I have heard from SolveEczema.org users, including doctors, who used the SolveEczema strategies just so they could wash their hands a lot and not dry or damage their skin.
Over the years, many site users who used Solveeczema.org to get rid of eczema, have also described successfully using the website to get rid of dry skin without needing moisturizers. So a few years ago, I started a multi-part blog post on how to use the SolveEczema website to get rid of dry skin without using moisturizers.
Based on my research and observations, and my experience trying to help people on the eczema side, I see so many misconceptions about what causes dry skin, that after writing the first post, I pretty much gave up on trying to make a separate set of instructions for ameliorating skin dryness. The best I can do is recommend: Read and understand the SolveEczema.org website! (It’s not what you think when you first look at it.) The principles work for dryness whether you have eczema or not.
You may have to dig a little bit, and keep an open mind. SolveEczema was never built to be the most efficient way to best explain the new concepts of how to problem-solve eczema this way, because, again, people’s preconceived notions get in the way. The site was built for people with infants, and to best help the most number of people—given the most common preconceived hurdles—to see this very different way of looking at skin health and persist in getting the benefits in their unique circumstances.
I think medical research, and basic biological principles, are at least pretty clear that the modern eczema epidemic is above all an environmental problem, with a genetic susceptibility. But there seems to be an underlying assumption that the environmental influence happens early and that children and adults with eczema have a fundamental immunological or skin defect that stems from an early environmental circumstance that can no longer be reversed. This assumption is wrong, and I believe I can demonstrate that it’s wrong.
When I went to solve my child’s eczema, I could see that the one indisputable aspect of the problem, according to research, was that it is primarily environmental, something about the modern environment, but I didn’t see anything that I recognized as environmental problem solving anywhere. So that’s what I did. This is why the SolveEczema site is basically an environmental problem-solving guide. Sometimes I despair of ever helping most people understand so they don’t keep suffering from what I believe is the completely solvable problems of eczema and atopic asthma, and even the majority of dry skin.
In solving eczema, it became really clear that everyone is affected by these same environmental influences even if they don’t have eczema—and I don’t just mean people, I also mean animals (indoors and outdoors), but that’s a topic for another day—and that the impacts are both short-term and long-term. Both short- and long-term impacts on membranes are reversible with the right environmental changes. The best results come from understanding and ameliorating both the short-term and long-term consequences of those environmental influences, but people can do a lot to solve dry skin just by understanding and ameliorating the short-term impacts.
Now that everyone is washing their hands frequently because of the coronavirus pandemic—since washing is superior to hand sanitizer when it comes to preventing the spread of infection—I’d like to try sharing this very different way of looking at skin dryness again. Because when people understand it, they can wash their hands really well, getting them very clean and even scrubbing, without drying out their skin and without needing moisturizers.
This kind of advantage is critical for medical professionals because damaged skin can harbor microorganisms and make doctors susceptible to infections themselves through broken, bleeding skin. Let’s face it, damaged skin just plain makes people not want to wash their hands frequently, too. Hand sanitizers, while important for when hand washing is not possible, don’t work as well as washing, and the alcohol (and other chemicals) in them can be absorbed. Sanitizers don’t work at all against some viruses like norovirus. Sanitizers have nevertheless become ubiquitous even where hand washing is available because handwashing is harder, and let’s face it, often times painful, because of the drying. It doesn’t have to be.
It’s so ingrained that washing well damages skin, there’s even a pandemic commercial that shows a medical professional scrubbing and proudly holding up red raw hands, as if it is an inevitable sacrifice. In my experience, for the majority of people who understand this different perspective, this familiar outcome of handwashing is not necessary, there is a better way.
If you’re willing to follow along and understand this very different perspective, at the end of this article, I will share a simple experiment you can do to demonstrate these principles at home.
With that goal in mind, the first and most important point I need to make is this:
Washing hands to get them really clean, washing hands often and really thoroughly, is NOT what is drying your skin.
Let me say that again another way: the reason your hands get dry, cracked, and raw when you wash them a lot, is not, as is commonly believed, because you are stripping oils from your skin when you wash.
Yes, there is something about the washing process that is making your skin dry and raw, but what you and pretty much everyone else have assumed and concluded about why is wrong. Understanding this can change everything.
The second critical point I need to make, and which I have made for over a decade on this blog, and tried to make more memorable by giving it a dopey name (my apologies), is Lumsdaine’s Law:
Lumsdaine’s Law: For most people, under most conditions, eczema and dry skin are more the result of what is left on the skin than what is stripped from the skin by washing.
Your skin is not getting dry from washing away oils. Your skin is getting dry because the residue of whatever you washed with—and there will be a residue, no matter what the product maker promised about rinsing—has unnaturally increased the permeability of your skin so that it loses more moisture than the natural dynamic repair processes of the skin can replace on an ongoing basis.
This is especially true for modern synthetic detergents like sodium lauryl sulfate, even the organic ones. (The important characteristic being the molecular properties of the products, notably, how hydrophilic—attracted to water, and thus, how good at increasing membrane permeability—they are, not the starting ingredients.) This characteristic of modern synthetic detergents has been amplified beyond anything possible in traditional soaps, and more so over time (in step with the allergy epidemic since WWII, I would note.)
Even a layer of water on the skin, all by itself, increases the permeability of skin. Not as dramatically as detergents do, and especially detergents with a layer of water, but you can see this if you wash your hands in the winter and don’t dry them properly, they chap. Your hands feel “moist” just after applying the water, but over time, they lose excess water because that extra layer of externally applied water increases the permeability of the skin. (Though few people would know the effect of water alone anymore since the vast majority of people have residues of detergents on their hands even if they rinse just with water. But the effect is the same.)
The molecular properties of surfactants that make them good at destroying surface tension/mixing with water and therefore good at cleaning also happen to make the residues left on skin good at unnaturally increasing the permeability of skin. Modern synthetic detergents (as defined on SolveEczema.org) are inevitably far more hydrophilic than soaps (also as defined on SolveEczema.org) and thus increase the permeability of skin far more. This is an underlying principle of SolveEczema. Even tiny residues of modern detergents left on the skin (yes, even “organic” ones) can unnaturally increase the permeability of skin on an ongoing basis.
This principle is supported by a recent study by a group in England, with one of my favorite dermatology researchers in the world as co-author, Dr. Michael Cork, whom I’ve mentioned before. The Effect of Water Hardness on Surfactant Deposition after Washing and Subsequent Skin Irritation in Atopic Dermatitis Patients and Healthy Control Subjects, Simon G. Danby1, Kirsty Brown1, Andrew M. Wigley1, John Chittock1, Phyoe K. Pyae1, Carsten Flohr2,4 and Michael J. Cork1,3,4, Journal of Investigative Dermatology (2018) 138, 68e77; doi:10.1016/j.jid.2017.08.037
The group methodically looked at whether the hardness of water affected residues of the detergent sodium lauryl sulfate left on skin, and they found that “Sites washed with hard water had significantly increased sodium lauryl sulfate deposits.” And that “These deposits increased trans-epidermal water loss and caused irritation, particularly in AD patients carrying FLG mutations.”
Translation: Rinsing with hard water left more detergent residues on people’s skin. The detergent residues remaining on the skin increased the loss of water from the skin and were associated with irritation, especially in people who are genetically prone to having eczema and allergies.
This still doesn’t address the, in my experience, wrong idea that skin dryness is the result of oils being stripped from the skin from washing, but it’s a start. (I will write more about this later, but based on my research, it seems that this idea, that washing away oils causes skin dryness, is more the consequence of innovations in 20th century advertising than scientific evidence.)
Using creamy moisturizers and “moisturizing” washing products backfires. Skin seems moisturized right after using them, but over time, they cause the skin to lose water.
This is also described in SolveEczema.org. I’ve heard this phenomenon described as the skin becoming “addicted” to the moisturizer and not producing enough oils because of the externally applied moisturizing, and that if people just stop moisturizing, after a painful period of adjustment, skin will be less dry. Again, this is a wrong interpretation that sadly causes unnecessary suffering and poor results.
What’s really happening, as I describe in SolveEczema.org, is that the creamy moisturizers are creating a condition much like water on the skin, in which it is temporarily externally hydrated in a way that causes increased permeability and excess water loss over time, and thus, dry skin.
Here’s that test I promised to prove all this to yourself, if you are able to handle very dry skin for a couple of days. (Note: if you have hard water, the results could be affected by the water hardness, per the paper I cited above. Given the need to wash hands because of Covid-19, I wouldn’t do this full test if you have to be out in the world and need handwashing for serious infection control. “Moisturizing” soaps don’t tend to clean very well, for one.) It’s a 3- to 6-day test, so set aside a time when you don’t expect to go out much.
Get a “moisturizing” bar soap. Also get a very neutral bar soap (like from my list of favorites, such as Sappo Hill unscented, which you can get by the bar at Whole Foods) that doesn’t feel especially oily or moisturizing and does a good job cleaning. Stick with “soap” as defined on SolveEczema.org, at least for the neutral soap. Do not use a product with detergent ingredients for the neutral bar soap. If you use a product with detergent ingredients (detergents as defined on SolveEczema.org) for moisturizing soap, then it may take more time to restore your skin to “normal,” possibly a lot more time. For the sake of keeping as many things controlled as possible, if you want to try a detergent in the first phase, maybe do a second trial after trying it first with only soaps (again, as defined on SolveEczema.org).
Glycerine “soaps” are perfect for the “moisturizing” one, although you can use any soap that feels really oily when you touch it, with added moisturizing ingredients. Such soaps won’t feel like they clean very well, but seem to leave “moisturizing” residues when you wash. (If you use them, you will see why I no longer recommend glycerine soaps at all, even though they are not detergents as defined on my site. They’re not really drying enough to cause eczema, in my experience, but … you’ll see.)
Once you have the two products, for the next 3 days, ONLY wash with the “moisturizing” product every time you wash your hands (showering counts, but use the soap in the shower then). Rinse well. Remember, don’t use a different product because you’ll wash off the residues of the test product. If you aren’t a SolveEczema site user, please recognize that your skin is regularly touching and absorbing detergents in your environment. Dry your hands for all of these tests with a paper towel (not a washed towel) to minimize that influence after you wash hands. Important: Don’t use a separate moisturizer for the duration of the test.
Immediately after using a glycerine bar or very moisturizing product, the skin seems very soft and hydrated. But then over time, over a period of hours in the short-term, and days in the long-term, it gets really dried out. You’ll probably see the effect within a day, but if you want to have no doubts, go 3 days. (Unless you get fed up from the dry skin earlier, in which case, move forward.)
After 3 days, wash your hands one more time with the “moisturizing”/glycerine soap, and wait for the moisturized-feeling phase to wear off—probably a couple of hours but may be shorter—so that your skin feels really dry.
Get out the neutral soap, like the Sappo Hill unscented (the best is an aged bar), and wash your hands really well. Get them super sudsed up, between your fingers, the back of your hands. Rinse them really well. Then dry them with a paper towel.
Wait the same amount of time that it took your skin to feel super dry after washing with the glycerine soap. (Try not to do things that would get more detergents on your skin, such as handling dust or clothing.) How do your hands feel? Your skin should be considerably less dry, more supple. If the cause of the dryness had been stripping oils from your skin, your skin would have been only more dry.
Keep washing with only this new neutral soap for 3 days. Notice the difference.
The Sappo Hill (or whichever product you chose) isn’t especially moisturizing or oily. It washes away oil and dirt better than products that are.
Having substances on the skin that increase the permeability so much that the skin’s natural dynamic repair processes can’t restore water fast enough is what is causing dry skin. You can wash those substances away; when you do that, your skin can replace water and become less dry fairly rapidly. It’s not days like the people who subscribe to the oil-moisturizer-addiction perspective think, it’s more like tens of minutes or hours, and the results are far better. If you don’t follow the SolveEczema site strategies, you are likely to be introducing hydrophilic substances that can cause drying to your skin in ways you don’t appreciate, which have long-term effects, but you should still be able to see the results of this test.
If you still want to moisturize your skin after this process, and you may, wash with the neutral soap, dry with a paper towel, and use a thin later of Aquaphor (which you can even wipe off with a paper towel—again, not a washed towel—almost entirely so it isn’t greasy, seriously that will work just as well or better than lots of product). If you keep using the neutral soap (and you don’t have exposure to other surfactants like the detergents that comprise virtually all commercial shampoos including the organic ones), you probably won’t need to use the barrier again.
Note: this same principle is at play with all of the surfactants you come into contact with: the laundry detergent, the detergents in personal care products, the dishes and household surfaces, the dust in your home (which is made up so much by lint, skin cells, and hair). It has been my experience and that of others using the SolveEczema site that changing to less-permeability-inducing household products can improve skin dramatically in the longer term, too.
Read my previous post about aging soap. Aged true soap may be less alkaline, I’ll have to do some testing on that. Regardless, a true soap that is neutral (non-oily) yet drying when you use it, will typically no longer be drying after it’s aged. If it has tons of moisturizing ingredients, though, so that the bar feels oily when you touch it and/or your skin feels like it has a coating of something moisturizing after you use it, aging the soap will never make it better.
Water hardness has such a dramatic impact on the performance of soaps and detergents—how well they suds, remove dirt, and rinse off—in my observation, water softness/hardness is typically a more important factor in cleaning performance than exactly what brand of soap/detergent one chooses. It is also a factor in dryness.
Over and over again I find with my site users that people with hard water have the most difficult time getting the detergents washed out of their clothing. Research has shown that there is more eczema in hard water areas than those with soft water. Soap doesn’t work well in hard water, and it forms insoluble residues. Detergents do, too, just not to the same degree. Those residues are why soft white fabrics get grey and coarse after repeated washing. When washed in real soap and soft water, soft light-colored fabrics stay light-colored and soft over time.
People tend to use a LOT of detergent when they have hard water, too, because hard water doesn’t allow sudsing or rinse as well and thus leaves a lot of residue (see the paper above). This is not an intuitive fact, because soaps and detergents develop lather and suds so much more easily with soft water, it can seem harder to rinse off. The reality is that with soft water, you can get things clean with far less product, and you can SEE the suds. That squeaky feeling people get when rinsing with hard water is actually residue, not actual clean.
This is not common knowledge, in fact there is a lot of misinformation on the internet about whether hard or soft water rinse better. Remember, the 2018 paper above showed that more detergents are left on the skin from HARD water rinsing. But because people see the suds disappear faster with hard water, they assume hard water rinses better. Even the Unites States Geological Survey gets that wrong: They wrote: “Hard water is actually much better at binding with the molecules in soap, allowing us to use less water to wash soap away, and making our skin feel “squeaky clean”.”
That is exactly WRONG!!!
Remember what the research study above proved?
“Sites washed with hard water had significantly increased sodium lauryl sulfate deposits.” And “Softening the water to remove calcium and magnesium ions significantly reduced the level of SLS deposition.”
Hard water doesn’t rinse away detergents well. Soft water rinses much better, and you can use less soap or detergent to begin with in soft water. Those residues increase membrane permeability, which increases water loss from your skin.
The USGS example is one of many you can find, which are likely the result of rationalizing from a simple observation, rather than using direct scientific testing. The same is true of old beliefs about dry skin and washing away oils, which as near as I can tell, came about because of advertising innovations mid-20th century.
At a time when washing hands well is so important to reducing spread of disease, it’s probably also important to know the difference between hard and soft water, and how each affects the performance of soaps and detergents, in particular, rinsing microbes away.
The best results come from following the SolveEczema site strategies fully. When fully and properly implemented, Solveeczema.org strategies typically result in a long-term improvement to skin which is most obvious in the first two months after full implementation. (Note: As I say frequently on my site for good reason, do not implement without first understanding it fully and keeping your doctor in the loop, it is a very different perspective and things can go wrong.)
When I was younger, if I traveled, I inevitably got cracked, dry, bleeding hands. Using those thick workmen hand creams only helped some, and they were a messy hassle. I thought for sure it was the dry air on airplanes. After implementing the site, I just take my own true soap (as defined on SolveEczema.org) with me in a pocket foaming dispenser to wash my hands with when I travel, and I don’t ever have dry skin anymore. I usually take Aquaphor with me but almost never have to use it. My soap is neutral, not moisturizing, and cleans really well—which is why it isn’t drying even when I have to wash frequently. Washing away the many harsh detergent residues I come into contact with when traveling also helps—so washing becomes an important way to prevent dry skin!
I would really love to impart this benefit to every doctor and nurse in the country who is suffering from handwashing, not just since the Covid-19 crisis, so that they can wash their hands as often as they need to, get them very clean, yet not suffer the kind of dry skin they may be suffering now.