Q. “What is the most difficult part of treating patients with dry and sensitive skin?”

ANSWER

The most difficult challenge of dry and sensitive skin therapy is educating patients to change erroneous skin care habits learned from years of TV, radio, and magazine advertisements. When it comes to dry skin, most people go to the drug store, buy lotion, and put lotion on their dry patches until they are smooth. The patient can’t understand why his or her skin itches. They are doing everything right according to the TV. The dry itchy patient frantically blames foods, drugs, and bugs, all the while sudsing with soap and turning up the hot nighttime furnace. Lotion and cortisone shots fail and don’t do much for effective long-term skin barrier repair. The itchier they get, the grumpier they grow. Finally, the patient comes to my office and I explain that they need to avoid allergens, bathe with gentle
cleanser, and apply cream. “I can’t do that.” They say in disgust. “I want a shot or a pill!” And so, the battle continues. Sometimes, the greatest obstacle in treating dry skin can be the patient’s own reluctance to avoid
allergens, bathe to hydrate, and apply topical creams. Some patients demand a shot or a pill to treat their problem. Some simply refuse to apply creams. A shot or a pill is not always the answer. The first steps toward getting better are the willingness to avoid anything allergic, to bathe, and to apply cream: ABC.

A second dry treatment obstacle is what I refer to as, “a la carte” therapy, in which a patient picks and chooses at will. There are patients who will do “A- Avoid” and neglect B and C. There are others who will do “B- Bathe” and forget “C- Cover.” Other dry and sensitive patients will do everything suggested, but refuse to give up their perfume. My point is: If a patient wants to get better, he or she must swallow the entire pill. In other words, the patient must follow the ABC’s exactly as given without “a la carte” exceptions.

Q. “What are the greatest enemies of my dry skin?”

ANSWER

Soap and dry air. Soap can remove your three lipids: Cholesterol, ceramides, and free fatty acids. You feel squeaky clean, but your skin barrier is damaged and loses its ability to protect water. Dry weather, your household furnace, and dry air add more misery to your dry skin. Skin water begins to evaporate, your skin dries out, and the lipid bilayers become depleted and damaged. The barrier is first injured. Then, dry air creates a wind blown effect and dries your skin like hair under a hot blow dryer. Add soap, and your protecting lipid oils are lost and washed away.