Basic Skin Care

The skin is the largest organ in the body and requires frequent washing. Normal skin has a pH of 5.5, has a protective lipid barrier and is well hydrated. Unfortunately, many skin care products on the market have an alkaline pH that irritates the skin, contain surfactants that wash away the skin's protective barrier and dry the skin and also contain chemicals that can trigger eczema. It is important to know how to make wise choices when choosing skin care products.

Choosing skin cleansers

Choose a skin cleanser that effectively removes dirt, leaves no sensitizing chemicals behind, moisturizes the skin and restores the skin's protective barrier. The products that do this the best are unscented, non-foaming, emollient, body washes. Many people believe non-foaming agents do not clean effectively; however, studies reveal they are effective cleansers. For people, who do not like non-foaming wash products foaming body washes that contain emollients (moisturizers) are the next best choice.

Bar soaps tend to be the most drying and irritating to the skin. They have an alkaline pH and contain surfactants that wash away the protective lipids found on the skin. Table 1 lists skin cleansing products ranging from the mildest to the most irritating among a large number of products.

Choosing a moisturizer

The skin of people who suffer from eczema continues to be dryer than normal, even during times when eczema is clear. For this reason people who experience eczema should use moisturizers regularly to help prevent flare-ups.

The most effective moisturizers are unscented and contain ingredients that will, soften and smooth the skin, draw water to the skin from the air and restore the skin barrier through replacing lost lipids. The choice of moisturizer will vary according to the individual's skin status, time of day, where it is to be applied, and personal preferences.

Ointments are the most effective moisturizers due to their ability to trap moisture in the skin. Their greasiness often makes them unacceptable to people, particularly for daytime use. For this reason some people use ointments at bedtime and creams during the day. Ointments should not be used on wet, weeping skin. They are however, recommended for use on dry, scaly and thickened skin.

Creams are less moisturizing than ointments but are easier to tolerate. They are also more effective moisturizers than lotions.

Lotions are less effective moisturizers than creams but are preferred for areas such as the scalp. When blisters are present and the skin is wet, lotions are the best choice.

Bath oils offer the skin protection from drying by forming a thin oily layer over the skin to keep the moisture from evaporating.

All moisturizers

• should be unscented
• should be applied after baths or showers and
• should be applied on a regular basis throughout the day.

Ingredients found in moisturizers

Moisturizers contain a number of ingredients that work in a variety of ways to keep the skin moist.

Emollients/moisturizers make the skin soft and smooth. They work by forming an oily layer on the top of the skin that traps water in the skin. Petrolatum, lanolin, mineral oil, linoleic acid, ceramides and dimethicone are common emollients. They should be applied immediately after a shower or bath to trap the moisture on the skin. In addition they should be applied throughout the day and at bedtime. Avoid lanolin if wool products result in eczema flare-ups.

Humectants are used to attract humidity to the surface of the skin. It is important to be aware of the effective concentrations of humectants as moisturizers since in higher concentrations some of these ingredients are irritating and are used as peeling agents.

Ingredients used for humectant purposes include propylene glycol, lecithin, urea and alpha hydroxy acids such as lactic acid or glycolic acid and glycerin (sometimes called glycerol),. Phospholipid products contain lecithin, which break down to oleic, palmitic and stearic fatty acids. Each phospholipid molecule forms a complex which binds fifteen molecules of water, drawing the water to the skin for hydration. Phospholipids can also give creams and lotions a pleasant smooth feel.

• Glycerin in concentrations less than 50% slows evaporation of moisture from the skin.
• Urea 10% moisturizes dry skin. Higher concentrations such as 20-30% are anti-itching and break down keratin, making it useful as a peeling agent in scaly skin conditions. In 40% concentration urea is strong enough to dissolve and peel misshapen nails.
• Alpha-hydroxy Acids (i.e. Lactic, citric, glycolic, malic, pyruvic, glucorninc) are moisturizing in 2-5% concentrations. In concentrations of 10% or higher these ingredients may cause irritation.¹