Visit any drugstore and you’ll find a dizzying array of choices for skin care products. That’s no surprise, says UC San Francisco dermatology professor Peter Elias, M.D., since at least half of Americans, maybe more, have sensitive skin or a diagnose skin condition such as eczema, atopic dermatitis or rosacea. But moisturizers and other products may be doing as much harm as good; especially for people with sensitive skin, according to Elias’ 45 years of research on the subject; which start with complaints from his patients.
“They were telling me that they’re applying some expensive stuff but it only provided relief for the first hour or so, and then their skin felt drier than ever,” he says. He wasn’t able to tell them what was going on, and wanted to find out. The skin bombard daily by our exposure to things that include sunlight and environmental toxins is highly effective and enduring in its role as a barrier, says Elias. He likens that barrier to a brick wall.
Moisturizers provide relief
In his dermatology practice, patients would tell him that moisturizers provide short term relief; but in the long term their skin would feel drier. That led him to investigate whether the moisturizers were playing a role in this “Swiss cheesing” of the skin. Fortunately for people with skin conditions, Elias is getting a clearer picture of what the problem is. Unfortunately, what he’s learn from a recent study of moisturizers is that many on the shelf may be doing more harm than good for certain people.
That’s because maintaining the brick wall comes down to a suite of relate factors: pH of the skin, the makeup of the “mortar,” and the body’s response to the “Swiss cheese” situation. Most common moisturizers, Elias says; are design to provide a layer that keeps skin from getting too dry; which is fine for normal skin. But these lotions may lack “mortar” ingredients; contain them in the wrong proportions; or change the skin’s naturally acidic pH.
The body perceives the “Swiss cheese” as an injury; also in response produces cytokines; so small molecules that trigger the inflammation response that leads to healing. But in people with sensitive skin or skin conditions; so their repair machinery the enzymes that make the three lipids aren’t functioning properly. So the injury remains and the cytokines keep coming; they causing greater inflammation and irritation.
Person with sensitive skin
Which often leads the person with sensitive skin to reach for a bottle of moisturizer and the cycle may continue. The key for people with sensitive skin may lie in a lotion that is formulated for skin repair and contains the “mortar ingredients” in their proper proportions; according to a study by Elias and his colleague, Mao-Qiang Man, M.D.; also a research scientist with the San Francisco Veterans Administration (VA) Health Care System-affiliated Northern California Institute for Research and Education.
Elias and Mao Qiang are planning two larger-scale studies in China. One will compare the effect of a lotion designed for barrier repair on cytokines in the blood with that of other off-the-shelf moisturizers. The other study will look into how much of the body needs to be covered regularly with the barrier repair formula for it to be effective.
The notion that repairing the “brick wall” could lead to these kinds of whole body benefits is a relatively new one. Elias believes that for a long time, the barrier function of the skin has been underappreciate because it fulfills its role so well. “It so rarely fails,” he says. “You only find the abnormalities when you really stress the skin.” Even then, Elias says, unlike many other organs; “the skin keeps limpin’ along, singing a song,” Which is a very good thing, he notes, “because they wouldn’t be here without it.”