Welcome to Ask A Derm, a monthly feature where board-certified dermatologist Shereene Idriss is on hand to answer your most pressing skin-related questions. Though nothing can substitute a visit to Dr. Idriss’ practice at Union Square Dermatology, think of this as your skincare primer before your appointment date arrives. Get to know Dr. Idriss a bit better through her Top Shelf here, and through her Instagram account, @shereeneidriss. Got a question you’d like Dr. Idriss to answer? Ask away at [email protected].
Coming In Hot: An SOS From Your Hands
Dear Dr. Idriss,
For obvious reasons, I’m washing my hands more than I’ve ever done before. And more intensely so, at that. While my hand hygiene has gone up, my hand texture has gone down exponentially. Now my hands are always dry, and even worse, I’ll periodically break out in a rash—red skin, bumps and all. It’s awful and I’m not sure what to do. My body lotion temporarily helps a tiny bit, but that’s it. What’s your advice on how I can give my hands some relief?
You should start out by asking yourself two questions: are your hands actually dry, or are you suffering from some sort of irritation, otherwise known as an irritant contact dermatitis? If your hands are irritated because of harsh soaps, then a simple moisturizer might not be enough. You might need to use a topical steroid first to calm the inflammation before moisturizing. The simplest is an over-the-counter hydrocortisone—if you try it and it’s not as effective as you like, you can speak to your physician to prescribe something a little bit stronger.
Second, when you’re thinking of moisturizers, consider the vehicle—from a serum to a lotion to a cream to an ointment. Serums being the most lightweight, and ointments being the thickest and most occlusive. I just started using Avène’s Hydrance Intense Serum myself, and then I follow that up with a lotion for more hydration. Try to go for moisturizers that are fragrance-free, because those are less irritating if you’re prone to allergic reactions (and you might be more prone now because all the handwashing is disrupting your skin barrier). I really like Vanicream, for example, because it’s formulated for people with sensitive skin—but whether or not you have sensitive skin it’s a really great option. And they sell a lotion and a cream, so you get to take your pick. I also really like Aveeno’s Eczema cream with colloidal oatmeal in it—it’s technically for babies—and I like it because it’s soothing. And Aquaphor has an ointment spray, which actually does not leave you feeling tacky. I was recently introduced to O’Keeffe’s Working Hands, and I also really like that moisturizer. And lastly, never underestimate plain old Vaseline. If you’re scared to put anything on, Vaseline is your best bet because it’s so pure in its ingredient list—no extra filler ingredients, and it’s going to deliver a pure occlusive layer to your skin.
If your hands are still persistently dry after doing all of that, get a pair of dishwashing gloves and create a DIY mask. Apply the steroid to your hands first, then the Vaseline or Vanicream, and then put your hands in the gloves for 15 to 20 minutes. Do that once a day and you’ll notice results in a day or two if you only have dry skin, and if your skin is reacting because of an irritant, you’ll probably notice results within the first day.
When Stress Leads To Breakouts Leads To… More Stress
Dear Dr. Idriss,
Like a lot of people right now, my stress levels are higher than normal. And at the same time my skin has never looked worse. It doesn’t make sense! I’m diligently following my routine and I hardly wear makeup. Call me crazy but I think there’s a connection between my newfound worries and the current state of my skin. I mean, is there? How does stress affect your skin?
Anxious and Irritated
You might think you’re going crazy being locked up indoors all day, but there is absolutely a connection between stress and skin—and hair. With stress, it’s been proven that a hormone called CRH is connected to your cortisol levels. When your cortisol levels are heightened, it can result in increased oil production that can lead to blocked pores and acne—but it doesn’t stop there. Your hair growth cycle can be temporarily disrupted, which can lead to hair loss, and even your blood vessels might also react, which can trigger or worsen rosacea. If you’re prone to chronic conditions like psoriasis or atopic dermatitis, stress can further disrupt how your skin functions and encourage flare ups. I would not underestimate the stress connection to your appearance at all.
Unfortunately, I can’t tell you to turn off your stress so you can get better right away. What I can say is that it’s important to be patient with yourself, and to be kinder to yourself more than ever. Another way to look at it is that this situation we’re all in—as stressful and terrible as it may be—is temporary. And these reactions you’re experiencing will be temporary as well. That alone might be the kind of feedback you need to give yourself to reduce your stress levels, and in turn help with your skin.
In the interim, I suggest avoiding really thick creams if you’re extremely oily, and to exfoliate with an alpha hydroxy acid like glycolic a few times a week. If that’s too harsh, use a beta hydroxy acid. It also may not hurt to introduce a benzoyl peroxide in your shower routine. It can be a little drying, so only use it a few times a week, and beware that it can bleach your towels. And if you’re feeling dry because of all of these treatments, but at the same time you want to moisturize without worrying that you’ll further clog your pores, opt for a lightweight serum to help you out.
When it comes to your hair, consider Rogaine foam for men to help with temporary hair loss—the men’s strength is as effective as the women’s one, but actually cheaper. And use the 5-percent formula and not the 2-percent. If that’s too difficult for you to do at this time, at the very least make sure you’re taking the right supplements, like a general skin and hair supplement, or Vitamin D and chelated iron. This should set you on a path to healthier skin and hair—I’m rooting for you!
Photo via ITG.