Medicosnext
Dry skin plagues almost everyone in the winter months. Here, we ask leading dermatologist Dr. Prativa Shrestha about how we can minimize or prevent dry skin.
Dr. Prativa Shrestha, MD, Dermatology, had her aesthetic training from American Academy of Aesthetic Medicine in 2013. She worked as a principal consultant dermatologist at Vayodha Hospital and Nepal Mediciti Hospital. She now runs her own skin and aesthetic clinic at Clinic One Jawalakhel.
Dry skin is a common ailment during the winter season. What are the preventive measures one can take in daily life to minimize dry skin?
Dry air and dropping temperature can take a toll on anyone’s skin. Regular moisturization and hydration is the key for prevention. The pH of normal skin is between 4.5-5.5; anything that increases the pH dries the skin. The pH of water and soap is around 8 and 11, respectively. So, every time one gets in contact with water and soap, the skin dries further. Hence, limit the shower time for max 15 minutes, moisturize while the skin is moist to lock the moisture, and double layer the moisturizer with lotion followed by cream.
In the present scenario, where washing hands and using sanitizer is the norm, hands can be extremely dry with cracks. Wear gloves while doing wet work. Wearing powder less plastic gloves for a few hours after applying moisturizer can do wonders for chapped and cracked hands.
Dryness caused by built-up of dead cells presents as scaly rough skin. Regular exfoliation with gentle mechanical scrub, such as loofah or fine smooth grained scrub, or mild chemical exfoliant, such as lactic acid, may be needed in addition to moisturizer.
Finding a good moisturizer is trial and error. I would always suggest keeping moisturizer of different compositions and shuffling their use. Look for urea, lactic acid, glycolic acid, ceramide, and hyaluronic acid in the ingredients, along with various oils, in a moisturizer. Keep a humidifier or a bowl of water in room where a heater or air condition is on to keep water loss from the skin at minimal.
Beside other measures, what is your advice on the kind of diet that can affect our skin. What foods and drinks one should avoid, and what foods and drinks one should take more to prevent dry skin?
A well balanced diet with carbohydrate, protein, and fat with regular fruits and green that are good for overall health is also good for the skin. During winter, people tend to take lots of warm drinks like coffee and tea. Caffeine is a diuretic, meaning it flushes fluid out of our system via urine. So, limit its consumption. Hydrate with enough water, soups, and fresh juice according to one’s preference.
Younger people have more elastic skin, so can be repaired more easily, what about the skin of older people? How can an older person retain youthful and well-hydrated skin through the winter months?
Dry skin can happen at any age, but older people are more vulnerable. They have to adjust in terms of shower time to maximum 15 minutes with lukewarm water and reduce a frequency to twice a week. As mentioned above, pH plays a very important role in the severity of skin dryness. I would suggest them to use pH-balanced face or body wash and moisturize frequently three to five times a day, preferably in a moist skin. Sprinkle some water and moisturize on top of it. Moisturize first with watery lotion and seal it with a rich creamy moisturizer. Shuffle the moisturizer with different compositions each time. Other measures are much the same as mentioned above
One enjoys being in the sun in winter, but too much sunlight is not good. How much time should one stay in the sun, and what is the connection between vitamin D and dry skin?
Ah! Winter sun is therapeutic for its warmth and mood elevation, and many enjoy it. That, too much sunlight is not good, has stemmed from the skin cancer and skin sun damage perspective. It is well known that sunlight is necessary for vitamin D production. Diet is a poor source of vitamin D. So, either it has to be produced naturally or exogenously via supplement. The melanin, brown pigment, in the skin interferes with vitamin D production. Being brown skins, we tend to pigment instead of producing vitamin D.
The sun exposure for vitamin D production is well studied for white skin. The recommendation is: exposure of skin below knees and elbows during summer, when the intensity of UVB rays is high between 10 a.m. to 2 p.m. for 15 minutes on alternate days, whereas rest of the skin should be well protected with either sunscreen or clothing.
Vitamin D is necessary for the optimum functioning of each and every cell. It helps in skin differentiation and proliferation and has anti microbial effects and skin innate and adaptive immunity.It is necessary for hair follicle cycling, sebaceous gland functioning, photo protection, wound healing, etc. Its deficiency is linked to hair loss, autoimmune disease, dry skin, weak bone, skin cancers, etc.
Is it necessary to take vitamins and other nutritional supplements to take better care of the skin this winter, and if so, which would you suggest are the best?
I would rather prefer to encourage on a well-balanced diet with carbohydrate, protein, and fat, with enough fruits and greens for vitamins and trace minerals. However, if anyone wants to take, there is no harm taking once a day supplement containing mixed vitamins and minerals, and omegas or fish oil. Those taking regular medicines for cardiac, kidney, or any other condition shouldn’t take over the counter supplements without consulting the concerned physician.
Besides dry skin, what are the other problems seen with the skin in the colder months, and how can one tackle them?
There are many skin conditions that cold can induce and is not relevant to discuss here as they are not common. One condition I would like to mention is perniosis, or chilblains. It is fairly common in winter. It results from exposure of damp, non freezing temperature for prolonged periods of time. It presents as localized reddish bluish swelling in the fingers and toes that itches and sometime ulcerate causing pain. Wear thick and warm socks and gloves to prevent it. Wear gloves while doing wet work.
Drinking more water is naturally a good thing, but for some people (e.g. heart failure patients) doctors advise only 1.5 liters of fluid a day. This could lead to dehydrated skin. What is your suggestion in this regard?
Patients with fluid restrictions due to their medical conditions may experience dehydrated skin. I would suggest such patients to stay in ambient temperature environment, not too warm or cold, keep humifider if situation demands, limit caffeine consumption, and apply humectants such as hyaluronic acid and glycerin. Humectants are molecules which draw and hold water from deeper layer of skin, as well as from air, to keep the skin surface supple. But, the problem is they can’t hold the moisture for long. Hence, a layer of humectants must be sealed with an occlusive, such as rich cream or petroleum jelly. Trying these may provide some relief.
There is a lot of talk on skin barrier these days. What is it exactly and why it is important for good skin?
A healthy skin envelopes the body and exerts anti microbial defense, regulates temperature, and prevents water loss. This physical, biochemical, and physiological function, together, is a skin barrier. Any deviation from its normal function can cause havoc to the body. It has always been the subject of interest for discussion and research among dermatologists and researchers. Well, the recent buzz is probably touted by cosmeceutical industry for marketing its moisturizers, sunscreens, and other products.
Does oil really hydrate your skin? What are some of the best facial oils for dry skin?
No, it doesn’t hydrate skin. Oils may contain ceramides and phospholipids, which seal the gap in the cells and provide protection against free radicals due to their vitamin content. They form a barrier that helps to prevent transepidermal water loss i.e., water evaporation from the skin. Hence, the skin may feel supple after applying oil.
However, I would refrain from advising anyone from using facial oil, though the market is flooded with oils marketed for face. Facial skin is prone to pigmentation, acne, allergies, and irritation, and applying oil may trigger these.
The best moisturizer for dry skin are the ones that contain humectants, emollients, and exfoliants. Most of moisturizers already have various oils in them as an emollient, so we don’t need to slather our face with oil. However, one may apply oil on moist skin on the rest of the body with readily available coconut or olive oil, depending upon personal preference, in addition to moisturizer. It doesn’t have to exclusive, expensive, and rare. I would rather suggest applying vitamin serum containing vitamin C, E, ferulic acid, and hyaluronic acid, followed by sunscreen for facial skin care, whether dry or normal.
