Look, what can I do there? Rash, boils, athlete’s foot: As a pharmacist, you have to be prepared to be presented with skin changes at any time. Those were always moments when I suddenly became very aware of why I didn’t want to study medicine. But of course, you have to wait a long time for appointments with a dermatologist, and for many things there are quick remedies in the pharmacy, be it cosmetics that are ideal for your skin problem.
I have looked at skin that is far too dry on various occasions – cracked, tight, flaky desert areas on the shins, upper arms or even larger areas are incredibly common, especially now from autumn onwards, when the heating air removes water from the skin. Around a third of adults have dry skin, and the number increases the older we get. A survey in a retirement home found it in 99 percent of the residents. So it comes to all of us.
But how do you combat it? Does dry skin need oil more than anything, or is it moisture that brings it forward? One is of no use without the other, that’s the short version. Caring for dry skin is always about introducing moisture into it, in the form of moisture binding agents such as urea (urea), glycerol (gycerin) or hyaluronic acid, which can retain water on site. But the special characteristic of dry skin is that the so-called hydrolipid film on it is cracked. This wafer-thin layer of the body’s own fat lies naturally on the skin and prevents water from evaporating from it. So the patent recipe is: pump moisture into the skin as intensively as possible – and use a little fat (lipids) to ensure that it stays there as well as possible.
The following applies: the drier the skin, the more lipid-containing the skin care should be. I know all of this from a so-called position paper from 2018, in which leading dermatologists commented on the diagnosis and treatment of xerosis cutis, dry skin, in a specialist journal for the first time. A water-in-oil emulsion is best suited for them, it says, in which tiny water droplets are finely distributed in an oily base. Because it has more fat than an oil-in-water preparation.
Which active ingredients should be used in these creams and lotions depends on which symptoms of dry skin are the biggest problem: urea, if the skin is primarily flaky, urea and/or dexpanthenol if it is cracked. For redness, dermatologists call Licochalcone A, which inhibits the release of certain inflammatory mediators in skin cells. For itching, use polidocanol, which has a weak local anesthetic effect. The authors attest that urea or urea has “by far the best evidence for xerosis cutis”. But here too there is another indication that the effectiveness can be increased even further in combination with lipids (here we are talking about ceramides: lipids that also occur naturally in the skin).
From my point of view, the position paper was a milestone; it was absolutely overdue for dry skin to receive recognition in science, which can trickle down to practices and to patients. Even if it is initially a cosmetic problem, it can cause itching and burning. And because it is often slightly cracked, it makes it comparatively easy for pathogens to colonize it. It is associated with inflammation in the armpits, psoriasis and neurodermatitis, according to the results of a Swiss-German study. And it reduces the quality of life – everyone who has it knows this, but scientists are now also pointing this out.
In order for your skin to change, you have to stick with it: apply cream every morning and every evening. And for a few weeks, nothing happens from one day to the next. You should also take showers as short, as infrequently and as cool as you feel comfortable. Water can wash away the precious moisture binders from the skin, especially when it’s hot and in combination with soap, which washes away the hydrolipidic film – just like dish soap washes salad dressing off your plate. And of course, alcohol also dissolves fat, so facial toners and the like are not particularly suitable for dry skin.
The good thing is: the right body lotions don’t have to be expensive. Urea – almost always under the Latin name urea, which simply sounds better – is a simple, small and cheap molecule; you can get it, for example, in Aldi’s body lotions and the own brands of many drugstores. Two percent urea is nice, ten is better. Such preparations have been shown to reduce water loss from the skin (TEWL or transepidermal water loss), and the skin surface appears slightly smoothed and relaxed. Exactly what you want.
At around this concentration, urea preparations also have an itch-relieving effect and help to remove dead skin cells. That’s why they are so suitable for the care of neurodermatitis or the so-called grater skin, which is caused by a keratinization disorder. If such a cheap product doesn’t have the desired effect, I would always go to the pharmacy. It can really be worth asking specifically about a water-in-oil lotion with ceramides. There are first-class care lines for dry skin, including those that are intended for basic care for neurodermatitis. If that’s what it says, it doesn’t need to confuse anyone; on the contrary, it speaks for the product.
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Note: The column can neither replace individual advice in the pharmacy nor the package insert or medical diagnosis and treatment.
