A patient wants help with her hands. Which of the things listed below should she STOP doing to get her hands healthy again?
- Using a petroleum-based moisturizer
- Washing frequently to prevent infection
- Neglecting to put on gloves when she cleans her kitchen with her home-made kitchen cleaner
- All of the above
The worst mistake I see patients making involves hand washing. Trying to keep the area clean, they wash tehir hands frequently with soap, resulting in chapped and cracked skin. But the best way to avoid a skin infection or unhealthy bacteria on your hands is to keep your skin intact. Skin that has a healthy barrier doesn't carry as many dangerous bacteria, such as Staph Aureus. That's true of dangerous bacteria like Staph Aureus at least. If your hands are sensitive, like many people's are this time of year, wash them only when they are physically soiled. Otherwise, use hand sanitizer.
Many patients have asked me for moisturizer suggestions to help with their dry hands. I do have favorite hand moisturizers, but none of them can undo the damage of frequent hand washing with soap. The worst soaps are the ones you'd find in a public bathroom; the antibacterial foaming hand soaps in pretty little dispensers such as Dial, Softsoap and Ivory; and bar soaps like Old Spice, Ivory, Lever 2000 and Dial. The problem with all of these is that they leave the skin more alkaline than it needs to be in order to maintain a healthy barrier. Castile soaps like Dr. Bronner's, Kirk's Castile soap or Vermont Soap are different. They don't leave the skin as alkaline. Once we clear up the dryness and irritation caused by alkaline soaps, I give the go-ahead for patients to use these high-quality castile soaps as long as they moisturize frequently to compensate for the loss of skin oils during washing.
#1 is not the correct answer. I would NOT tell her to stop using her petroleum-based moisturizer. I understand that relying on petroleum for our skincare is not environmentally ideal, but just like with our cars, we are forced to be practical sometimes. Dermatologists routinely turn to petroleum-based moisturizers because they are so gentle and well-tolerated by patients with sensitive skin. I see excellent results when patients use Aveeno Skin Relief Repair Cream or Cerave Moisturizing Cream. Both have ceramides which help restore the skin's barrier. Unfortunately, both contain parabens, but that's a whole other dilemma. To avoid this post never ending, and to keep things simple, I'll just say that these moisturizers perform so well that their use is justified at least for patients with extreme sensitivity or an active hand dermatitis. My goal with hands that are extremely irritated is to heal them quickly so they no longer make a good home for Staphylococcal bacteria which is much more harmful than parabens. I encourage patients to go back to their Emu oil, coconut oil, shea nut butter once they get their hands under control.
I threw in option #3 as a trick because this patient happens to use a home-made cleanser in her kitchen that is not harsh on her hands. The formulation is equal parts rubbing alcohol, vinegar and water. I wouldn't want her bathing in this concoction but it isn't damaging her hands when she comes in contact with it. This is an inexpensive, effective and gentle cleanser for the home. I would however tell her to routinely wear gloves while doing dishes, again, to avoid contact with soaps.