Dry skin? Choosing a moisturiser

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Allergy-causing products?
A study published earlier this month in JAMA Dermatology in the US demonstrates that many branded moisturisers labelled as hypoallergenic actually contain ingredients that are known allergens – these ingredients can cause a dermatitis (inflamed, dry skin) in susceptible people. Out of the 100 best-selling moisturisers in the US that were assessed, only 12% were free of all the standardly tested for allergens, despite many of them claiming to be hypoallergenic. For products that claimed to be fragrance-free, 45% had at least 1 fragrance cross-reactor or botanical ingredient.

Organic or botanicals?
Natural or organic ingredients are not less likely to cause allergy or irritation – many “natural” ingredients and botanicals can cause irritation in sensitive skin. Plants are made up of chemicals too! If you have sensitive skin you are better off focusing on products that are free of fragrances and preservatives, rather than looking for labels such as “natural” or “organic”.

Terminology:
Some of the terminology in the world of moisturisers can be confusing: what’s the difference between an ointment, a cream and a lotion?
• Ointments (a water in oil base) tend to be the richest and best for very dry skin. However, ointments may also look and feel the most greasy.
• Creams (an oil in water base) are usually less greasy, but may not provide the richness required for very dry skin.
• Though lotions (thinner, high water content) are, in general, the least potent moisturisers, these tend to be the most widely used according to the same study published in JAMA Dermatology. This finding may be surprising to many Dermatologists who would tend not to recommend lotions to those with very dry skin.
Sometimes the best balance may be to use an ointment at night for intensive moisturisation and a more cosmetically acceptable lighter cream during the day. For people with less dry pimple/acne-prone greasier skin, a cream or even a lotion may be preferred.

Cost:
Often over the counter products widely available in many pharmacies are just as good as expensive potions from the cosmetic counter in terms of product tolerability and these products also tend to print an ingredient list on their bottles/packaging: making it easier to avoid specific ingredients for individuals with a known allergy.

Some examples of over the counter products which tend to be helpful for dry skin and are widely available in Australia (in no particular order):
• La Roche-Posay Lipikar Baume AP+
• Bioderma Atoderm Nourishing Cream
• QV Intensive Cream
• Cetaphil Moisturizing Cream
• Avene XeraCalm A.D Lipid Replenishing Balm or Cream
• Dermeze Intensive Moisturising Ointment
Individuals will have different sensitivities – trialing testers of different brands is a good way to find out what suits you best.

Dry skin recipe:
1. Have short (5 minute) warm showers and avoid prolonged hot showers. It may seem counterintuitive but water can dry your skin. Hot showers can dry out the skin further, especially in Winter. If you have a tendency to shower more than once a day, reducing the frequency to once daily may help.
2. Avoid soaps. Use a shower product labelled “soap-free”. In the bath, a simple bath oil may be a useful addition (but take as care as oils may make surfaces slippery!)
3. Moisturise at least daily directly after your shower with a good moisturizer as per the above!

Declarations: No conflicts of interest. The list of products above is from personal preference - these products are not endorsed by The Skin Hospital/ Skin & Cancer Foundation Australia.

References:
• Xu, Kwa, Lohman et al., Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-Selling Moisturizers. JAMA Dermatol. Published online September 6, 2017. doi:10.1001/jamadermatol.2017.3046
• Zirwas MJ. Attempting to Define “Hypoallergenic” JAMA Dermatol. Published online September 6, 2017. doi:10.1001/jamadermatol.2017.3045

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