From the Experts           <Back to experts area

SoapPractical Advice on Skin Care

3 April 2004

From Dr Darion Rowan, Consultant Dermatologist, Manukau SuperClinic

What causes dry skin?

  • Low humidity (dry winter weather, windy conditions)
  • Excessive washing
  • Decreases in natural oil production with age
  • Inherited conditions such as ichthyosis
  • Eczema and psoriasis
  • Skin rashes that dry as they heal

Soaps cleanse the skin by removing excess dirt and grime

Traditional toilet soap such as Palmolive and Lux is alkaline while skin pH is acidic. Soaps can irritate skin because of this difference.

Soap Substitutes are formulated to be more gentle on the skin, and result in fewer side effects such as irritation and drying, while still adequately cleaning the skin. They are low pH, nearer to the skin's normal acidic pH.

They may be a bar, cream, liquid gel, washes or wipes.

Scrubs with a grainy texture are more irritating on skin.

Antibacterial cleansers reduce normal skin bacteria and they are seldom indicated because they reduce the normal bacterial counts, and could cause resistance of dangerous bacteria.

Facial moisturisers aim to make your skin look younger, by reducing dryness of the skin, plumping it out and reducing wrinkles. They may be oil-in water-emulsions such as cold creams and vanishing creams, that are soft to the feel, or water-in-oil emulsions which are more greasy. There are many ingredients in most creams including makeup. These include the cream's base (eg lanoline, vegetable and mineral oils), fragrances and perfumes (including masking fragrance which hides or masks the smell of the base ingredients), preservatives, “active” ingredients and water.

Types of moisturisers include:

  • Lotions, creams and ointments that add a layer of oil on the skin surface and slow water loss.
  • Some humectants, which are agents that work by adding water to the most superficial layer of the skin, the stratum corneum. They include glycerine, urea, alpha hydroxy acids
  • Some moisturisers have both properties

Finding the best moisturiser is often by trial and error. If your skin is very dry, a greasy thicker moisturiser will usually be best. If your skin is not so dry, a lighter moisturiser will suffice. For many skin types it is not necessary to use a moisturiser at all. People with acne or an oily skin will reap little benefit from moisturiser use, and their acne may be worsened.

Some moisturisers have special additives for a particular purpose. eg sunscreens, or anti aging agents such as alpha hydroxy acids or "fruit acids" and retinol derivatives.

Body moisturisers (creams, lotions or oils) are not needed by many people, but are useful in patients with dermatitis (eczema) and psoriasis. Patients with inherited types of dry skin (ichthyosis) and those with healed rashes will find they assist with healing.

“Natural products” are often more complicated preparations than synthetically prepared creams, and often contain plant derivatives which are more likely to produce irritant or allergic reactions from the ingredients than the synthetic products. Mostly they are not scientifically proven to be beneficial.

Fake tanning is not harmful, but does not protect against sunburn and the damaging effects of ultraviolet light. Products containing dihydroxyacetone are the most commonly used for self-tanning and they react with amino acids on the surface of the skin to produce pigment. Constant reapplication is needed, but with experience the cosmetic result can be good.

Skin aging in New Zealand is aggravated by sun exposure, which causes premature aging. Changes in collagen and elastic tissues in the dermis (the second layer of skin, under the protective epidermis) occur naturally in everyone, as they grow older. (Compare the appearance of your facial skin with the inside of you upper arm).

The face in lupus

There are three common types of skin changes in lupus erythematosus (as well as some rare types).

  • Discoid lupus – well defined red lumps often with thick scaling on the surface which become scarred with either an increase or decrease in normal pigmentation
  • Subacute cutaneous lupus where there are red thinner patches on the face, but more especially upper trunk and arms
  • Butterfly rash on cheeks in patients with systemic lupus.

These rashes are all aggravated by sun exposure, both UVA and UVB. A flare of the internal symptoms of systemic lupus is also possible after exposure to the sun.

COVER UP AT ALL TIMES WITH SUNSCREEN, HAT AND CLOTHING WHEN YOU ARE OUTSIDE

Sun protection

Avoid unnecessary sun exposure, by staying indoors, especially between the hours of 10am to 5pm during the summer months (daylight saving time). You will have 50% protection from the sun if you stay in shaded areas, but will still receive exposure to UV light from reflection from the surroundings.

Clothes can offer up to 90% protection especially closely woven fabrics in bright colours. Polyester and blends are more protective than cotton. “Rash suits” (which many children now wear) should be worn when swimming.

Wearing a hat with a 10cm solid or thick brim also offers up to 50% protection.

Always use a sunscreen.

Sunscreens

Should be broad spectrum, i.e. they protect against UVA and UVB. Factor 15 is the minimum recommended protective factor to use. Factor 30 sunscreen adds only slightly better protection. Sunscreens must be reapplied every two hours if exposure is constant. Thick application is much more effective than a thin layer. Apply the cream once then reapplying half an hour later can be a good way to ensure the thickness is adequate and also prevent “missed” areas.

Sunscreens should not be relied on alone because an inadequate level may be applied to the skin, they come off during washing, sweating and swimming, and because of their chemistry, after several hours the effectiveness of the sunscreen may be greatly reduced. Reapplication is very important.

Steroids on skin

These are often used to treat lupus rashes, and also for dermatitis or eczema and other inflamed skin disorders.

  • Topical steroids may be lotions, creams or ointments (the latter is the greasiest, and is usually most effective)
  • Hydrocortisone is weak and relatively safe even if used for prolonged periods. (But is not very effective for lupus rashes).
  • Stronger steroids can cause thinning of the skin if used for months on the same area of skin. A pimply rash, stretch marks and “broken capillaries” (telangiectasia) can also result.

They are safe to use for up to a month and most adverse affects are reversible. Be guided by your doctor's advice.

For more information see the New Zealand Dermatological Society's website, www.dermnetnz.org .

Darion Rowan
Consultant Dermatologist
Manukau SuperClinic
Great South Road
Manurewa New Zealand

Legal Disclaimer

Lupus Care & Support has made every effort to ensure all information on this website is accurate. However, Lupus Care & Support does not accept any liability for any statements or advice contained on, or omissions from, this website.
In all medical matters, we recommend that the user seeks professional advice from a qualified doctor or health professional.



Home | About Us | What Is Lupus? | Membership | From The Experts | Personal Stories | Links | Top

Legal Disclaimer

Lupus Care & Support has made every effort to ensure all information on this website is accurate:
However, Lupus Care & Support does not accept any liability for any statements or advice contained on, or omissions from, this website.
In all medical matters, we recommend that the user seeks professional advice from a qualified doctor or health professional.