Combatting modern threats to skin health

Your hosts Dr George Moncrieff and Dr Roger Henderson explore the challenges our skin faces in today’s environment and share practical ways to protect it. From understanding what makes our skin vulnerable to the impact of modern habits, they cover essential insights into achieving healthier skin.  

Key takeaways: 

• Environmental impacts: how central heating, air conditioning, and frequent washing contribute to the rise of dry skin conditions like eczema and psoriasis. 

• Skin microbiome: why maintaining your skin’s natural microbiome is key to resilience and tips on avoiding damage. 

• Effective emollient use: simple methods for using emollients effectively to improve skin hydration. 

Tune in to learn how everyday choices impact your skin and what you can do to protect it. 

Thank you to our kind sponsor AproDerm, who provide a range of emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis. 

Everyone’s skin is unique and what works for one person, may not work for another. That’s why AproDerm has developed the AproDerm Emollient Starter Pack. This pack contains all four of their emollients varying in their formulation, consistency and hydration, giving you the choice to find a routine which suits you.  

Find out more here. 

IG: https://www.instagram.com/aproderm/ 

FB: https://www.facebook.com/AproDerm  

We hope you find this podcast interesting and helpful. Please leave us a review or email [e-mail] with any feedback on this episode or suggestions on skin-related topics that you would like to hear about in future podcasts. 

The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content. 

Episode Transcript

(00:10):
Hello and welcome to this SkinDeep podcast, where we'll be
looking at skin-related issues andtreatments in, what I hope is, an
interesting and informative way.
I'm Dr Roger Henderson andI'm a GP with a long-standing
interest in this area of health.
And I'm Dr George Moncrieff.
I was also a GP, though I retiredfrom my practice a few years ago.

(00:32):
I'm also the past Chair of theDermatology Council for England.
Today, Roger and I will be talkingabout some skin basics, including why
dry skin problems are increasing sorapidly, in both children and adults.

(00:55):
This hostile world that we live in.
You know, if we were to go back 2000years, it would be interesting just
to see, you know, the incidence ofskin disease now compared to then.
And from my point of view, in myexperience over the last 30, 40 years,
there are probably three or fourthings that spring to mind as to really

(01:15):
what have given our skin a hard time.
The most obvious one, perhaps, isthe modern, dry world we live in.
We have central heating, we washto within an inch of our life.
Dirt is the enemy and I think we bothagree that, you know, a dirty child
is a healthy child, a lot of the time.
Antibiotics, we mentioned themicrobiome before and antibiotics,

(01:37):
you know, interfere with that.
And obviously, unfortunately,you know, as we live longer and
get older, our skin thins and wemake less, less grease or sweat.
So, that's my take on that.
Would you concur with those, if youlike, the 'big four' that perhaps have
changed compared to 2000 years ago?

(01:58):
Absolutely.
I suppose also, infectionswere often lethal...
Yes.
...2000 years ago and things like scarletfever were catastrophic until modern
days, um, when the bacteria became lessvirulent and we had treatments for it.
But no, absolutely, ourancestors lived in humid worlds.
This world we live in now with carpets,dry walls, modern building standards,

(02:20):
air conditioning, as you mentioned, andcentral heating; it means that we have
this very dry environment for our skin.
It didn't use to have to copewith that dry environment.
I think people underestimatejust how damaging washing is.
If you just look at the prevalenceof atopic eczema in children
after the Second World War, i.e.
in living memory, about1 child in 40 had eczema.

(02:45):
It was that sort of number.
It's now 1 child in 4 has atopic eczema.
I can think of no other inflammatorycondition affecting the body, um,
that has increased in that way.
And it's just increasedabsolutely continuously.
It's plateauing now at this epidemic leveland so what has changed in these 70 years?

(03:06):
I think, as you say, I thinkit probably is our washing.
Our ancestors, up until aboutthe end of the Second World
War, washed maybe once a week.
Certainly if you go back a few centuries,people very rarely washed or not at all.
Yeah.
And washing does a lot of harm.
Not only does it wash off thebody's natural microbiome, which is
important, but it also raises thepH, rendering the skin alkaline.

(03:31):
And that is very damaging to the top layerof the skin, to the barrier of the skin.
The barrier becomes weaker.
But it also degreases the skin.
Detergents are designed to degrease andthe grease is a top layer on top of all
that skin that prevents water evaporating.
So detergents are verydamaging to the skin.
As you mentioned, antibiotics.

(03:51):
They will wipe out that microbiome, whichis healthy and it keeps things at bay.
Older people don't make muchgrease and they certainly sweat
a lot less and sweat is acidic.
So their skin is particularly vulnerable.
So I totally agree with you.
Yeah, all those.
When I talk to patients about antibiotics,some of them now uh, they have made a

(04:12):
link between taking oral antibioticsand their gut flora, their gut microbia.
But they really don't twig that itcan impact on their skin, uh, as well.
You sometimes just have totalk about that with them when
you're prescribing antibiotics.
But the rise and rise of dry skinbecause of all the reasons that we've

(04:33):
mentioned, these obviously can thenbe exacerbated by the common mistakes
that people with dry skin then make.
Which in all fairness, they thinkthey are doing the right thing
but actually their skin is reallyprotesting at what they're doing.
I mean, I've got a little handful oftips that I always give to my patients.

(04:56):
What are your messages from thewayside pulpit when you're talking
to someone with dry skin aboutwhat to do and what not to do?
I can't tell you how often I'veseen somebody with essentially a dry
skin condition, eczema, psoriasis,maybe even rosacea and when you talk
to them, you discover that they'restill washing with detergents.
They're using a shower gel.

(05:18):
They're washing their hair andthey're vigorously rubbing that
down onto their itchy, dry scalp.
And they're allowing that shampooto rinse off over their skin.
Down past their dry, cracked legs and ontotheir dry, cracked heels, which they're
standing on in this broth of detergent.
[They] may be using a foam in a bath.

(05:38):
Having a bubble bath occasionallyand they're using soap on their skin
and vigorously adding it to the skin.
All these detergents, these harshdetergents are powerful alkalis
and they all degrease the skin.
And I say to them, look, your skinwill never get better until you
stop [using] those detergents.
Instead, you can wash with anemollient as a soap substitute.

(06:01):
Emollients are balanced topreserve the acid mantle.
They have a slight acidic buffer inthem, so maintain that acid, um, buffer.
They also will regrease the skin whenyou're washing, rather than degreasing it.
So, washing with an emollientcan dramatically change things.

(06:21):
Really, really important.
That's probably the most common mistake;that people are continuing to wash.
I haven't used shower gel.
I haven't used shampoo,perhaps for other reasons.
But, I haven't used bubble bathor any soap on my skin, apart from
my hands, for over 20 years now.
I wash with an emollient.
I wash every day, but Iwash with an emollient.

(06:43):
I think the next problem peoplehave is that they, sometimes after
washing, they apply an emollient.
Which is the right thing to do, whenthe skin is still nice and moist
and a little bit warm, from the,hopefully not too hot, bath or shower.
If it's too hot, you'll melt offnatural oils and make it more itchy.
But then they rub their emollient in,or their creams in, far too vigorously.

(07:04):
They need to be stroked onto the skinand in the same direction as the hairs.
So you just stroke theemollient on all over the skin.
In eczema, the whole skin is abnormal.
Not just the areas whereyou've got visible eczema.
The whole skin has a raised pH.
The whole skin has an abnormal microbiome.
So the whole skin needs to be treated.
Same with psoriasis.
And that is actually a pointthat is often forgotten.

(07:26):
Not only by patients, but also by, Ithink, some healthcare professionals
who concentrate on the inflamed partof what you can see and ignore the
other, sort of, nine-tenths of theiceberg under the water that you can't.
Yeah, absolutely.
It's such an important point.
It really is.
So you need to cover the whole skinand I say you need to put enough on.

(07:47):
Actually, I say to little children,"can you draw a little face when
you've applied it or write your name?"
It's that sort of quantityyou should put on and within a
couple of minutes it soaks in.
So, just stroke it on, the whole skin,in the same direction as the hairs.
Just doing it gently.
Another problem I see is all ointmentscome in tubs and some creams come in tubs.

(08:08):
It's unforgivable to put a cream ina tub because you could have a pump.
But if you extract the cream or theointment from that tub with your
fingers, we now know that within a weekthe cream will become contaminated.
Then the next time you put that on toyour broken skin barrier, you're putting
back bad bacteria onto your skin.

(08:28):
It can cause an eczemaflare or an infection.
So you should extract itwith a spatula or a spoon.
There's one product now, AproDerm®Ointment, comes with little
green spatulae in the lid.
Which I think is a really goodmessage for our patients to extract
it with that spatula, you can thenclean the spatula, let it dry, and
it won't carry infection into it.
And if you're using the spoon, when I'veseen this in some patients, don't use the

(08:51):
spoon and then just leave the spoon ontop of the tub quietly gathering bacteria.
Use a fresh spoon every time.
Clean it and dry it that's,all it needs to be done.
Yes, exactly.
And occasionally put it inthe dishwasher, I guess.
And I think, the other thingis, people use too little.
Emollients are not expensive and,if you're going to use enough, you
need a few kilograms per month.

(09:12):
Um, NICE, the National Institute ofClinical Health Excellence, advise that
a child with eczema should expect toget through half a big pump dispenser.
250 grams per week.
So they need a kilogramof emollient per month.
That will raise a lotof people's eyebrows.
Absolutely right.

(09:33):
Absolutely correct.
But, when people are used to getting 30grams prescribed or 60 grams, they're
homeopathic levels of emollients.
If we're going to, I suppose, haveone take-home message amongst all the
many, in this particular podcast, itwould be always get enough emollient.

(09:54):
You almost can't have too much.
If you are having to, sort of, go backrepeatedly to get small tubes of ointments
or creams, it's being done all wrong.
The only advantage of the small tubesis perhaps to have one in your handbag
or one in your car, so that, uh, whenyou're out and about you can use some.
But absolutely, couldn'tagree with you more.

(10:15):
So we'll talk in the next podcast aboutemollients in a little bit more detail.
But from the point of view of thisone, you can really, I think, already
just see how crucial our skin is,not only to our general health and
wellbeing, but also to our survival.
Also, it's important tokeep it so well moisturised.

(10:40):
And for those of you listening, Ihope you found this interesting.
Huge thanks to AproDerm® forall their help in putting these
Skin Deep podcasts together.
We couldn't have done it without them.
Absolutely.
So until the next time,it's goodbye from George.
Goodbye.
And it's goodbye from me.
Goodbye.