I grew up in Ohio. I had great loving parents and grandparents and was fortunate to have been raised by them. When it came to bathing, my family was adamant about using soap and water on a daily basis – it was what you did to stay clean. I didn’t know anything different; to me you had to use soap and water daily. Oh yeah, when I had hair, I used shampoo daily, too!
When I went to medical school we learned a few things about the skin, but more about skin disease and treatment than how to keep skin healthy. Same thing in residency when I did my dermatology rotations, it was more about recognizing and treating skin disease rather than how to keep our skin healthy.
So I’m quite capable of doing research and reviewing articles and reviewing pathophysiology. When I started thinking about opening Azura, I did my research and thought “it’s a bit like learning a new language; I’ll eventually ‘speak’ it fluently”. With the help, knowledge and expertise of Azura’s aestheticians and PA who already speak the language of skin care fluently, this is what I have learned and re-learned about the normal pathophysiology of skin and how to care for it:
- The skin is the largest organ by area that we have.
- The skin is the sensory receptor of the body – it houses the nerves that transmit signals to the brain. When we are exposed to extremes of temperature, the skin tells us. When we touch something sharp or rough or smooth, the skin tells us. When the skin is damaged, we sense pain. When we are caressed, we feel pleasure.
- The skin synthesizes Vitamin D. Sunlight converts cholesterol into a precursor that becomes Vitamin D. The vitamin D produced in the skin is converted by the kidneys and the liver to produce the biologically active form of Vitamin D. Vitamin D is very important in bone health via its effects on calcium absorption, phosphorus maintenance, and on osteoblasts and osteoclasts. Vitamin D also is important in the modulation of cell growth, neuromuscular function, immunological function and reduction of inflammation. Vitamin D likely helps prevent colon cancer via some of these mechanisms.
- The skin is a physical and biological barrier to our environment and is important in immunological surveillance. The skin prevents too much water from evaporating from our bodies. Intact skin keeps dirt, grime, toxins, and microorganisms from penetrating. Normal skin’s oils actually help keep skin smooth, soft and intact. The normal bacteria and fungi present on the skin actually help fight pathologic bacteria, viruses and fungi. Certain cells in the dermis layer of the skin are immune cells that can help fight microorganisms and help produce antibodies. The skin increases melanin to protect us from UV light damage.
- The skin helps dissipate mechanical forces.
- The skin helps regulate body temperature through the dilation and contraction of blood vessels and production of sweat. When our core temperature is too hot, superficial blood vessels in the skin dilate to allow heat loss. Sweat is also produced that when it evaporates; it cools the skin. Conversely, when our core temperature is too low, superficial blood vessels constrict preventing additional heat loss and sweat is not produced.
All of this information tells me the importance of healthy skin, but doesn’t tell me to how to keep the skin healthy so it can do its job. Further research lead me to the following:
- Traditional bar soap is NOT that good for the skin; especially the skin on the face.
- Soap has a higher pH (up to pH 9 or 10, the most alkaline a substance can be is a pH of 14) than normal skin which has a slightly acidic pH of about 4.7-5.5; neutral pH is 7.0.
- Soap damages the protective fatty acids, oils and hydrating proteins that are normally present on the skin which leads the skin vulnerable to incursion from environmental factors, like microorganisms. It also eliminates the normal skin biome that actually helps as previously learned, especially if it’s a disinfecting soap.
- Natural oils present on the skin help keep it hydrated; soap destroys these oils which lead to dehydrated skin. When the skin is dehydrated, the skin can actually produce more oils in an attempt to compensate and that can lead to oily, damaged skin and acne. Dehydrated skin also promotes wrinkles and fine lines as well as dry, flaky skin.
- The thickeners that help keep bar soap together can actually clog pores.
- Specially formulated cleansers and certain soaps are less damaging to the skin than traditional soap, but are more expensive.
- The best soaps and cleansers have a pH that is close to that of skin (4.7-5.5) and have a surfactant that allows oils and water to mix which allows for dirt and excessive oils to wash off.
So what do I do now? Azura’s aestheticians have recommended that I try one or two things at a time, observe how it affects me and then try adding something else until I find what works for me.
My current regimen, which seems to be working for me, consists of routine body cleaning where I still use soap every morning; but only on the areas that have apocrine sweat glands. I use a brush or loofah on the rest of my body. I change the brush or loofah once a month. In the morning, for my face and bald head, I first use a facial cleanser (ZO’s Foamacleanse or Oilacleanse); secondly, I use a mild exfoliant (ZO’s Offects Exfoliating Polish); thirdly, I use a toner (ZO’s Balatone) to balance my skin pH; fourthly, I use ZO’s Ossential Daily Power Defense to keep my acne-prone skin under control and lastly, I use Elta MD Clear Broad Spectrum SPF 46. At night, before going to bed, I use the Foamacleanse, Offects Exfoliating Polish, Balatone and then ZO’s Glycogent Exfoliation Accelerator only on my face and not my scalp. Around my eyes, I use Neocutis’ Lumiere Biorestorative Eye Cream. It sounds like a lot, but I can clean and treat my face in less than five minutes in the morning and in the evening. The tubes I get last me about three months. My skin has fewer blemishes, is MUCH smoother and looks “fresher”. If I get something particularly unpleasant on my skin, I use soap – old habits die hard!
-Craig A. Stevens, MD