Jan 12
1
Winter Skin Care for Women Over 50
Happy New Year! In the dermatology world, the winter months are the time when our thoughts turn to moisturizers, especially for women over 50. Cold air, low humidity, and indoor heating combine to pull moisture from our skin, making us dry and itchy. In fact, there is a highly technical name for that seasonal dry itchy skin: winter itch! Keeping the skin hydrated is especially challenging at this time of year, but it’s an important part of maintaining our skin health throughout the year as well.
Many of my patients ask me if they should moisturize. With some exceptions (for example, extremely oily skin,) the answer usually is “yes.” The reason may be a little more complex than one would think. Of the many important functions the skin performs, barrier function is probably the most important; that is, the skin has an outer lipid layer that forms a barrier between us and the outside world. It keeps good stuff (like water) in and bad stuff (like bacteria and irritants) out.
Our over-50 skin requires a certain level of moisture to do its job and form an intact barrier. Without adequate hydration, the skin becomes flaky, rough, dull, and inelastic, leading to cracks and fissures. The skin is now “broken,” and the disrupted barrier allows harsh chemicals, detergents, and other irritants to enter and cause damage. The skin cells then send out molecular
“distress signals,” also known as cytokines, that activate an inflammatory cascade, leading to further barrier disruption, redness and rashes. Skin diseases can lead to barrier dysfunction, but it also goes the other way: barrier dysfunction can lead to skin disease. This is why moisturizing is such an important part of treating skin conditions such as eczema and psoriasis. “It’s half the battle,” I tend to say.
But there’s more. We now know that inflammation is the final common pathway for multiple illnesses, from arthritis to heart disease, to certain cancers, to autoimmune diseases, to aging itself. With respect to the skin, we know that the inflammatory cytokines produced by distressed skin lead to the production of a group of proteins (called matrix metalloproteinases) which chew up collagen and leave us with wrinkles. So, in order to prevent skin aging, we need to prevent skin inflammation. How do we do that? By treating our skin well, protecting it from ultraviolet radiation with sunscreens and sun avoidance, avoiding harsh cleansers, using topical antioxidants, and maintaining a healthy barrier with adequate moisture.
Should everyone moisturize? Probably, unless you’re naturally oily. If you suffer from psoriasis, eczema, or seborrheic dermatitis (facial dandruff,) then absolutely! Even acne sufferers can benefit from a lightweight moisturizer, as it has been shown that improving 
barrier function improves acne. (Also, many acne treatments leave the skin dry.) Rosacea patients tend to have dry skin and an inherent barrier dysfunction, so moisturizing is essential in managing this condition as well.
Most moisturizers work by forming a seal to prevent water loss through the skin; some also contain humectants which pull moisture into the skin from the tissue below. Oil-in-water lotions are generally not as moisturizing as water-in-oil creams. Research in skin physiology has shown that there are 3 main lipids in the skin barrier: ceramides, cholesterol, and fatty acids. We are now starting to see the advent of new “physiologic” moisturizers on the market that contain one or more of these ingredients and do more than just provide an occlusive water barrier; they actually help the skin rebuild the lipid barrier.
Here are some general tips for managing dry skin:
- Avoid overly hot baths or showers. Hot water tends to dry out the skin.
- Try to avoid harsh soaps, which dry the skin. A non-soap cleanser, such as CeraVe, Cetaphil, or Dove Unscented is a good choice.
- After bathing, gently pat the skin skin dry with a soft towel, and then apply moisturizer while the skin is slightly damp. This helps to “lock” moisture in the skin.
- If your skin is irritated or rashy, try to avoid irritating fabrics such as wool or polyesters. Cotton is a good choice. Avoid fabric softener sheets, as many contain potentially irritating fragrances. Use a mild laundry detergent such as All Free Clear.
- Consider a humidifier to combat indoor dryness.
- Reapply moisturizers during the day as needed. The hands tend to be particularly prone to dryness, due to frequent washing, which strips away the lipid barrier. Keep some hand cream handy and reapply after hand washing.
Here are some of my favorite moisturizers:
- For the body: CeraVe Cream, Eucerin Cream, Cetaphil RestoraDerm Skin Restoring Moisturizer, Amlactin cream, and Vanicream (this is a good one for super sensitive skin.)
- For the face, I like Olay Total Effects Mature Skin Therapy, Aveeno Ultra-Calming Night Cream, and CeraVe PM Facial cream. (Note: these creams also come in daytime versions, with sunscreen.)
- For hands, I like Neutrogena Norwegian Formula Hand Cream, Gloves-in-a-Bottle, or Eucerin Plus Intensive Repair Hand Creme. For more serious cases of skin dryness, there are also some prescription moisturizers. If you are not getting relief from over the counter creams, see your dermatologist.
Here’s to healthy over-50 skin in the new year!
Katherine Farady, M.D.
