Skin Care during Winter

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Caring for Your Winter Skin

WebMD Live Events Transcript

The cold and wind outdoors and the dry, heated air indoors can wreak havoc on your skin. What can you do to keep your skin healthy during the winter months? Ask the dermatologists! Katie P. Rodan, MD, and Kathy A. Fields, MD, joined us on Jan. 20 to answer your questions about winter skin care.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live. Much of the country is in the grip of wintry weather. What kind of problems does that create for our skin?

RODAN:
It's dry, itchy, cracked skin, especially on the legs, fingers and face. It happens because of the low relative humidity in the air and when you're outdoors it's cold, dry, and windy, which zaps the moisture from your skin. Then when you go indoors you have the heat turned on, and the indoor room temperature is also warm and dry, removing the last little bit of moisture in your skin. The answer is twofold: one, the environmental temperature outside; then inside, because of the radiant heat, the climate is dryer and hotter.

MEMBER QUESTION:
How can I keep my skin from looking like lizard skin in between showering and lotions?
I drink water, but it doesn't seem to help, I use lotion all the time... as soon as it dries my legs look just like they have never seen lotion.

FIELDS:
The first problem is the soap you may be using. Soaps are surfactants, which can strip your top hydrating lipids on the skin, so you should be using a soap substitute, called moisturizing soap lotions, which come in a liquid form. These two-phase cleansers-moisturizers are excellent to use in the winter. Number two, you should apply your moisturizer immediately after the shower while your skin is damp. Apply moisturizers lavishly.

MODERATOR:
What should we be looking for in a moisturizer?

FIELDS:
There are many moisturizers today: soy-based products, oatmeal-based products, theramide-based products, hydroxy lactic acid, alphahydroxic or even urea-based products. There's a huge list of possibilities that when you apply immediately after a shower, hydrate your skin and lock moisture in the barrier of the skin which has been stripped by the shower, the natural skin barrier.

RODAN:
The question also refers to drinking a lot of water to hydrate your skin. This is a common myth, that you can hydrate your skin by taking in copious amounts of water. We're not like a plant that wilts and then sucks up with a little extra H2O. You want to drink adequate water so you're not thirsty and your thirst mechanism will be your most important guide. If you're severely dehydrated it may show in your skin, however, this is quite rare. The bottom line is drink enough water to satisfy the thirst mechanism but don't overdo it in the hopes of reversing your dry skin.

MEMBER QUESTION:
Can I use a moisturizer that contains hyaluronic acid on top of Retin-A?

FIELDS:
Hyaluronic acids can be used over Retin-A. It's a humectant that draws moisture from the air and helps lock in moisture on the skin. They are generally light weight and not heavy and may need reapplication for sufficient moisture.

RODAN:
Just one comment about the use of Retin-A during the wintertime. Retin-A and retinol may be slightly drying and irritating for the skin, particularly in the wintertime. Therefore, if you find that your skin is getting so dry and no moisturizer seems to help, back off on your use of retinol or Retin-A. For example, instead of using it nightly, you may want to use it only every other night, and use a heavier night cream moisturizing agent in the alternate nights.

"The most important thing to remember is to keep your hands out of water as much as possible. When you're doing dishes or housework, wear gloves."

MEMBER QUESTION:
What about using antibiotic ointments on dry cracked skin from hand washings?

FIELDS:
Antibiotic ointment may be more than necessary. Just petrolam-based products will be very effective at locking in moisture. Minimize washing as much as possible. Reapply barrier creams. Recommendations for possible hand moisturizers include Aquafor ointment, silicone-based products like Gloves in a Bottle, which restore the barrier without leaving your hands very greasy, and urea-based products with reapplication after hand washing. When you wash your hands, try to minimize hand contact, washing only the fingertips and drying the hands thoroughly after washing.

Dry Skin Quiz: Test Your Dry Skin IQ

RODAN:
This is a very common concern among my patients, particularly in the winter or in patients who in the past have suffered from eczema. My recommendations are similar to Dr. Fields, however I tell them to use Cetaphil, a non-soap based cleanser you can apply to your hands, rub in and towel dry off. Note that I did not say rinse off. That will clean your hands as well as soap and water and won't be drying.

If you have fissures, little cracks in the skin which are painful, believe it or not, you can apply Superglue to those cracks. That will seal off the fissure and prevent it from getting worse, allowing it to heal under the glue. Then liberally apply moisturizers several times during the day. You may want to apply a lighter weight moisturizer so it doesn't feel greasy. At night use the heavier moisturizers like Aquafor or Vaseline Intensive Care Night Repair, or another favorite of mine, Roc hand moisturizer.

Finally, the most important thing to remember is to keep your hands out of water as much as possible. When you're doing dishes or housework, wear gloves. The types of gloves I tell my patients to buy are two pairs of gloves. First a cotton glove that goes next to the skin and a plastic glove that goes on top. You can find those at most drugstores. Hand protection is key.

MEMBER QUESTION:
What about Vaseline on the hands at night and wearing cotton gloves? Does that work? I heard an actress say she did that to keep her hands looking good.

RODAN:
Yes, that can be helpful. Even better are the silicone lined gloves you can find in department stores or in some catalogs that are meant to be worn at night with a moisturizer underneath. The reason this works is because of the principle of occlusion. Occlusion is an old-time dermatologic secret. By covering the skin after a moisturizer or medicated cream is applied, the occlusion will increase the penetration.

MEMBER QUESTION:
My lips are so chapped from all the cold weather. My mother keeps telling me to use Vaseline, but it's so thick and tastes awful. What do you recommend for lips?

FIELDS:
Lips often dry out because of open-mouth breathing during the night, and by air rushing across your lips so the lips literally dry out. During the day people often lick their lips or chew on the dead skin which further exacerbates the problem. The remedy is to breathe through your nose and put a heavy layer of Vaseline type product on your lip while you sleep to keep that delicate skin hydrated. During the day there are many lip creams. There's a product called Bag Balm and Burt's Bees, and a product by Philosophy called Kiss Me.

MEMBER QUESTION:
I don't use a moisturizer because my skin does not seem to need it. It is hardly ever dry and never tight after I wash it. Is it bad to never use a moisturizer if I get SPF from my makeup?

RODAN:
Absolutely not. If your skin is oily, adding more moisture and oil is like taking coals to Newcastle. I advise my patients with oily complexions, adding more moisture is going to add to the shine all day. For some people the eyelid skin is dry or wrinkly. You can apply an eye cream to that area only to relieve the problem and improve the appearance of your skin. However, just because your face is oily the rest of your skin may be dry, so don't neglect your elbows, shins, your hands, in applying moisturizer.

MEMBER QUESTION:
We are going skiing. Any tips for protecting my face while on the slopes? I have naturally oily skin and usually don't need to worry much about dry skin.

FIELDS:
When you are skiing you are faced with low humidity, direct wind, which further tortures your skin, and freezing cold. So you're a setup for problems. Ideally, you should wear fleece-based protection for your entire face to both comfort the skin and protect from wind. A good layer of sunscreen on your skin is mandatory because of the further damage from UV radiation. Moisturizing with sunscreen every time you get to the lift while going up will be good to protect your skin. Use highest SPF, 30 to 50, and preferably a zinc-based or avobenzone based sunscreen. Don't forget to moisturize your lips with a sun block lip protector, as well. Goggles are also extremely important.

MEMBER QUESTION:
After skiing or sledding, my kids often come inside with what we call "wind burn" on their cheeks. Is there something soothing you recommend for that?

RODAN:
You can apply aloe-based moisturizer and that might help alleviate the problem. One important point to make is don't forget the sunscreen in the winter. Most people don't think they're receiving ultraviolet light, a big dose, when it's cold or rainy or snowy outside, but guess what? You are. So sunscreen will act as not only environmental protection against that UV-UVB light, it will also provide much needed moisturizing agents.

MEMBER QUESTION:
I was wondering about a "winter skin" problem. I have what seems to be dry and itchy skin on my upper inner thigh and on my upper inner forearms. I have been controlling it with Johnson and Johnson's Baby Cream and also applying a thin layer of Curad Liquid Bandage. It seems to help for a few days but it then recurs, looking for a "solution." I have not had this problem before this year. I'm 32 years old and have hot water baseboard heat.

FIELDS:
The rash you're describing is most likely eczema, but it is unusual in its presentation. There may be an irritant reaction to perhaps fabric such as pantyhose that are making these areas more susceptible to barrier breakdown, rash and itch. Over the counter hydrocortisone cream, 1 percent applied once a day for a week followed by moisturizer may rapidly improve this condition. If you are not better, see your local dermatologist.

MEMBER QUESTION:
We just got a whole-house humidifier. Will this help our skin (and our dog's coat)?

RODAN:
You bet. I recommend that all the time to my patients, because adding moisture, increasing the humidity of your environment will keep your skin moister. Don't forget the other measures we've described in this chat. For example, limiting your frequency of bathing and hand washing, applying moisturizer after cleansing or showering to damp skin; using a heavier moisturizer while you sleep at night and a lighter one which will be more comfortable, by day.

MEMBER QUESTION:
Will a vaporizer do the same as a humidifier. Will it help if only used at night?

FIELDS:
In general, when you put moisture into the air, you will be helping your skin, and it's a good idea. Just make sure the vaporizer is cleaned regularly so that bacteria do not build up in the unit.

MEMBER QUESTION:
Are there specific ingredients we should look for in a winter sunscreen?

Dry Skin Quiz: Test Your Dry Skin IQ

RODAN:
Yes. The most important sunscreen agents are zinc oxide or benzone, also known as parsol, 1789. Either of these agents block out UVA light. UVA light is the aging ray, and is present 365 days a year from sunup to sundown, 100 times greater in amount than UVB. All sunscreens provide UVB protection, as reflected by the SPF number. In selecting a sunscreen, I advise my patients to not only pay attention to the SPF number, 15 and above, but also look on the back of the bottle where the ingredient list is and make sure under active ingredients, your product contains either zinc oxide or avobenzone.

Many patients wonder if they need to use a moisturizer in addition to their sunscreen. For people with normal to oily skin, a moisturizer is unnecessary, because sunscreens, by themselves, will provide significant moisture. Finally, don't forget to reapply your sunscreen often if you are outdoors. A single application in the morning will not last throughout the day.

MEMBER QUESTION:
Our 6 month old son has had, since 3 months old, a large area of dry skin on his forehead. His pediatrician attributed it only to "winter skin" and said it was not serious. However, over the past few weeks it has begun spreading to his cheeks and has become very itchy and he is very uncomfortable. We've made an appointment for a dermatologist next week, but in the meantime, can you recommend anything to make him more comfortable? OTC eczema creams don't seem to help. Thank you.

FIELDS:
Basically, childhood eczema can look like many different things. The environment has a huge impact on delicate baby skin. Consider a short course of over-the-counter hydrocortisone cream, 1% to the affected areas only, twice a day for 3 to 5 days until you see your doctor. Long term use of a steroid is not indicated. We also advocate the use of Cetaphil lotion, for hydration, over the medicine. Use lavishly.

MEMBER QUESTION:
I have a 7-month-old baby girl who seems to have dry raised circles on different parts of her body. I've seen them on her belly, arms and legs. The doctor said to mix hand cream and hydrocortisone cream together and put it on the spots. It doesn't seem to be doing anything to stop the patches. Any advice? It's mostly on her arms and belly. Is it OK to put hydrocortisone on her baby skin on her face?

RODAN:
We can't diagnose a skin condition without seeing the patient. What you may be describing is eczema, also known as atopic dermatitis. This condition affects approximately 20% of children in the first year of life. I tell my patients it is the itch that rashes, not the rash that itches. Parents may not realize that their child is scratching at their skin because this often occurs at night. The itching may be relieved with Benadryl, an over-the-counter antihistamine taken orally, not topically, mild topical steroid, or newer creams, such as Elidel or Protopic.

In addition, limited bathing is critical. In America, we have a hygiene fetish and believe we have to give our babies nice long baths every night. Water alone is very drying for the skin. When the skin is dry it's going to itch more, which is going to start this cycle of itching, scratching and eczema. Therefore, in place of daily bathing, use Cetaphil, soap free cleanser, over the entire body, wipe it off and wash key areas like the diaper area, as needed. You can do this every other night. As always, if the rash is not responding quickly, within a matter of days, please see your dermatologist, as many other conditions, including ringworm and psoriasis, may mimic eczema.

MEMBER QUESTION:
In the winter my skin gets tight and itchy all over my body. My heels crack as well. What can I do to stop the itch on my arms, legs, and torso? I only shower every other day and use warm, not hot, water. I use body butter after I shower. It helps with the skin somewhat but my heels are still awful. And do you have any special suggestions for my feet and heels?

FIELDS:
Winter itch is caused by the release of the chemical histamine into dry skin. This histamine release can really be highly itchy and highly disturbing. Ideally, continue your short lukewarm showers, moisturize with either a urea-based moisturizer following the shower and repeat, particularly on your heels at night. Vanimide is a particular favorite cream, and consider taking Benadryl, if you're an adult, 25 milligrams at night to stop the histamine reaction. Benadryl may make you sleep well at night, but may cause drowsiness by day. Topical antihistamine creams after the morning shower will also be helpful.

MEMBER QUESTION:
Can you give some suggestions for men and shaving? My poor husband's face gets so dry in the winter and shaving everyday seems to make it worse.

RODAN:
Shaving when the skin is very warm and moist will soften the hair; so for starters, he may want to try shaving in the shower. Using high-glide shaving products, like Edge, can also be helpful. Changing the blade more frequently will reduce friction against the skin. If your husband has curly beard hair, releasing the curled hair from the skin --gently using tweezers -- prior to shaving will help stop the shaving bumps. Following shaving, applying a moisturizer with sunscreen will improve the dryness. Red, tender shaving bumps are a different issue. These can be treated by a dermatologist who may recommend a combination of a topical antibiotic and/or cortisone cream.

MEMBER QUESTION:
I have heard that you must apply moisturizer about 3 minutes after you get out of the shower or washing your face because it penetrates more deeply. Is this true?

FIELDS:
Yes, that's correct. While the skin is wet the moisturizer can penetrate faster and more completely. That's the best time to apply a moisturizer.

MEMBER QUESTION:
What's the best treatment for chapped skin around the mouth, not necessarily on the lips? Would you use the same treatment for an adult as a toddler?

FIELDS:
There is a common condition with cracking of the corners of the lips. It's called perleche. The nighttime remedy is zinc oxide ointment applied to the corners of the mouth which seals in moisture and acts as an anti-yeast agent and anti-inflammatory agent as well. It can be used on children or adults. In the daytime, you must continue with petrolatum-based or dimethacone-based products hourly to seal in the moisture and stop the continued water loss.

"Look for moisturizers that are either labeled oil-free or noncomedogenic. These labels indicate the product will not clog pores, causing acne flares."

Dry Skin Quiz: Test Your Dry Skin IQ

MEMBER QUESTION:
Is dabbing on glycerin and rosewater okay for my winter face, even if I'm acne prone? Will that cause more breakouts?

RODAN:
If the glycerin based product is hydrating enough, go for it. It should not break you out. You bring up a very excellent point. Acne-prone patients often have dry skin and are concerned about using a moisturizer that will exacerbate their breakouts. My suggestion is to look for moisturizers that are either labeled oil-free or noncomedogenic. These labels indicate the product will not clog pores, causing acne flares. If you're on prescription medicine, your doctor may need to modify it slightly; instead of a modern dry-based medicine, replacing it with a lotion-based medicine. That may help, as well.

MODERATOR:
We are almost out of time. Before we wrap things up for today, do you have any final words for us?

FIELDS:
Thank you for allowing us to help you with your winter skin problems. We look forward to other opportunities on the wonderful topic of skin to help you. Remember to use soap substitute, lavishly moisturize and wear sunscreen even in the winter and your skin can last a lifetime.

MODERATOR:
Our thanks to Katie P. Rodan, MD, and Kathy A. Fields, MD, for joining us today. And thanks to you, members for your great questions. I'm sorry we couldn't get to all of them. For more discussion on this topic, be sure to visit the WebMD message boards to ask questions of our online health professionals and to share questions, comments, and support with other WebMD members.



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Reviewed on 2/1/2005 10:19:30 PM

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