Sandy Skotnicki is the founder of Toronto’s Bay Dermatology Centre, an assistant professor in the department of medicine at the University of Toronto and a consultant dermatologist at St. Michael’s Hospital. She is the author of Beyond Soap: The Real Truth About What You Are Doing to Your Skin and How to Fix It for a Beautiful, Healthy Glow.
The woman came to see me just before the holidays with a rash I’d seen all too many times. An operating room nurse with a tentative smile, Janet had finally reached her breaking point.
“I give up,” she said. “If you can’t help me, I am not sure what I will do.”
Janet was beset by angry, red, scaly skin on her upper eyelids, the sides of her neck and her upper back. Some days were better than others, she told me, but the affliction was pretty constant, resolving only temporarily with topical steroids.
I knew immediately what I was looking at: “Given the distribution on your body, it’s likely your shampoo.”
Most patients look at me sideways when I suggest shampoo is the culprit behind their irritation. After all, what link could their hair products possibly have to their skin?
An October, 2020, study from Journal of the American Academy of Dermatology (JAAD) provides an answer. The analysis, which pooled 1996 to 2016 data from top allergy clinics in North America, including three in Canada, showed a 2.7-fold increase in adverse reactions or skin rashes resulting from personal care products (PCPs).
What was most interesting in the data were the differences in men and women. Most women noted reactions on the face, with hair care products being one of the top offending PCPs. In men? Trunk and limbs seem to be where they experience itching and dryness from cleansers, body washes and soaps.
All told, allergies and irritations caused by PCPs are still relatively low, but there is no denying the steady rise in these types of cases. Why? The ever-expanding use of PCPs (such as washes, scrubs, serums, exfoliators, moisturizers, masks and peels) used in combination with one another. Add to that our society’s obsession with showering, bathing, scrubbing and soaping on the daily and the explanation for these ailments starts to take shape.
Now with COVID-19, our skin is living in a kind of social experiment. Namely, what happens when external factors render obsolete the need for hairstyling, makeup or even showering? Are our complexions faring better in this vanity-free climate?
Admittedly, the data thus far are purely anecdotal. In querying some of my patients and friends about how they felt personally and how their skin felt amid lockdown, their responses – much like in the JAAD study – broke down along gender lines.
The men I spoke to said they felt free, in large part because they don’t need to shave, shower or groom on the daily. I asked whether their body felt less dry or itchy since the work-from-home orders went into effect last spring.
“Come to think of it, I usually do get pretty itchy and dry in the winter,” one friend responded. “Do you think not showering everyday has something to do with it?”
Women offered more varied responses than the men. While many loved the option of forgoing makeup, others said doing so has revealed dark patches they didn’t notice as much prepandemic.
In my 2018 book, Beyond Soap, I examine the damaging effects of our modern skincare rituals, including daily showering, scrubbing and shampooing, and how those habits are damaging our skin’s protective bacterial barrier, better known as our microbiome. I also explore the extent to which those habits are behind recent increases in allergy, hay-fever, asthma and atopic dermatitis.
It’s important to remember that there is a difference between cleanliness and hygiene, two concepts that often get conflated.
Whereas cleanliness is the absence of dirt, hygiene involves those practices required to protect us from infectious disease. In the initial months of COVID-19, that meant washing and sanitizing our hands way more than we were prepandemic.
How much more?
The Healthy Handwashing Survey conducted by the Wisconsin-based Bradley Corp. found 78 per cent of Americans were washing their hands more than six times a day in April, compared with just 37 per cent who washed their hands that much before COVID-19. Those figures have since moderated with 57 per cent of respondents surveyed in January saying they wash their hands more than six times a day.
The question remains whether we will go back to our prepandemic routines of soaping our hair and scrubbing our bodies.
In my virtual follow-up appointment with Janet, it was obvious how relieved she was to have finally addressed the root cause of her irritation. “I cleared up in one week,” she said of her skin transformation since eliminating her shampoo. “I hate the fragrance-free shampoo you suggested but I have no more rashes.”
I will eventually conduct an allergy patch test to pinpoint the exact ingredient that caused the reaction, but in the interim it’s a relief that she’s found some, well … relief.
When I asked her whether she would go back to her previous shampoo even after we determine what ingredient she was allergic to, her answer was similar to most patients in her shoes: “My skin has never looked and felt better so there isn’t any point. But, I will always wash my hands.”
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