Skin’S EnEmy: irritation and  inflammation

 

 

it HurtS EvEryonE

I started my career as a cosmetics consumer advocate by warning women about the dam- age being done to their skin by using irritating skin-care ingredients that trigger chronic inflammation when used day in and day out. Over the years my fears about irritation and the resulting inflammation it causes have been reconfirmed over and over by numerous scientific studies. Indeed, chronic irritation and the inflammation that results are a bigger problem for the skin than even I had suspected. Irritation immediately causes inflammation whether you can see it or not, and just as quickly can cause an abrupt breakout response. Or it can cause redness, flaky skin (which can clog pores), or rashes, and it can even cause capillaries to surface on the face.

Chronic and even acute irritation and inflammation can destroy the skin’s integrity by breaking down the skin’s protective barrier, and that, over time, damages the skin’s collagen and elastin components. Inside the skin, inflammation impairs the skin’s immune and healing responses. Additionally, breaking down the skin’s protective barrier can allow the introduction of bacteria, thus raising the risk of more breakouts. Any way you look at it, irritating the skin in any manner is almost always not a good idea, and especially not when it happens every day with sun exposure or the skin-care products we use.

(Sources: Inflammation Research, December 2008, pages 558–563; Skin Pharmacology and Physiology, June 2008, pages 124–135 and November–December 2000, pages 358–371; Journal of Investigative Dermatology, April 2008, pages 15–19; Journal of Cosmetic Dermatol- ogy, March 2008, pages 78–82; Mechanisms of Ageing and Development, January 2007, pages 92–105; and British Journal of Dermatology, December 2005, pages S13–S22.)

 

inflamm-aging

I wish I had invented that term but I came across it in a research journal I was reading (Source: Rejuvenation Research, Fall 2006, pages 402–407). Much of the research on “ag- ing” and wrinkling has to do with inflammation and what it does to skin. As a result of this research it is becoming clear that anything generating inflammation is bad for skin. Irrita- tion generates inflammation and that puts it into the category of things to avoid. (Sources: Skin Research and Technology, November 2001, pages 227–237; and Contact Dermatitis, November 1998, pages 231–239.)

What causes skin irritation from a skin-care perspective? Many elements are responsible for hurting skin, including hot water, cold water, sun exposure, pollution, irritating skin-

 

 

care ingredients, soaps, and drying cleansers, plus just scrubbing the skin. You may think that none of those things bothers your skin. However, it is startling to learn that even if your skin doesn’t feel or appear irritated after exposure to those things, it is still being ir- ritated and the skin breakdown is nonetheless taking place. That means if you are out in the sun, sitting in a sauna, or using a skin-care product that contains potentially irritating or sensitizing ingredients, the irritation damage is still taking place even though the skin doesn’t show it. (Sources: Journal of Biochemical and Molecular Toxicology, April 2003, pages 92–94; Skin Research and Technology, January 2003, pages 50–58; and Dermatotoxicology, edited by Hongbo Zhai and Howard I. Maibach, Seventh Edition, CRC Press, Boca Raton, FL 2007.)

We can get a clearer idea of how this underlying, hidden damage from irritating skin-care routines or products takes place by likening it to what happens to skin in response to unprotected sun exposure. Being exposed to the sun day after day from early childhood results in cumulative damage that takes place beneath the skin’s sur- face and doesn’t show itself on the face until after many years of exposure. Diet offers another good comparison. Overeating or eating foods that aren’t healthy can cause serious health problems; you don’t feel or even notice that the food is hurting you until sometime in the future, yet the damage is still taking place day in and day out.

Avoiding the obvious substances and elements that irritate skin is crucial for healthy skin. This includes not smoking, avoiding unprotected sun exposure at all costs, and not using irritating or harsh skin-care products. Not paying attention to the irritation potential of certain ingredients in skin-care products can be damaging to the health of your skin. What skin-care ingredients irritate skin? That list is presented in the next section. Keep in mind that throughout this book when I indicate something is a possible skin irritant, it means it can be irritating to everyone’s skin, even if your skin doesn’t appear to have a reaction. Some ingredients always create irritation beneath the skin’s surface and cause damage, and that is not good for anyone’s skin.

Note: Some irritating ingredients can also have positive results for skin, such as AHAs, BHA, Retin-A, Renova, sunscreen ingredients, some antioxidants, and some preservatives that keep products stabilized. All of those can be considered essential for many skin types and product formulations, yet they do pose a risk of irritation. In this case, it’s simply a tradeoff in which the positive benefits outweigh the potential negatives. On the other hand, some ingredients are not only irritating but also have no positive impact on skin, meaning they don’t help it in any way and are best avoided. Those are the ones I consistently warn about and advise you to avoid.

 

How to BE gEntlE

Being gentle to your face is one of the most important parts of any skin-care routine. Along with diligent sun protection (which is really about reducing the inflammation in skin caused by the sun), using gentle, nonirritating skin-care products is part of how you can achieve the best daily and long-term skin-care results possible—so you can have the

 

 

skin you’ve always wanted. (Sources: American Journal of Clinical Dermatology, May 2004, pages 327–337; Dermatologic Therapy, January 2004, pages 16–25; Cosmetics & Toiletries, November 2003, page 63; Global Cosmetics, February 2000, pages 46–49; and Contact

Dermatitis, February 1995, pages 83–87.)

We do many things to our skin and buy an assortment of skin-care products that can cause serious irritation. Yet it is far easier than you may think to eliminate these skin-“care” culprits. With that in mind, here is a list of typical skin-care and makeup ingredients and specific cosmetic products and tools to avoid or use cautiously. The skin can react negatively to all of the following products, procedures, and ingredients.

Irritating Skin-Care Steps and Products to Avoid

•          Overly abrasive scrubs (including many at-home microdermabrasion scrubs)

•          Astringents containing irritating ingredients

•          Toners containing irritating ingredients

•          Scrub mitts

•          Cold or hot water

•          Steaming or icing the skin

•          Facial masks containing irritating ingredients

•          Loofahs

•          Bar soaps and bar cleansers (Sources: International Journal of Dermatology, August 2002, pages 494–499; Skin Research and Technology, May 2001, pages 98–104; and

Dermatology, March 1997, pages 258–262).

The Most Common Irritating Ingredients to Avoid:

(These are of greater concern when they appear at the beginning of an ingredient list.)

•          Alcohol or sd-alcohol followed by a number (Exceptions: Ingredients like cetyl

alcohol or stearyl alcohol are standard, benign, waxlike cosmetic thickening agents and are completely nonirritating and safe to use.)

•          Camphor

•          Citrus juices and oils

•          Eucalyptus

•          Excessive fragrance

•          Menthol

•          Menthyl lactate

•          Menthoxypropanediol

•          Mint

•          Peppermint

•          Sodium lauryl sulfate

•          Arnica

•          Bergamot

•          Cinnamon

•          Clove

 

 

•          Eugenol

•          Grapefruit

•          Lavender

•          Linalool

•          Wintergreen

•          Witch hazel

•          Ylang-ylang

These ingredients are extremely common; you would be surprised how often they show

up in skin-care products for all skin types. Ingredients like camphor, menthol, mint, and alcohol are sometimes recommended because they are considered anti-itch ingredients. The theory works like this: When your skin itches, the nerve endings are sending messages begging you to scratch. If you place these irritating ingredients over the area that itches, the nerve hears the irritation message louder than it hears the itch message and interprets this as a reason to stop itching. That reasoning is fine if minor, sporadic, occasional itching is your problem. If it is not and those ingredients are present in skin-care products meant for everyday use, they introduce a constantly irritating assault to the skin, and cause dry- ness, rashes, increased oil production, redness, and breakouts. None of those side effects are attractive.

Skin doesn’t have to hurt, tingle, or be stimulated even a little to be clean. (If the skin tingles, it is being irritated, not cleaned.) The major rule for all skin types is, if a product or procedure irritates the skin, don’t use it again.

Exceptions to the rule: When you initially begin to use an AHA or BHA product or Retin-A, Renova, azelaic acid, or Differin, stinging or tingling can occur. You may need to cut back if it is more than a little tingling, or stop altogether if these symptoms persist for more than a few weeks or worsen with repeated use.

 

anti-irritantS and anti-inflammatoriES

Avoiding irritating ingredients is important for the health of your skin, but it is also help- ful to use skin-care products containing ingredients that mitigate or counter the effects of irritation on skin. Anti-irritants and anti-inflammatories are a group of ingredients known for reducing or relieving skin irritation and inflammation. Because irritation and inflamma- tion are well known to be problematic for skin, anti-irritants as well as anti-inflammatories have become popular and necessary terms and components in the cosmetics world and in most medical fields, particularly in dermatology. Many ingredients perform the function of anti-irritants or anti-inflammatories, and better ones are being discovered all the time. Interestingly enough, most antioxidants function as anti-irritants because one of the skin’s responses to free-radical damage is irritation and inflammation. These ingredients go a long way toward helping the skin deal with its daily struggle against sun exposure, pollution, skin-care routines (topical disinfectants, sunscreens, and exfoliants can be irritating to skin), and seasonal environmental extremes (Sources: Exogenous Dermatology, June 2004, pages 154–160; and Toxicology Letters, December 2003, pages 65–73).

 

 

HEat iS a ProBlEm

Because irritation is a problem for skin, anything that irritates the skin should be avoided as much as possible. Heat is one of those things that should be avoided. As good as hot water, direct steam, or dry saunas feel on the skin, they end up causing more problems for the health of the skin. For years, I have recommended washing the face with tepid water. This is because hot water burns the skin and cold water shocks it, and both leave it irritated and dry. These two temperature extremes can also injure skin cells, dehydrate the skin, and cause capillaries to surface. Extreme temperatures in any form cause problems for the skin, but heat is the more attractive alternative (most people avoid a cold shower or bath).

Dry heat is clearly dehydrating. Whether the dry heat comes from a dry sauna or an arid desert climate, it pulls water right out of the skin cell. That’s bad for any skin type, but especially for someone with dry skin.

Wet heat is a bit more deceptive. We all know how great the skin feels initially when we exit a hot shower, Jacuzzi, or sauna. It feels plump and saturated with water because the skin absolutely loves drinking up all the water it can. After even a short soak in a tub, your skin can swell and become engorged with water. When you leave a bathtub and your fingers are all thick and wrinkly, it isn’t because they are dry, but because they are distorted and swol- len with water-saturated skin cells. Because the surface layer of skin likes water so much, hot water can enter the skin, stay there, and cause a burn-like reaction. As a general rule, if water feels hot to the touch, it’s too hot for the skin, especially the face. Be very skeptical about facial treatments that involve the use of heat or washing your face with hot (or cold) water; down the line, they could cause more trouble for your skin than you want.

 

don’t SmokE

In this day and age it seems almost silly to remind people that smoking is killing them, killing their teeth, skin, lips, heart, lungs, and causing myriad other associated health complications. Don’t we all know this? I have never seen any research anywhere to the contrary. Yet people worldwide continue to smoke. It is shocking and distressing to see this behavior. Addiction or not, stopping smoking is indisputably a primary step in fighting aging and wrinkling.

Smoking is, at the very least, equal to, if not worse than the sun in the direct damage it causes to the skin’s surface. In actuality, it is probably even more insidious than sun exposure when it comes to damaging healthy skin. Not only does smoking cause serious free-radical damage and block the body’s ability to utilize oxygen, it also creates necrotic (dead) skin tissue that cannot be repaired. Even more unattractive is the breakdown of the elastic fibers of the skin (elastosis), which gives rise to yellow, irregularly thickened skin. At least sun provides some benefit such as vitamin D production and warmth! Smoking provides no benefit of any kind whatsoever.

Moreover, smoking causes a progressive cascade of damage inside the body (restricted blood flow, reduced capacity of the blood to take in oxygen, impairment to the body’s im- mune system) that eventually shows up on the surface of skin, making it look haggard and dull. It also creates serious deep wrinkling around the lips and lip area.

 

 

While smoking can make skin look prematurely wrinkled and aged, it’s unattractive for many other reasons as well, including the permeating smell of smoke on clothing, breath that smells like smoke, and yellow stains on hands, nails, and teeth. Smoking isn’t pretty and it can be deadly. Quitting smoking is one of the most healthful, beautiful things you can do for your skin and body.

(Sources: Journal of Dermatologic Science, December 2007, pages 169–175; Experimen- tal Gerontology, March 2007, pages 160–165; Journal of Dermatological Science, March 2007, pages 169–175; Skin Pharmacology and Applied Skin Physiology, January–February 2002, pages 63–68; Journal of the American Academy of Dermatology, July 1999, “Cigarette Smoking-Associated Elastotic Changes in the Skin,” and May 1996, “Cutaneous Manifesta- tions and Consequences of Smoking”; and International Journal of Cosmetic Science, April 1999, pages 83–98.)

 

fragrancE in Skin-carE ProductS

Essential oils are only essential for your nose, not your skin. They are one of the two groups of ingredients almost universally added to cosmetics (the other being preservatives) that are often the culprits when our skin becomes irritated or sensitized by a cosmetic product. An article in the January 24, 2000, issue of The Rose Sheet discussed an advisory report issued by the Scientific Committee on Cosmetic Products and Non-Food Products, a European Commission agency. The report stated that “Information regarding fragrance chemicals used in cosmetic products that have the potential to cause allergic reactions should be provided to consumers.” According to the article, “It is seen that a significant increase in fragrance allergy has occurred and that fragrance allergy is the most common cause of contact allergy.…”

Concurring with this conclusion is an editorial by Pamela Scheinmann, MD, entitled “The Foul Side of Fragrance-Free Products” (Source: Journal of the American Academy of Dermatology, December 1999, page 1020). She states that “Products designated as fragrance- free should contain no fragrance chemicals, not even those that have dual functions.” She continues by saying that “hypoallergenic, dermatologist tested, sensitive skin, or derma- tologist recommended are no more than meaningless marketing slogans.” A large body of evidence comes to the same conclusion and expresses this same concern.

Lots of women assume that the risk to skin from fragrance in skin-care products applies only to synthetic fragrance “chemicals” and not to fragrant plant extracts and oils. When it comes to the health of your skin this would not be a wise assumption. Regardless of the source, most fragrances, natural or synthetic, can cause problems for skin one way or the other. For example, lavender smells wonderful and it may have some anti-microbial proper- ties, but other than that there is no research showing it has any benefit for skin (Sources: Phytotherapy Research, June 2002, pages 301–308; and Healthnotes Review of Complementary and Integrative Medicine, www.healthwell.com/healthnotes/Herb/). But more importantly, it can be a skin irritant (Source: Contact Dermatitis, August 1999, page 111) and a photo- sensitizer (Source: Family Practice Notebook, www.fpnotebook.com/DER188.htm). Research

 

 

also indicates that components of lavender, specifically linalool, can be cytotoxic, meaning that topical application causes skin-cell death (Source: Cell Proliferation, June 2004, pages 221–229).

Essential oils are a group of volatile fluids derived primarily from plants and used in cosmetics primarily as fragrant additives. These components most often include a mix of alcohols, ketones, phenols, linalool, borneol, terpenes, camphor, pinene, acids, ethers, aldehydes, and sulfur, all of which have extremely irritating and sensitizing effects on skin. Even a seemingly benign ingredient like lavender can cause cell death. It’s not that some of these ingredients can’t have benefit. But why choose them when there are so many other plant extracts that don’t have the capacity to irritate skin and provide superior results with- out any downside?

Why does the cosmetics industry at large continue to add fragrance (synthetic and natural) to products even when there is a lot of information showing it to be a problem for skin? The cosmetics industry knows that, emotionally and psychologically, most women prefer cosmetics that smell nice, even if the consumer says they want to avoid fragrance. When a cosmetics company produces products without fragrance, you will instead get the scent of the ingredients, which are not in the least as appealing as an added sweet, floral, or citrusy fragrance. This is why, in order to kill two marketing birds with one cosmetic stone, companies often list the fragrance components as essential oils or plant extracts rather than listing fragrance or perfume on the label. As lovely as essential oils sound, they are still nothing more than fragrance. So while you don’t see the word “fragrance” on the list, and you may approvingly think wintergreen, lemon, cardamom, ylang-ylang, bergamot, rose, geranium, and many, many other fragrant plant oils sound pleasant and healthy, your skin won’t be happy about it.

(Sources: Chemical Research in Toxicology, January 2008, pages 53–69; British Journal

of Dermatology, August 2007, pages 295–300; Contact Dermatitis, July 2007, pages 1–10; Journal of Infection and Chemotherapy, December 2006, pages 349–354; American Journal of Clinical Dermatology, April 2003, pages 789–798; Contact Dermatitis, October 2001, pages 221–225; American Journal of Contact Dermatitis, June 1999, pages 310–315; and September 1998, pages 170–175.)

As for preservatives, they are impossible to avoid in water-based cosmetics because without them our skin-care products would become contaminated with mold, fungus, and bacteria and pose a serious problem for our skin in just a short period of time. However, you can and should stay away from cosmetics, particularly skin-care products, that contain fragrance. It smells nice, but fragrance serves no purpose for skin. Even fragrant ingredients that may also offer a positive benefit are easily replaced with ingredients that can perform the same function without the irritation aspect of the fragrant component. It sounds simple enough to avoid products with fragrance, perfume, or parfum by just reading the ingredient list and then not buying those products. But ingredient lists aren’t always that easy to decipher.

The next time you admire the fragrant quality of a skin-care product you’re about to apply to any part of your body or face, think twice. Similarly, aromatherapy shouldn’t be a skin-care treatment, however therapeutic it is for the sense of smell and emotions. Fragrance

 

 

might be nice for your spirits, but it is a health risk for skin. And it doesn’t matter if the source of the fragrance is essential oils or plant extracts; as far as the health of your skin is concerned, they are all the same.

 

allErgic rEactionS

Allergic reactions are not the same thing as what happens when your skin is irritated. Almost anything can illicit an allergic reaction. On the skin, an allergic reaction to a sub- stance can look nearly identical to an irritant reaction, but when it comes to what is going on beneath the surface of your skin it is a completely different reaction. How can you tell the difference when your skin is reacting because it is being irritated versus an allergic reaction? Generally, an allergic response includes persistent redness, itching, and some amount of swelling, causing skin to look more distended. For more information please see the chapter on Solutions for Allergy Prone Skin.

 

diEt, BEauty SuPPlEmEntS, and wrinklES

Up until a few years ago I would have said we know diet is important to the skin’s health. After all when you don’t eat, you die, and that looks particularly bad! But the research pin- pointing what kind of diet works the best just wasn’t there. That has changed, with research showing what aspects of your diet can fight wrinkles and possibly reduce your risk of skin cancer from the inside out. It all boils down to the theory of reducing inflammation because chronic inflammation prematurely ages the skin. In essence consuming an anti-inflammatory diet is one of the more beautiful things you can do for yourself.

Eating an anti-inflammatory diet has many health benefits, too many to list, but for the sake of this book it’s all about the positives for skin. Think multicolor when you choose what to eat: the reds of peppers, apples, cranberries, pomegranates, and strawberries; greens from broccoli, kiwi, kale, green tea, and chilis; blues from blueberries; brown from cocoa and coffee (without sugar), and black from blackberries and black tea; coral from salmon; purple from grapes and purple-colored cabbage; and on and on. Include monounsaturated fats such as olive oil, nuts, and avocados; and sources of omega-3 fatty acids, which are present in cold-water fish such as wild Alaskan salmon, sardines, and anchovies, as well as walnuts and flaxseed. In addition, add a bit of flare to your meals with ginger, turmeric, curry, tamarind, cumin, and cardamon, all of which have potent anti-inflammatory properties.

In terms of taking antioxidant supplements for your general health or cancer prevention, the research is truly mixed. Some studies suggest that taking supplements is not helpful, especially a specific one for a specific problem. Others vehemently disagree, especially those in the vitamin supplement business—and then there are those who say the research isn’t there to base an opinion on one way or the other. If anything, there is research suggesting that taking supplements may be problematic but no one is sure what that research means.

What does seem clear is that supplements alone do not make up in any way for an unhealthy diet. The claims for “Beauty supplements” that say they can enhance collagen production and fight wrinkles do not hold water; the research isn’t there unless it’s been

 

 

paid for by the company selling the supplement. What you absolutely must know is that a pill of any kind doesn’t alter the need for a complete, healthy diet. Always check with your doctor before adding any type of supplement to your diet.

(Sources: Journal of Investigative Dermatology Symposium Proceedings, 2008, pages 15–19; Lipids in Health and Disease, October 2008, page 36; Nutrition and Cancer, February 2008, pages 155–163; The Journal of Nutrition, September 2007, pages 2098–2105; American Journal of Clinical Nutrition, January 2007, pages 314S–317S; Annals of Internal Medicine, September 2006, pages 372–385; Skinmed, November–December 2004, pages 310–316; and International Journal of Cosmetic Science, December 2002, pages 331–339.)

Along with an anti-inflammatory diet, the best advice is to avoid environmental and emotional “irritations” and stress, and to use skin-care products that don’t irritate skin. That can go a long way to prevent many of the pro-inflammatory elements you have to deal with so they don’t accumulate and cause more damage.