The Downside to Modern Skin Care with Dr. Sandy Skotnicki

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In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Sandy Skotnicki talks about the downside to modern skin care.

Dr. Sandy Skotnicki is the founding director of the Bay Dermatology Centre and is Assistant Professor at the University of Toronto, Department of Medicine in the Divisions of Dermatology and Occupational and Environmental Health. Dr. Skotnicki is a consultant Dermatologist at St. Michael’s Hospital in Toronto and is an expert in Allergic Skin Disease.

She is also the author of Beyond Soap: The Real Truth About What You Are Doing To Your Skin And How To Fix It For A Beautiful, Healthy Glow, which details her “product-elimination diet”.

Main Questions Asked about Skin Care:

Why is there such an epidemic of skin issues these days?
How does the alkaline nature of soap affect the bacteria on our skin?
Can you explain your product elimination diet?
What do you see as the future of skin care?

Key Points made by Dr. Skotnicki about Skin Care:

My interest is allergic reactions and just reactions to skin care and other things that touch the skin. It’s part of the reason I wrote the book.
It’s been shown both in the US and in Europe that reactions to skin care products and skin care ingredients, both natural and synthetic, have increased.
A lot of it has to do with how we take care of our skin, which is we do too much to our skin.
One of the most fun chapters to write was chapter two, where I kind of look at the history of cleanliness. How did we get to the point where we have a shower every day or sometimes twice a day? We use shampoo every day, even when our hair’s not dirty; and that’s to make a distinction between what it means to be clean and what it means to be hygienic.
Your hands are the thing that you really want to keep clean, because they’re the tools for transmission of disease; and most people don’t do it properly. You have to do it for two Happy Birthdays.
The other thing is that it’s more about pH. The pH of the skin is acidic, so that’s key to everything the skin needs to function, and if it isn’t acidic, it doesn’t work properly. The first soaps that came along in the 40’s and 50’s were alkaline.
We feel that the high pH cleaning of the skin has damaged our barrier and maybe led to the increase in eczema and allergies.
Then, there’s a further issue of just the sheer number of ingredients in skin care products, and the lack of regulation in North America in particular.
We don’t really know what the use of alkaline soaps for the last 50 to 60 years has done, we don’t have the science, but a lot of people are asking if we haven’t done something to our skin microbiomes over these decades.
If you think about your skin as a brick wall, where the cells are the bricks and your lipids are the mortar, and even just water and soap diminish that mortar so that you end up with a leaky wall; so, what have we done?
Shortly after my book was published, I found a link between food allergies and the skin barriers. There was a study that looked at mice who were sensitized to peanut allergy through the skin, once their skin barrier was disrupted with soap and water.
One of the really important parts of the book is where I write that the reason we’re so clean has nothing to do with health, and everything to do with advertising. We’ve been told that we need to wash every day to be healthy and beautiful, and I’m trying to show the opposite.
If you look at the evolution of humans, and homo sapiens has been around bout 200,000 years, and it’s only in the last 150 that we’ve been cleaning up.
So, we clean up, we’re damaging our microbiome; so, the marketing machine of beauty will latch on to this and say now we need products to repair the microbiome. There’s already a company that has a spray of bacteria that you can put on your skin.
There was study published in about 2012 showing that kids growing up on farms had less asthma. There’re also studies showing that kids that have animals have less allergies. You’d think it would be the other way.
Furthermore, the studies indicate that by adulthood your microbiome is stable and doesn’t change, which makes how we wash the kids in infancy and childhood critical.
Another reason I wrote the book is that I was frustrated with patients coming in with persistent reactions and saying, “I think I’m reacting to something I’m using. I’m not sure.” A lot of people when they get rashes or rosacea decide they’re going to go natural because they want to use something “natural”.
But when it comes to rashes, eczema, itchy skin, red, scaly stuff, whatever, you want to us things that aren’t going to give you reactions, either allergic or irritant. It’s got nothing to do with plant-based or synthetic. There’s a difference between what is toxic and what can give you a rash. Poison ivy can give you the worst rash imaginable, but it’s a plant. Right? It’s natural. There’s a big disconnect in the public.
Part of the reason for the product elimination diet was to give patients a list of products that don’t have ingredients that will give them rashes. Some of my products have parabens, but parabens don’t give rashes. My product elimination diet isn’t about toxicity; it’s about having a list of products you can use if you’re having chronic eruptions.
The other reason is because marketing and labelling are not regulated; consumers are at a disadvantage. The diet is a play on words.
It doesn’t have the most common things in skin care that give reactions, that includes fragrances, both synthetic and natural, preservatives, and other kinds of organic ingredients associated with both allergy and irritation.
Patients basically follow this product elimination diet from head to toe, including shampoo and detergents and everything that touches the body. Hopefully they improve within a month. Once they’re better, they can reintroduce products that they miss, one per week.
The other thing about this diet is that products have to play together. If you look at the average woman, and you look at how many products she puts on her face, she could have as many as 500 ingredients. It’s the accumulation of all of them; it’s not one thing causing the problem, and that’s why you have to eliminate all of them and start over.
But there’s still a percentage of people who have actual disease. If you have eczema, your mom or dad had eczema or asthma (which are somewhat genetically related), and you cut out everything and see a 60-70% improvement, you’ll still need medicine because you have a genetic disease.
I was seeing a lot of people on medication who weren’t getting better because they were still using products that aggravated their condition. It’s like having asthma and smoking, no amount of medication is going to stop flare-ups because the smoke is aggravating the condition.
I think we’re so oversaturated in this market of beauty and skin care that the pendulum, at some point, has to swing backward.
If you talk to any chemist who makes products, you really only need six to ten ingredients to make something that works properly. Everything else that’s added is for marketing purposes.
There is a Canadian brand, The Ordinary, for example – some of their products have only two ingredients. This is where skin care needs to go.
It’s going to be hard; it’s a billion-dollar industry that needs to change. I think we’re starting to see some of it – less is more: fewer ingredients, no fragrance.
Be careful of plants. Plants can give you rashes. There was a study published last year that showed young boys using tea tree oil and lavender oil had hormone disruption and breast development.
Just because it’s plant based doesn’t mean it’s safe; just because it’s synthetic doesn’t mean it’s bad. There are good synthetics, bad synthetics, good plants, bad plants. It’s not black and white.
I think it’s very important to get this message out to young people. They’re the ones that are so touched by the advertising.