There are numerous benefits of moisturisers and in my opinion as a Dermatologist most people do need them on a daily basis, some more than others. To understand what a moisturiser is and what it does for our skin is important. A well hydrated skin is a healthy skin which helps to keep the skin barrier functioning in an optimal way.
“There are numerous benefits of moisturisers and in my opinion as a Dermatologist most people do need them on a daily basis”
We often talk about dry, dehydrated skin when we think of using a moisturiser. Dry skin often lacks epidermal lipids especially in older skins and transepidermal water loss leads to dehydration. Not all moisturisers are created equal and it is important to find one that is best suited to your skin type and skin concern.
There are various skin diseases that benefit from moisturisers. The Icythyoses are a group of genetic skin diseases which occur when there is a defect in the production of the protein filaggrin in the epidermis. This results in a very dry skin that presents at birth and unfortunately persists for a whole lifetime. It is important that these people wash with milder soaps or cleansers and that they use a moisturiser on a daily basis.
Approximately 1-in-5 children in the Western world will develop atopic eczema. This can be a very debilitating condition for the patient and for their parents who care for them. The underlying problem is a defective epidermal barrier function and therefore the regular use of an appropriate moisturiser is absolutely essential for the treatment of this condition. Clinical studies have shown that regular use of moisturisers in patients with atopic eczema, reduces the amount of topical cortisone cream necessary to treat the skin.
“Approximately 1-in-5 children in the Western world will develop atopic eczema”
As we get older and our skins get drier and thinner a very common type of eczema is what we call an asteatotic eczema or dry eczema. The treatment of this condition is again to only cleanse with mild soaps and cleansers but it is also important to use an appropriate moisturiser for a very dry skin.
Most women wear some sort of make-up which they remove in the evenings with a cleanser. Depending on the cleanser used this may result in dryness and irritation of the skin and to counteract this a moisturiser is recommended. Most people will concede, with the exception of those with an oily skin, that they could not skip using a moisturiser after cleansing as it often leaves the skin squeaky clean but dry.
Using the correct cleanser is vitally important because no matter how good or sophisticated your moisturiser is, if your cleanser is not the correct formulation for your skin type you will not get the optimum effects from your moisturiser. I often hear my patients say that their moisturiser is not hydrating enough and then find that their cleanser is too harsh or not suited to their skin type. By changing to the correct cleanser they usually find that their moisturiser is in fact providing more than enough hydration and moisture.
There are some who believe we do not need moisturisers at all and perhaps in the days of the cavemen when there was no make-up or environmental challenges such as pollution and other factors affecting the skin, not using a moisturiser might have been acceptable but this is certainly not true in our modern world. Our skin barrier is under constant bombardment and we need to maintain it and the best way is to use a moisturiser formulated for our skin type and concerns.
“Our skin barrier is under constant bombardment and we need to maintain it and the best way is to use a moisturiser formulated for our skin type and concerns”
In post-menopausal women, oestrogen declines to very low levels and the skin is the casualty as it loses its ability to keep hydration levels comfortable. It also loses natural lipids, (ceramides, fatty acids and cholesterol) which all help to maintain a healthy skin barrier function in a younger skin.
When we are young the pH of the skin is more acidic and this acid mantle protects the skin. It is easier to keep the microbiome of the skin healthy but as oestrogen and lipids begin their natural descent the skin’s pH becomes more alkaline which weakens the skin barrier function causing dehydration and sensitivity which leads to inflammation. This can cause great discomfort and accelerated skin ageing.
“When we are young the pH of the skin is more acidic and this acid mantle protects the skin”
An ideal moisturiser usually contains a mix of emollients, occlusives and humectants – together these hydrate, prevent water loss and dehydration and they protect against dryness by helping to restore lipids and other essential components in a healthy skin.
Emollients are mainly lipids and oils which hydrate and help to keep the skin soft, smooth and supple. They include free-fatty acids, cholesterol, ceramides, coconut oil, canola oil, sunflower seed oil and shea butter and are popular with people who have a more drier skin.
Occlusives reduce transepidermal water loss by creating a hydrophobic barrier over the skin but they are often greasy. People with an oily skin would not be able to use these as they would be too fatty and comedogenic causing further breakouts. Occlusives would include petrolatum, mineral oil and silicones. Lanolin is still used as an occlusive in many moisturisers but more people are becoming allergic to lanolin or wool fat so I would recommend avoiding moistursiers that contain lanolin.
Humectants are able to attract water from external environments especially in humid conditions and they also enhance water absorption from the dermis into the epidermis. Some examples of humectants include glycerol, urea, alpha hydroxyl acids, propylene glycol and hyaluronic acid.
In recent years some of the heavier formulations in moisturisers have been replaced with silicones that are more easily absorbed, providing a more luxurious feel and they are able to penetrate deeper into the skin and not ‘sit’ on the outer layer. With more sophisticated technology many modern moisturisers contain micro-encapsulated active ingredients that target very specific skin concerns.
Moisturisers used on the face should be non-comedogenic and it is best to use the appropriate moisturiser for the person’s age, sex, skin type and body location i.e. one can use a thick, occlusive moisturiser with a higher concentration of urea for cracked heels and a lighter lotion formulation for men with hairy legs and trunk.
Skin changes as we age and it is important to get the correct advice on what moisturiser you should use as your skin progresses from the teens through to the twilight years.
To summarise, a good moisturiser should be effective in reducing transepidermal water loss to produce a smooth and supple skin, restore the normal physiological lipids in the correct ratio and maintain the correct skin pH 3.5 – 4.2. They should also preferably be fragrance-free, lanolin-free and SLS-free.