Treat your skin well, or it’ll simply give up.
As the previous post inferred, using harsh cleansers on a regular basis will lead to dry skin. While that doesn’t sound TOO horrible, it does have further implications, which will be addressed in this post.
Dryness from Over-Cleansing and/or Using Harsh Cleansers
As stated before, dry skin is in essence the result of not having enough water in the stratum corneum (SC). The cause may be a enyzme deficiency or something else entirely, but water is the common denominator that affects everything. Could I be more generic…?
But anyways, skin dryness has two elements to it: what you see (visual) and what you feel (tactile and sensory).
Visual Dryness–Flakiness
First the flakiness appears. Then comes the scaling, redness, and itchiness.
Typically, flaky skin is the first sign of dryness. This is caused by the rapid swelling and shrinking that was discussed in the Short-Term Effects article. This constant cycle of gross bloating followed by swift desiccation increases the amount of individual corneocytes that have broken away from the lipid matrix, which of course can be compromised by surfactants. This loss in cohesiveness leads to flaky skin. If the condition worsen, the flaking will become more evident and lead to scaling, where cracks in the skin will appear. This is when the more tactile and sensory characteristics of dry skin become evident.
Tactile and Sensory Dryness–Scaling, Brittleness, and Cracking
As water becomes less and less able to remain in the SC, the skin will begin to feel rougher, more jagged, and may even rip from tensile force. The skin’s ability to repair itself will also become more comprised; the lag-time between the dip in water content from the initial cleanse (see picture) and when the skin is back to a more normal state, will continue to increase until the dehydrated state becomes longer than the normal state. This happens because the essential enzymes of the SC, such as those responsible for desquamation (exfoliation), depend on the presence of water in order to function. Lamellar granules may extrude them, but water activates them.
The Effects of pH on the Stratum Corneum
Thus far, I have not really mentioned the effect that pH has on the skin. This is because, while the pH of alkaline (true) soaps are damaging to the skin, when used occasionally, no negative side effects will manifest. This is because the SC has an inherent buffering system that is somewhat resistant to pH change; after all the SC has its own pH right?
The pH of the SC is regulated by the formation of free fatty acids from structures such as phosphilipids and ceramides, and the accumulation of hydrogen atoms from the sodium-proton pumps, among other mechanisms. So, its basically the lipid matrix of the SC that is responsible for its pH, right? And what did we learn in the previous post? We learned that surfactants reduce and leech away the lipids of the SC via solubilization and insertion/intercalation. If this happens only on occasion, the skin will retain its full capacity to repair itself. But if done on a regular basis, the “lag-time” will increase more and more, which will lead to a higher pH of the SC in general, since there’s less and less lipid content in the matrix.
The skin knows how to repair itself. But with an increased pH, a reduction of both lipid and protein content, the lag time (the triangular dip) will grow longer and longer.
And what will a higher pH of the skin on a more permanent basis allow for? Well for starters it will:
- Reduce the skin’s ability to exfoliate, which will lead to even MORE flaky skin, as demonstrated by the above-mentioned link;
- Increase the susceptibility of the skin to bacterial proliferation;
- And ultimately affect the LIVING layers of the epidermis that depend on the SC’s ability to inhibit both external exposure and internal water loss.
Increased Sensitivity, Erythema, and Pruritus
When the damage gets to this stage, the skin will respond with increased sensitivity… to everything. That includes cleansers, moisturizers, the SUN, and even artificial lighting. These responses manifest as erythema (redness) and/or pruritus (itchiness).
Erythema
Interleukin 1α is one of the inflammatory cytokines responsible for activating NF-κB, the main conduit of general inflammation in the skin
Redness typically occurs when some agent–including the surfactants themselves, penetrate down into the epidermis and dermis via insertion and elicit some sort of inflammatory response from the skin. Typically, the skin will generate cytokines as the inflammatory response, which can lead to increased free radical damage, and the like.
Pruritus
Itchiness is the body’s response to some foreign substance. Usually, the skin doesn’t have too many of these types of responses, since a healthy SC will keep most foreign objects from penetrating that deeply. That’s not to say that certain compounds like essential oils, fragrances, and preservatives don’t have a natural affinity to do so. However, a compromised SC will increase the rate and intensity of these reactions, which can be allergic and/or delayed hypersensitive types.
Worst of all is allowing some kind of viral, bacterial, fungal, etc… organism to penetrate from the skin into the body. I know, I know we’re getting into the realm of science fiction here because really, who’s going to let it get THAT bad? But given that the average person touches his/her face several hundred to even thousands of times a day, it’s a risk.
In Reality
Will anyone allow things to get that bad? Probably not. And even using a “bad” cleanser with a mediocre moisturizer will significantly mitigate any damage. That being said, this IS the Ideal Skin Care Routine series. Stay tuned for the final part of the Cleansers series!
The Triple Helixian 
There’s nothing quite as humbling as looking at dry skin on the backs of my hands. Oy.
I’ve really enjoyed this series. Thanks for all the hard work!
Posted by Amy | October 11, 2014, 7:10 amWelcome! Thanks for reading it all.
Posted by John | October 12, 2014, 12:54 pmI felt like this was your first post in the new series that felt less academic and more matter of fact. Just an observation. Perhaps because this topic seems so relevant to me… I’ve thought about it before, but this organized some of the information I’d heard in a framework that made more sense for me to understand the big picture. It’s really quite interesting.
So mentioning that the cause of dry skin may be an enzyme deficiency is speculation or is there some enzyme that’s been shown to improve dry skin?
I remember a time when I used to have more seemingly oily skin, as well as a time that I may not have had a skincare routine at all. I’m glad I’ve graduated from those days of feeling confused and in the dark about skincare, but I still have my off moments and times. And I’m concerned that I’m missing something. I’m going through my 2nd flare-up since April or May of 2013 and both times were in the Fall (last time was a few months later I think last year). I think I get too experimental and get in trouble when I stray from what works (what my skin likes best) and need to get my routine to be more consistent. I also want to use pH strips to test my cleansers to rule out the alkaline ones.
I’m my most red and itchy that I’ve been in a long time, mainly because I’m trying a new prescription acne formula and after a month my conclusion is that I need something gentler. But I was curious to try it especially since for the first time in many months (I can’t remember when exactly), acne cysts started coming back – first on my right temple, then I think my left side of my chin, then the back of my right ear, then below the right side of my mouth. I’m wondering if I’m not washing my hair enough when I’m feeling more run down health-wise and bacteria from my long hair is absorbing into my skin. Glad I don’t have bangs.
This is the new prescription acne formula I’ve been trying. Some purging has been happening, but the sensitivity I have to it is too much. I tried Retin-A many years ago and remember being sensitive, especially on my nose, but don’t think I had a good skincare routine then. So it was worth trying again making sure I was more moisturized, but regardless, my skin is much more sensitive than before using this new product even with giving my skin breaks from this prescription formula until sensitivity is more tolerable.
Active Ingredients:
Tretinoin (0.018%), Clindamycin (1%), Azealic Acid (8%)
Inactive Ingredients:
Water, Vegetable Glycerin, Stearic Acid, Myristyl Myristate, Cetearyl Alcohol, Ceteareth-20, Glyceryl Stearate, Jojoba Seed Oil, Soybean Oil, Cetyl Alcohol, Carbomer, Shea Butter, Calendula Flower Oil, Passion Fruit Seed Oil, Rice Bran Oil, Acai Palm Fruit Oil, Phenoxyethanol, Ethylhexylglycerin.
Apparently from CosDNA, two of these ingredients additionally may be concerning: myristyl myristate gets a 5 out of 5 as a potential acne trigger, and soybean oil gets a 3 out of 5 as a potential acne trigger. So perhaps that’s not helping either.
What you wrote here is alarming:
“Worst of all is allowing some kind of viral, bacterial, fungal, etc… organism to penetrate from the skin into the body. I know, I know we’re getting into the realm of science fiction here because really, who’s going to let it get THAT bad? But given that the average person touches his/her face several hundred to even thousands of times a day, it’s a risk.”
How would you know if your skin was at risk for getting that bad? If you aren’t even using “bad” cleanser and a mediocre moisturizer? Are you planning on addressing this topic more in future posts?
I wonder if the opposite can be true too, that internal physical conditions like bacterial infections, inflammation, etc can drastically affect acne severity (ramping up in number and more prone to cysts), redness (even triggering rosacea or worsening) and inflammation. I really think that’s been true for me.
I suppose the most basic take away seems to me is to make sure we are using a cleanser and a moisturizer. But for those of us already in the worst case scenario with skin going haywire and a possible damaged barrier function (I’m guessing this implies a higher pH of the skin on a more permanent basis) causing super sensitivity needing Skin Rehab… it would be nice to know recommendations of what we can do too. I’m thinking your post suggests that while someone with decent skin can get away with a “bad” cleanser and a mediocre moisturizer, someone with inherent higher facial skin pH and/or body skin pH would do best if they want to improve their condition to avoid alkaline cleansers. And additionally, to utilize exfoliating acids (without alcohol or other sensitizing ingredients) and a proper repairing/restorative moisturizer. I’m sure there’s a lot more to take into account such as what to look for in a moisturizer, but I’m sure you have much to cover on that topic in the future and I very much look forward to it 🙂 Thanks so much for continuing this series!
Posted by C | September 26, 2014, 5:58 amGlad to hear you like this post. Okay, to address your questions:
1. There are in fact enzymes in the skin that require water in order to properly function. So it’s not speculation.
2. As for you acne, there can be so many causes. I’m not sure if you told me more about your skin, but I only speculate. Since it seems that you are quite sensitive to a relatively low amount of tretinoin, I would venture to say that you actually have some form of rosacea. Flare ups can be caused by weather, stress, diet, etc.. Have you noticed anything out of the norm during those times of flare ups?
3. As for the pore-clogging potential of those two ingredients you mentioned, while there is some concern, I doubt they are the primary cause of your breakouts, since they are likely present at concentrations less than 5%.
4. Like I said in the original article, the alarming sentence that you emphasized, is highly unlikely to happen. The skin is remarkable resilient, except in the case of some kind of genetic defect or massive environment assault. As for external manifestations of some internal condition, that can certainly be a possibility; though, they tend to not manifest in the form of breakouts, especially when they are so few in number. But like I said before, were you experiencing anything out of the ordinary during your flare ups?
5. Yes, a higher pH’d skin is indicative of an impaired barrier function. As for skin rehab, the best thing to do is cut everything out of your routine, except the most basic (but well-formulated) moisturizer and cleanser.
Does that make sense?
Posted by John | October 10, 2014, 10:05 pmHello John pls I wanted to ask what are the causes of recurring acne? On upper part of the cheeks
Posted by benaziralbashir | September 24, 2014, 9:03 amThere are SO many causes. Tell me a little bit about your skin and your skin care routine.
Posted by John | September 28, 2014, 7:52 pmmy skin Is combination with balckheads and it’s oily around my forehead chin and nose inflamed acne I stared using tretinoin almost a year and half ago. My routine was neutrogena salicylic acid in the morning and tretinoin at night my skin was clear. But my spots didn’t fade. I bought the retin a 0.025 then neutrogena acne stress control and Mary Kay even complexion essence. What I noticed is that before I could use my tretinoin nightly but now the retin a I can’t if I use nightly irritation occurs. My spots have faded my.complexion seems more even. I use the Aveeno clear complexion cleansing bar then my sa in the morning then Timewise even complexion essence then Mary Kay age fighting mosituriser. In tho night I cleanse with the Aveeno use Timewise complexion essence and age fighting I use retin a every other night but I realise when I was using the other tretinoin nightly I rarely broke out. Now that I skip a day using retin a I tend to break out. I notice I break out on the same area quite often at the moment I have four painful acne on my cheeks my skin itches this ddnt happen before, pls John I need your help urgently
Posted by benaziralbashir | September 29, 2014, 1:48 pmIt sounds like using tretinoin every night helps keep your acne at bay. Why did you stop using it every night? Try using the Mary Kay Essence after the tretinoin.
Also, try a more gentle liquid soap instead of the Aveeno Bar Soap.
Keep me updated!
Posted by John | October 10, 2014, 10:13 pm