hand gel, or indeed every time we wash our hands, we should also be moisturising with a lipid replenishing moisturiser- so those that contain ceramides, of course, which we know are the building blocks of the skin or particularly the skin cement, but also those that have a decent amount of liquid paraffin and white soft paraffin. These, the way that I described them, is that they help form an oil slick over our skin. They’re providing a barrier on top of our natural skin barrier that will then help prevent the chemicals that we’re exposing our skin cells to from really penetrating through.
These hand creams shouldn’t be heavily fragranced. They should be nice and minimalist in terms of their formulation. Gone are the days of people going out and buying those really smelly hand creams that just smell like potpourri, and they’re just not necessary. In truth, they probably trigger skin allergy. I’m a much bigger fan of the very simple hand creams that don’t have to cost you a fortune and you can purchase them at basic pharmacies.
The most important thing is that you use it regularly, not just once a day or twice a day, but really every time you wash your hands.
Something that so many of us are doing in the winter is taking these long, hot showers, which are the best thing ever- but what is hot, hot water doing to our skin? And is there an ideal temperature for cleansing and washing our skin?
It’s so true because we wake up the mornings are so cold. We wake up and we’re already cold, then the first thing people like to do is to jump into a scalding hot shower, to almost rejuvenate, wake them up and just basically get warm again.
The problem is that hot water is actually very drying to our skin. The theory behind that is that when we overheat our skin, our epidermis and dermis, we actually will give rise to more water evaporation over the next half an hour to an hour, even up to two hours. So, if you think about it, the reason we sweat is to cool our body down. It’s a thermoregulatory mechanism. If we increase our body temperature through hot water, all we’re going to do is sweat more. We’ll actually lose more water from our skin, and that will therefore dry our skin our something shocking. Then, unfortunately, we’re setting it up because we often shower in the morning, or most people do, and then we’ll set up the rest of the day to just evaporate more water off.
In terms of ideal temperatures, and a lot of people will want to kick me for this, we’re really looking at lukewarm water as being the ideal temperature. Lukewarm is defined as somewhere between 36 degrees and 42 degrees Celsius. That’s the ideal temperature for water.
If we think about the way that should feel is that when you run the water over your skin, it should still feel warm without feeling too hot. A lot of people, particularly anyone who has children and they’ve had to warm up baby’s bottles, will know that they test it on their skin to make sure it doesn’t burn the baby- that’s about the temperature that we’re looking at. A warm to lukewarm temperature, without being overly hot.
Is it true that the best time to apply a body moisturiser is immediately after our shower?
Absolutely. That’s my all time favourite time of the day to moisturise for a few reasons.
One, just practically, it’s the time that we have our clothes off, so it’s the easiest time to apply the creams. But the reason that it works so well is that it does trap in some water molecules that are sitting on our skin surface a little higher up in the epidermis. When you hop out of the shower, pat yourself dry, but don’t over dry your skin. Let it remain a little bit damp. Not so damp that you’re going to wet your clothes, but you’re going to just leave a little bit of moisture on there and that’s the best time to trap in that moisture. It works a treat and it’s actually absorbed much better by the skin.
I received a lot of questions from listeners who were concerned that their products and ingredients, namely hyaluronic acid as that was the one that came up the most, aren’t actually being absorbed into the skin. I had one listener ask about the actual form of hyaluronic acid, because she’d read that it only works in “serum form” rather than creams and lotions. So how can we ensure that we are using the correct form of hyaluronic acid?
Your listener is completely switched on. They’re clearly doing a lot of their own research, and I really love to hear that because there are so many myths and so many untruths told by the skincare industry, basically all aiming to get more money. It’s all about selling product. That’s what they want to do.
We know that hyaluronic acid is a natural molecule found in the skin. We know that that’s in the epidermis and in the dermis in particular, and what it does is work like a sponge. It draws and holds water molecules to it to plump up the skin and hydrate. The problem is that it’s a really large molecule, so it cannot penetrate the skin, the epidermal layer, as lot of skincare companies will have you believe. The formulation that actually has been proven to help penetrate the skin is the salt form of hyaluronic acid, which is known as sodium hyaluronate. In a laboratory setting, it looks like a crystal- a little like salt does. In the same way, it’s only when hyaluronic acid is in the form of this salt that it can actually penetrate. It’s small enough to penetrate through the skin. It actually undergoes a chemical reaction within the skin to turn into hyaluronic acid.
So it’s not so much as to whether it’s in a serum or a lotion or a cream. That’s not quite correct in terms of the base. It’s in terms of the actual formulation. Now, many skincare brands will not label it accurately. So you actually might need to delve a little bit more deeply, either by emailing the company to say “What form of hyaluronic acid is contained in your product?” If the label simply says “hyaluronic acid” by itself, for example a hydrating booster cream cleanser or cream itself, you can assume that it probably doesn’t penetrate through the skin. It’s just going to sit on the outer layers of the skin, so it leads to a very temporary plumping effect. These products that contain straight hyaluronic acid will make the skin look more hydrated for a matter of seconds to minutes, because all that’s happening is it sits on the top of the skin and then the water evaporates off. So it isn’t giving any long lasting hydration to the deep levels of the skin.
I’ve had another listener ask “I’ve heard about products just sitting on the surface of the skin and not really absorbing or doing anything. Is there a way of knowing that your products have been absorbed into the skin, or a rule of thumb on how long we need to wait between steps?”
When you look at a label, one of the first ingredients that’s listed is water. The vast majority of the components of a cream actually is meant to evaporate off the skin normally. So that’s true. What’s meant to be left behind are the so called “active” ingredients. So whether that’s a bit of niacinamide, whether it’s a retinol, a vitamin C or any other active ingredient, it will be left to penetrate through. There’s no real way of knowing how much of that is penetrating through the skin’s surface, so then it comes down to, well, what percentage is the company using? And this is the million dollar question, because they will never actually tell you what is the active ingredient percentage that is penetrating through the skin. It’s where one there’s one skincare company versus another, it makes it really hard to know which is which, which ones are being honest, which ones have evidence behind what they’re saying. This is why a lot of dermatologists won’t recommend a specific active ingredient or a specific moisturiser or serum over another, because there’s no evidence to do that.
My advice is to use a product that you are familiar with, that doesn’t irritate the skin, doesn’t contain three or six different active ingredients, doesn’t smell very fragranced, and then wait no more than 30 seconds to a minute to apply moisturiser on top of it. There should be no reason why applying a good moisturiser on top of your active ingredient reduces its efficacy. If it’s going to work, it’s going to work, and putting some moisturiser on top certainly shouldn’t reduce how effective it is.
What about overnight hydration, specifically? I had a lot of people writing in asking about night creams, and they were saying that, on waking, they feel as though their evening skincare routine hasn’t actually provided any hydration at all. Is there a benefit to applying a hyaluronic acid serum to the skin before moisturiser at night?
I think so. I think what it will do is add just that little bit of longer lasting hydration, which is what I think your readers and listeners are asking about. When we talk about an evening regimen, we’re talking about actives. We’re talking about alpha hydroxyacids, beta hydroxy acids, retinols, retinoids, and perhaps some vitamin C or niacinamide. None of those products are designed to be hydrating. They’re designed to do various different things. So they might anti-inflammatory, they might stimulate some collagen synthesis, they might help reduce tyrosinase or inhibit pigmentation, but none of them in and of themselves will be hydrating.
That’s where I tend to say I like a night cream. I like a good moisturiser on top, because it will trap in moisture. It will reduce sensitivity of the skin, because we know that some of these actives will be slightly irritating and slightly drying to the skin. So I think if people are particularly prone to dry skin, a hyaluronic acid based serum or lotion or cream will be of assistance to them- as long as it contains sodium hyaluronic, so not the big HA molecule that they think is going to penetrate the skin.
I think as well, and I certainly used to do it, it’s easy to confuse texture with actual hydration. I would wake up in the morning and thing “Oh, my skin doesn’t have any of that tackiness that it did when I applied my night cream. It mustn’t have worked.”
That’s right. What you’re describing there is how skincare companies will put in a few different ingredients that actually sit on the skin, giving a smoother sensation. Dimethicone, I think is what you’re referring to. Dimethicone gives a silkiness and and slight tackiness to skin because, again, it’s a large molecule, it doesn’t penetrate through [the skin]. A moisturiser doesn’t have to feel like it’s leaving the skin with an extra layer. Where we really want the hydration to be is deeper down in the skin. When products contain a lot of liquid paraffin and white soft paraffin, it sits on the top of the skin as that oil slick sensation as I mentioned earlier, which is part of a good moisturiser but not the whole story.
That’s definitely a trap that I’ve fallen into in the past.
I think we all do. As you say, it’s texture, and we think that that equals hydration- but it doesn’t.
Something that popped up a lot, almost overwhelmingly so as readers and listeners were submitting their questions, was skin that is both dry and acneic. I think this can be so confusing for so many people because your first instinct with acne is to dry it out, but then if you already have dry skin, that’s probably not your best bet. So how do we balance it?
It’s a really good question, and one that is almost in and of itself contradictory. You think “I’ve got oily skin in some parts and dry skin in the others.” It’s that classic combination skin- but what does that actually mean?
Combination skin, to me, reflects a differential between the oil glands that are overactive, usually in the T zone but not always, and drier outside, so around the forehead, or maybe in front of the ears and around the inferior aspects of our nose. My approach, personally, is to ensure that patients with combination skin or even acneic skin are using a lightweight, noncomedogenic and minimalist formula moisturiser. I think that is very important.
Why? Because even in acne, and acne rosacea in particular, we know that the skin barrier is defective. So if we’ve got a defective skin barrier that’s not holding in moisture, it will actually aggravate the underlying problems. So people with rosacea, for example, who get pimples and spots and they think those look like acne, part of their daily regimen is a very good moisturiser. So it’s not that the patients with combination or acne prone skin shouldn’t moisturise, it’s that, that they shouldn’t be using the very occlusive moisturisers that contain a lot of liquid paraffin or white soft paraffin, or even dimethicone. It’s about having a lightweight, hydrating moisturiser- again, ceramide based, and even having a small amount of hyaluronic acid would be very good. Add into that a little bit of niacinamide, and then they’re turning the moisturiser into a moisturising anti-inflammatory agent as well.
So I definitely get my acne patients to moisturise. They’re almost always on some form of drying active anyway, they’re often using retinols or retinoids and they might be using medical strength retinoid, so on prescription or even orrotane or isotretinoin, so these patients need to have a good moisturiser, for sure.
One listener has written in to ask about acne. She was saying that she’s getting persistent pimples, but the pimples themselves feel really dry and crusty and then they hang around for months. What treatment options would she have?
It sounds like this patient has what I’d call papulopustular acne, and the question is do they have straight papulopustular common acne, which is called acne vulgaris which everyone thinks of as teenage acne or hormonal acne, or does she have acne rosacea? Because in both types you can have a deeper type of acne pimple, which is essentially inflammation around an oil gland.
The reason they’re getting the scale, this is all happening a little bit deeper in the skin. The oil glands sit quite deep. They get inflamed. As they push up on the skin, the very outer layer of the skin forms these little scabs, and if you pick at the scabs, you don’t actually get puss out of them there because the oil glands are inflamed deeper down. So this sort of patient, in my opinion, probably needs what I call a systemic therapy, meaning an oral medication. I’d be encouraging her to seek assistance from a GP or a dermatologist to get a medicated product that will work, because a lot of the topical things that she might’ve tried, a lot of the over the counter stuff, it’s just not going to penetrate deep enough to go where it needs to. Products like isotretinoin and may be important for her but, of course, everything needs to be tailored to the patient.
Perfect segue, because I had so many questions about roaccutane and everything in that family. So many people who have come off that, and then have the driest skin they’ve ever had in their life. How do they resolve it?
It is true, because the isotretinoin, the active drug which has a few different brand names (roaccutane, accutane), the way that it works is to reprogram oil glands at a genetic level. So what it’s actually doing is altering the DNA of these oil glands to become less active and to shrink them down. The theory is that it should actually work, mostly while you’re on the medication, but the medication actually builds up in the skin and then slowly releases over months to years. For patients who are left with persistent dry skin post isotretinoin, I generally just recommend a very good ceramide based moisturiser for them to use twice a day. Unfortunately (or fortunately!), they will never necessarily have their preexisting oily skin. I use the word fortunately, because that’s what led to their acne to begin with. So it is a little bit of a catch 22, because these patients come with horrible acne and persistent acne in their twenties and in their thirties, it’s not a teenage problem, and I say to them “Look, if you are left with dry skin after this treatment course, we have to just know how to manage it.” It all comes down to using the best products.
Another frequently asked question was on exfoliation, so I would love to spend a bit of time on that. Firstly, it’s a broad one, but what are the safest and most effective ways to exfoliate dry and eczema prone skin.
It’s almost a little bit of an oxymoron. You want to exfoliate, but doesn’t that just dry the skin out more? And the answer is yes, it can. So the idea I suggest to patients is to have a gentle exfoliating cleanser in the shower. They can include a small amount of salycilic acid, a small amount of alpha hydroxy, I’d say anywhere between 2% and 6% alpha hydroxy acid- there are a few different brands that will do cleansers that contain these two active ingredients. AHAs and BHAs are, in my opinion, the most effective active ingredients to exfoliate. The idea is that you would do it in the shower with a nice gentle loofa, or one of those micro bead gloves, gently exfoliating the dead layer of skin. I always advise against over scrubbing and over irritating the skin because, after the shower, you are going to have to use a moisturiser. So that’s a two step process.
How important is it to moisturise straight after exfoliation?
It’s very important, particularly with the dry skin. If you simply use these potentially harsh chemicals on the skin, all it’s going to do is degrade the skin barrier which will then aggravate dry skin. And what does the dry skin do? It actually creates more dead skin cells. So you end up having this vicious cycle of actually just drying already dry skin out even further.
So it’s a two step process- gently cleansing in the shower with a salycilic acid or alpha hydroxy acid based cleanser with the loofa, and then moisturising the skin afterwards.
I wouldn’t do it every day. I would say to patients, perhaps only aim to exfoliate once to twice per week, depending on how much their skin needs it. I think people tend to over scrub and over exfoliate, and that actually causes skin issues.
Would I be right in saying that when we are moisturising afterwards, we should be sticking with our fragrance free really minimalist formulas?
Yes, definitely. If you can really smell a product from the end of the room, it’s got way too much fragrance in it. I don’t really see much of a role for fragrance in a good moisturiser, other than to conceal some of the active ingredients in the moisturiser that perhaps don’t smell particularly good.
So [a good moisturiser] should just smell neutral. It shouldn’t be fragranced. A lot of fragrances are unnecessary and will trigger a skin allergy, so I always harp back on minimalist formulas that are ceramide based, and a product that doesn’t cost the earth.
So a gentle exfoliant. I had heaps of questions about acids and how strong people should go, so that’s good to know.
Yes, keep it gentle. And definitely over the winter, when the skin’s drier, I don’t want people over exfoliating. They will really pay it, basically. The skin will really revolt, and they’ll notice that they actually cause patchiness, itchiness, sensitivity and potentially even trigger problems like acne where they didn’t necessarily have it, because of this over exfoliating problem.
Another listener asked “Do I need to ditch retinol in the winter if I have dry skin?”
I don’t think they need to ditch it altogether, but I would be more conservative in my usage of the stronger irritating products. One option would be to reduce it to what I’d call a low grade maintenance regimen- perhaps Monday, Wednesdays and Fridays only but, again, using a moisturiser on top of the retinol or the retinoid every night. I think if people have a good moisturiser, they won’t need to ditch their actives.
I think the problem is that a lot of people don’t know what to use and which moisturiser is best. They’ll often choose the moisturiser that has been sold along with the retinol. This is the cosmeceutical industry- they don’t just have your retinol, they’ve got your retinol, they’ve got your B3, your B5 and they sell it to you as a package. So $500 later, you’ve got six different products or maybe even only three, and you’re having to use their product that they sold to you as a package. That’s what you think you should be doing, but actually no, you should definitely pick and choose products from various lines depending on the evidence behind it and what actually works properly.
My advice is that you should still use your retinol, if your skin can tolerate it, but have a good moisturiser to go on top.
I had a few listeners write in asking about how to treat dryness on quite specific areas of the face. One that came up quite a lot was the eyelids. How should we go about treating dryness on our eyelids?
The first thing to say is that there are a lot of ranges that will sell eye creams specifically, and I am yet to see an eye cream that genuinely makes a huge difference. I think there is a lot of fancy marketing in that, and I’ll leave it at that.
Basically, to me, the same principles apply for eyelids as they would the forehead, the nose and the lateral cheeks. You want a basic, fragrance-free moisturiser. I like it to be slightly thicker for the eyelids to give them the extra boost, that slightly higher percentage of shea butter or white soft paraffin, so that it’s not just water evaporating off the eyelids immediately. The eyelids are the thinnest part of skin on our face. They’re going to be the site that reacts first to irritants, to fragrances and to active ingredients that come to close to the eyes.
I don’t necessarily choose a separate eye cream for basic moisturising. I think if you’ve got a good cream that you’ve got for the face, it should be able to be used on the eyelids without causing issues.
They were also quite a few questions about redness and dryness around the nose. Is that connected to the skin barrier? Should we be treating it differently?
This is something I see anywhere between three to five times a day in my clinical career, and what these patients are actually referring to is a condition called periorificial dermatitis, or POD.
POD is a really well established phenomenon whereby patients will get redness, irritation, dryness, and maybe even small bumps, what we call papules around the nose, particularly in that crease. It can also occur around the mouth and around the eyes. Around the crease of the nose is a really specific site that will irritate patients.
I believe that it can be due to a combination of things. We know that there are a few things that aggravate it. One is a disrupted skin barrier, as you just said, the second is an overgrowth of a particular bacterium called fusobacterium. We also think that harsh chemicals, sunscreens and actives will trigger this. I’ve seen POD being triggered by retinol and by retinoids that even I’ve prescribed. So we have to be very careful with that site, because it’s clearly a very sensitive site. Because it is a little crevice, it accumulates chemicals more consistently and more easily than others parts of the face. It is very tricky site and often needs medicated therapy to improve it.
How important is cleansing? I didn’t get heaps of questions about cleansing, which makes me want to talk about it because I feel that with dry skin, everyone goes immediately to their moisturisers, but I assume cleanser plays a role as well. We’ve got hydrating cleansers, we’ve got purifying cleansers- how do we choose the best one for our skin?
I think it does come down to skin types. Patients who have oily or combination skin may be able to afford using a slightly more “purifying” cleanser. Let’s delve into that a little bit more. What is a purifying cleanser? In my mind, a purifying cleanser is one that contains artificial surfactants. These are chemicals that help remove dirt, grime and oil from the skin, and are slightly keratolytic so they slightly break down excessive skin around hair follicles. These products will not suit everyone. A gentle cleanser that is slightly foaming and slightly keratolytic may be appropriate for patients who have more oily skin types, but will be completely inappropriate for patients who have dry skin or sensitive skin.
Thinking about those two groups of patients, I generally would use a cream based cleanser, again completely fragrance-free. The point that you raised earlier is that we always focus on the moisturising cream is very true, but the cleanser itself can be hydrating if it contains ceramides. That’s one way of optimising the hydration level of the cleanser.
The other active I like it niacinamide. If that’s contained within a cleanser, you have a couple of already good actives that will rehydrate the skin. Then you’re following that up with a good moisturiser. So you’re spot on- it’s not just the moisturiser that you should pay attention to.
We love those ceramides. I was going to ask why ceramides are important, but they’re the building blocks!
So we know that they are naturally made by our skin. They’re found in about 50% to 60% of the epidermal layer within the cement that holds our skin cells together. The reason I’m such a big advocate for them is because they’ve got a really good research and evidence behind them. They’re not just products that some company has made up. There are literally ingredients that are registered trademarks of cosmetic companies. Why?! That’s because they’ve just made them up. They’ve made them up, and they do these little Mickey Mouse studies to show that they work. One of my colleagues in London described it really well. If you run a baking competition, you bake a cake, and you’re both the tester and the judge of that cake. That’s what these companies do.
I like ceramides because they are evidence based. They are a real ingredient, they are naturally formed, and we know that they are a very important part of the skin barrier. That’s why I harp on about them.
Aa few listeners have asked about stubborn, flaky skin around the hairline. This is something that we did touch on last time, but again, being winter, it’s worth revisiting.
Definitely. So I think that these patients are developing what we call seborrheic dermatitis, which is a really common skin problem that results in dandruff and an itchy, dry, flaky scalp. This is something that we see not only on the anterior hairline, but also in the eyebrows and even coming down the sides of our cheeks besides our nose.
It should be treated like any medical condition, so with a medicated shampoo, and I generally recommend a ketaconazole which is an antifungal shampoo, and also a really nice gentle moisturising shampoo as well. So again, this is when using something that has got a bit of research behind it and that’s not overly expensive and overly drying to the scalp is really important.
Often these patients will need some sort of medicated therapy, whether that’s a topical lotion that I might ask them to rub it in two or three times a week, or even a good moisturiser that will remove some of the scale. But that’s what it is- seborrheic dermatitis.
One listener has asked “Is it true that gut health can play a part with dry skin?”
Yeah, this is a really good question and one that I think is the subject of a lot of growing research.
I attended a conference in Seoul, Korea late last year. It was a really fascinating one that was trying to link the gut microbiome, so all the bacteria that live in the gut, with the bacteria that live in the skin. And we do think there’s a relationship between the two, we just don’t know exactly how to manipulate it yet.
This is a growing area of research. We know this concept of the leaky gut, similarly with people who have a skin barrier deficit, their bacterial colonies on the skin are also abnormal. I often am now starting to promote moisturisers that do have prebiotics in them as well, for this reason. I think there is growing evidence that trying to respect the skin’s microbiome is something we can do externally. We don’t quite yet know how to manipulate our gut microbiome, but we do know that there is a link. I think it’s just a bit of a “watch this space.”
While we’re on internal factors- does drinking water actually help our skin?
The answer is both yes and no!
Probably the biggest myth or misconception is that if you drink lots of water, you are going to rehydrate your skin. Now let’s just unpack that a little bit. The body is a very intelligent system, a very complex system. We’ve got this thing called homeostasis, which means that if our skin is particularly dehydrated, our body will try to shift fluid into the skin to try to normalise it. And that’s just what it does. So if someone is adequately hydrated, you can’t maximise that hydration anymore.
The problem really lies in the fact that we generally walk around very dehydrated. I’d estimate perhaps 90% of people, maybe more, are walking around dehydrated. So if we are under hydrated, then by normalising hydration levels by drinking water, we will ensure that all body organs, whether it’s our brain, our liver, our kidneys or our skin, have the optimal amount of water in it. But if we’re already well-hydrated, then chugging back litres upon litres upon litres of water, won’t actually help our skin any more. It’s about making sure, just for our general health, that we stay hydrated.
The truth is that in winter we are going to be even more dehydrated. We’re constantly evaporating more water off our skin because it’s drier and we’ve heaters on, but let’s say that we were already adequately hydrated, then drinking more water is not going to do anything.
A question I received that I loved and I think would be a really nice note to wrap up on- are there any absolute non-negotiable must have ingredients for dry skin?
I think my number one, two and three, if it isn’t already obvious, is ceramides. Ceramides have to be a part of a good moisturising cream.
The other, if I can frame it slightly differently, is what do I not want in moisturisers? I think that is the fragrances. I don’t want any of those. We know that they’re irritating to the skin and they’re doing nothing other than breaking your bank balance.
So I think moisturisers that contain ceramides, ideally some sodium hyaluronate would be ideal.
And if we can sneak a little bit of niacinamide in there as well, we do know that vitamin B3 again, has growing evidence. I’m not here to say that it’s got a heap of research behind it, but we’re just growing and I do believe in it. So I think those three ingredients are probably what I’d recommend.
To learn more about CeraVe, visit cerave.com.au
