Care of the skin is very important, not only for its appearance, but also to prevent certain problems.
Cleansing: Hygiene is one of the most important interventions for maintaining one’s health and well being. Cleansing is one of the routines followed to maintain hygiene. Cleansing is meant to remove the dirt, sebum, dead cells, bacteria etc. However, the act of cleansing is being promoted recently as a means of relaxation and a way to improve the skin health and appearance. These days, a wide variety of cleansing agents are available, made of different colours, scents and a variety of ingredients supposed to provide benefits to the skin.
Relatively young people with normal skin can use the cleansing agents of their choice. However, people with atopic predisposition, elderly, those suffering from acne, eczema (dermatitis) and those with sensitive skin should choose the cleansing agents that are compatible with the condition of the skin. A dermatologist may help in choosing cleansers.
Cleansing agents are of three major categories.
- Synthetic detergents (Syndet bars)
- Lipid free cleansing agents
Soaps are alkali salts of fatty acids obtained from saponification of fatty acids derived from coconut or tallow (sodium cocoate, sodium talloate). They have an alkaline pH (>7). The irritancy potential of the soap depends upon the fatty acids used. Coconut derived fatty acids are believed to be more irritant to the skin. By adding certain additives, a variety of subsets of soaps are made:
- Transparent soaps contain humectant glycerin that counters the drying effect of soap
- Superfatted soaps contain excess of fatty materials like triglycerides, lanolin, paraffin, stearic acid or mineral oil. These are suitable for dry skin. These can cause pimples when used on the face, particularly in adolescence.
- Deodorant soaps or antibacterial soaps contain antibacterial agents like triclosan, triclocarbon or carbanilade. Use of these soaps should be restricted to certain areas of the body like the arm pits, toe web spaces where the growth of bacteria can result in bad odour.
- Anti acne soaps contain chemicals like sulfur, resorcinol or salicylic acid which have keratolytic properties. These should be used judiciously
Synthetic detergents: In contrast to the soaps, synthetic detergents’ structure often is tailored to impart specific properties to the molecules. Synthetic detergents are made up of surfactants which fall into four categories based on the charges.
- Cationic (positively charged) surfactants
- Anionic (negatively charged) surfactants
- Amphoteric (both positively and negatively charged) surfactants
- Non-ionic (uncharged) surfactants
Anionic surfactants are most commonly used in the cleansing agents. Among this group, sodium lauryl sulfate is the most commonly used surfactant and has the greatest irritancy potential. On the other hand, salts of isethionate such as cocoyl isethionate have excellent skin compatibility and are good detergents. Cationic surfactants such as acrylate polymers or non ionic surfactants like propylene glycol are combined with anionic surfactants to reduce the irritancy. Other surfactants that have got good skin compatibility are alkyl ether sulfate, alkyl glyceryl ether sulfonates (anionic) and betaines (amphoterics). Betaines, such as cocamido propyl betaine, are used in combination with anionic surfactants to reduce the irritancy of the anionics. However, cocamido propyl betaine can cause contact allergy in some individuals. Knowing the type of surfactant used in the cleansing agent is important, as it will help to know the offending agent in case of any adverse reactions.
Lipid free cleansing agents: These lotions contain fatty alcohols and they are designed for people with sensitive or dry skin. They also contain emollients and humectants (propylene glycol) to counter the irritancy or drying potential of the surfactant used.
Individuals with atopic dermatitis, eczemas, aged skin, sensitive skin etc., should follow the following precautions while cleansing:
- Use luke warm water for bathing; avoid long bath
- Use as minimal cleansing agent as possible
- Use a mild cleanser
The mildness of a cleansing agent depends upon:
The pH of the soap: Though it is widely debated, it is believed that maintaining the pH between 4 and 6.5 prevents the overgrowth of certain micro-organisms on the skin.
Surfactant used: Combination of anionic surfactants with acrylate polymers and/or propylene glycol reduces the irritancy potential of anionic surfactants.
Skin cleanser residue: The agents that remain on the skin for longer length of time have greater irritancy potential. Lipid free cleansing lotions are associated with less residue.
Moisturizing: Skin care products like moisturizers can be used regularly on the body immediately after bath and it is a must after the age of 30 years and in those individuals with dry skin. [See moisturizers]
Clothing: Clothing should be comfortable and soothing to the skin. Woolen and rough clothing can precipitate itching and dermatitis in persons with dry skin. Tight clothing can precipitate boils/acne over the upper back, upper arms and buttocks.
Facial skin should be handled carefully after puberty. Those with a tendency for pimples should not use oily cosmetics. They should cleanse the face with proper cleansers. Facials should be avoided as it can precipitate burst of new pimples. Compacts and foundations that contain waxes should be avoided, on the other hand loose powders should be used. Use of turmeric and sandal can cause extreme dryness of the skin that can change the look and feel of the skin.
- Do not use soaps that are too harsh
- Do not wash the hands frequently with soap
- Wipe your hands dry immediately after hand wash and in between the work
- Moisturize your hand skin as frequently as possible
- Do not use plain rubber gloves; use cotton-lined gloves instead
- Do not use your finger nails to open the lids or scrape the dirt. Once you create a space between the nail and nail-bed, you will be inviting infection that can make your nails and nail folds look ugly.
- Do not cut the nails too short, see that the nail bed is covered
- Do not destroy the cuticle during manicure and pedicure
- Regular use of nail polishes and removers can remove the moisture content of nails and can make them brittle.
Hair cleansing should be done 2-3 times a week
Shampoo should be used in place of bath soap. Shampoo should be selected based on the type of hair
Excessive oiling of the scalp can precipitate acne after puberty and worsen dandruff. Oiling of scalp should be done 1-2 hours before hair wash. If oil has to be kept for longer duration, it should be applied only to the hair and not to the scalp. Oiling only conditions the hair and will not in anyway increase the number of hairs. Scented and medicated oils do not have any extra benefits over the ordinary oils.
- Massage of the scalp improves the blood circulation and may increase the rate of growth. But if done vigorously, it can cause boils.
- Minimize trauma while shampooing, drying, combing, brushing and styling
- Hair should not be combed when wet; the hair shafts are prone to fracture due to increased elasticity when wet. Detangle with fingers and wide toothed comb.
- Hair drying should be natural. If a dryer is used, it should be held at least 6” away and the lowest heat setting should be used
- Minimize chemical treatment of hair