Skin Deep

Potholes the sizes of outhouses, overcooked shrimp and high humidity rank toward the top of that list of frustrations in this city we call home. Our gumbo soil breeds potholes like rabbits. Restaurants overcooking shrimp either go out of business or live off tourists. We utilize heating and air-conditioning to reduce high ambient humidity to more livable levels – at least for inside microenvironments.

Humidity, of course, refers to the amount of water vapor in the air. Warmer air can hold more water vapor. While high humidity fuels mold growth and dust mite expansions that play havoc with allergies, it’s a curse with a silver lining. Humidity is your skin’s best friend. New Orleanians as a group spend less on moisturizers than inhabitants of cooler and more arid areas. And we have prettier skin.

When the warm and muggy days of summer turn to the cooler and damp days of fall and winter, humidity falls. Even so ambient humidity levels usually stay high, explaining our bone-chilling wet and cold days even with temperatures well above freezing. But the air inside our mostly poorly insulated offices and homes is still warmer and dryer than outside. Winter brings our own set of winter skin woes.

Skin isn’t a mere wrap for the body. It is actually an organ, the largest human organ. Skin is a five-layer Doberge cake of connective tissue, pigment cells, sebaceous glands, sweat glands, blood vessels, elastic fibers, nerves and even a Vitamin D factory topped by thin four- or five-layers of cells called the epidermis.

“The No. 1 skin problem I see in winter is xerotic eczema, also known as eczema craquele or asteatotic eczema. It is commonly called winter itch,” says Dr. Neil Farnsworth, a young and popular Uptown dermatologist who moved back to his native New Orleans from Texas a few years ago.

Dermatologists are great wordsmiths. “Xerosis” I knew was a medical terminology for dry; “eczema” is usually just another word for dermatitis; oh, and “asteatosis” is skin dryness caused by a decrease in oily secretions from the skin’s sebaceous glands. But Farnsworth sent me running to a dictionary to find that “craquele” originally referred to the fine pattern of cracking that distinguishes old paintings.

For many men in their mid-30s to early 40s, the first medical symptom of aging begins with itchy lower legs. The usual history is that a hot bath relieves the itch temporarily, but the itch quickly returns. Scratching makes things worse and self-inflicted red streaks on both lower shins are common. In general women are better moisturizers, and these early winter skin manifestations are less common in women. Prompt intervention with a good moisturizer is usually all it takes to stop the itching.

More advanced cases of winter skin itch progress into the eczema craquele category with skin that’s cracked as well as dry and itchy. Again, the worse areas are usually the lower legs over the shins, but other body parts can also be involved. The dermatology literature describes advanced cases as looking like a dried up riverbeds or cracked porcelain vases.

“Moisturizers are definitely not made equal. Dermatologists generally recommend creams over lotions, which often contain more drying alcohols. The top moisturizers contain special oils found naturally in human skin called ceramides. Several brands now contain these, and while they may cost more my patients often make a strong point of thanking me for introducing them to these,” says  Farnsworth.

“Besides lower humidity and inside heat, hot water baths, harsh soaps and even electric blankets can aggravate winter skin dryness,” he continues. “I have seen some everything from first- to third-degree burns from electrical blankets, and recommend using them with caution and automatic shut-offs if possible.”

He continues, “Daily baths are fine for good hygiene; however, we don’t need to put soap all over every day. Lukewarm water is best. I often recommend using soap on the body-folds daily, and other spots such as arms, legs and back with every other day. And make sure you use a mild soap. Interestingly Ivory, Irish Spring and Dr. Bronner’s are the three worse offenders I see. Dove Sensitive, Vanicream and Cetaphil are much milder soaps.”

Tips for Your Tips
“For chapped lips, we generally recommend Aquaphor ointment or simple ChapStick with as few ingredients as possible. Carmex and other aromatic balms can sometimes irritate and worsen lips.”

You can often use the same products on hands and feet, but sometimes you need different properties or characteristics for different sites. A great new product is Excipial Daily Protection Hand Cream from the Cetaphil folks. It’s moisturizing but not at all greasy. For thick, scaly feet I often recommend something with a gentle acid to soften the feet such as AmLactin, CeraVe SA or Excipial with 20 percent urea.

Generally speaking, synthetic socks wick moisture away from feet better than cotton. In our humid climate that difference can be subtle. If nylon socks made you sweat more, it may have been due to a tighter weave or perhaps thicker fabric.”

Source: Neil Farnsworth M.D., 891-8004,

Winter Skin Care
“Prior to getting out of the shower, while still wet and warm, I rub a thin coat of Aveeno Daily Moisturizer over my entire body. It’s a dimethicone water-based cream. When in the states, I purchase the Wal-Mart “Equate” brand, as it’s cheaper. Since I’m wet and it’s water-based and dissolves quickly, a few squirts covers my entire body. If time allows, I air dry for a few minutes, then towel off. It’s amazing how well it works. If my feet get dry and cracked in the winter, I lube them up with Udder Butter or Albolene before putting on my socks. By the end of the day, they feel great.”

Source: Joe Rawlings M.D., psychiatrist who began his training at Charity Hospital and now travels the globe for the U.S. Department of State



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