You Need To Use Soap & Sanitizer — But You Also Need To Tend To Your Skin Microbiome
Considering the recent state of the pandemic, it's not a bad time to revisit hand hygiene, skin health, and the skin microbiome. Practicing safe hygiene measures is of the utmost importance for keeping us safe right now. But we also don't believe you should neglect your skin barrier and microbiome health. A flourishing skin microbiome and strong barrier is part of our overall health, after all.
It's a topic many doctors, derms, and various experts have mulled over the past two years—here, we spoke with a few of them.
Before we begin: Don't skip safety precautions.
Given these unprecedented and uncertain times, first and foremost keep yourself safe. This means listening to the recommended guidelines set out by health officials and local government, practicing smart social behaviors, wearing a mask, and keeping hygienic.
While we can't change the fact that we all need to be using antimicrobial and sanitizing products with frequency—and have been for the last two years—we can address another element of our hygiene process to better serve our skin.
However, let's start to think about our microbiomes, too.
A brief description of your skin microbiome: "We typically think of skin only as it relates to beauty—but it's essential to our overall health," writes physician and naturopathic doctor Kara Fitzgerald, N.D. "The skin microbiome2, sometimes called the skin flora, is the term for the trillions of bugs3 that live on our skin. There are 1,000 different bacterial species and up to 80 different fungi species. Some of these are also residents of your gut microbiome."
A few things that our skin microbiome does:
- Helps us deal with skin infections. "From what we can tell, a healthy skin microbiome protects against infection in much the same way a good gut microbiome does: by crowding out overgrowth of pathogenic organisms," she says.
- Acts as a vital part of our skin barrier function. One of the skin's most important roles is acting as a barrier. The microflora is a vital part of that function and makes sure the skin is less permeable (read: bad stuff can seep through; good stuff can get out).
- Protects us from environmental damage. "The microbiome also aids in wound healing, limits exposure to allergens, minimizes oxidative damage, and keeps the skin plump and moist," she says.
- Communicates with our immune system. "We once thought that our microbiome only existed on the surface of the skin and that the deeper dermal layers were sterile. We now know that's not true as scientists did a deep dive4 into the dermis looking for microbes, which were found all the way to the subcutaneous fat layer," she says. "While the researchers noted that more studies are needed, it appears that the most intimate communication between the microbiome and our immune system takes place at this layer."
The concern with sanitizers and antimicrobial agents is that they don't just kill the bad stuff; they kill the good, necessary parts of our biome too. "Hand sanitizers that are effective at preventing the transmission of COVID-19 are, by definition, biome-unfriendly. To kill the virus we are all trying to protect ourselves from, they must contain alcohols, which are incredibly effective germ killers, meaning they can kill many disease-causing bacteria and viruses within seconds," says board-certified dermatologist Whitney Bowe, M.D. "The problem is these types of alcohols do major damage to the natural lipids and fatty acids on the surface of your skin, so they damage your skin barrier."
What does this mean for our skin, really? "We'll see a lot of people with skin rashes, a lot of people with weird skin infections, from overuse of these ingredients that are killing the good bacteria on our skin," Cate Shanahan, M.D., tells us on a recent episode of the mbg podcast.
The concern here, notes dual-board certified dermatologist Keira Barr, M.D., is antibiotic resistance. "Even though the sanitizers generally don't contain antibiotics, when microbes become resistant to some of the sanitizers, it becomes easier for them to be resistant to important antibiotics."
As for broader, long-term concerns—that we just don't fully know. "We know that the microbiome is proven to be critically important for our health, and using products that can disrupt the microbiome is concerning. At this point, we do not know the long-term ramifications or how significant the impact might be of this behavior," says Barr. "There's still a lot of work that needs to be done to better understand the skin microbiome, especially the microbes that are on our hands. While we've learned a lot about what types of bacteria typically live on us, we know less about what each one's specific function is and how our behaviors impact them."
"For example, there's a study that highlighted that the hand microbiome is a critical component of the human microbiome5, and the hands have a very high variability of microbes that vary throughout the day even," she continues. "So the bottom line is that more studies need to be done to fully understand the role of the bacteria on the skin and the intrinsic and extrinsic factors that impact them."
Luckily, she assures us, our skin is a highly resilient organ—and our skin microflora is able to repopulate itself easily, if given the right tools.
What can you do: favor hand soaps.
Given that there's just not much you can do on the hand sanitizer front: 60% ethanol and 70% isopropanol (the recommended amount from the CDC6) is a large concentration and difficult to buffer even if you infuse it with softening ingredients like aloe vera.
"I only recommend hand sanitizers when you don't have access to soap and running water. Consider them a last resort. Ideal hand soaps are made without harsh sulfates like sodium lauryl sulfate that can damage the skin barrier. I also love seeing hand soaps that are enriched with soothing, hydrating ingredients like milk, aloe, honey, and oatmeal," says Bowe. "Also, any ingredients that restore the barrier and help bring the pH back to the normal range (slightly acidic) are imperative. Our skin has an invisible layer called the acid mantle, and we need to respect the pH of our skin to keep it healthy."
Shanahan agrees, noting that "soap physically destroys everything equally. Unlike hand sanitizer, where it's selecting out viruses that survive the chemicals in your product, those could become more aggressive and burrow into your skin and cause serious infections."
Invest in a natural hand cream.
Be diligent about taking care of your skin after washing. This includes using a natural, high-quality hand cream. "It's essential to moisturize as often as possible to restore those lipids and encourage the regrowth of healthy bacteria," says Bowe. "I carry a hand moisturizer with me at all times and apply it within moments of washing or sanitizing my hands throughout the day. If you wait too long, you miss that narrow window of opportunity to really trap and seal those nourishing ingredients in the skin before all the water evaporates off the surface, further compromising your skin."
And according to Barr, with the regular use of hand cream or moisturizers, we'll be able to tend to our skin even if we are washing or sanitizing more. "The hope is that you can balance the damage with maintaining skin barrier integrity by using emollients or humectants," she says. "You are trying to restore some sort of balance at this point—because you have to wash your hands."
And as Jeffrey Rediger, M.D., tells us on the mbg podcast, "I go into patients' rooms all day long, so yes I am quite careful to wash my hands or use sanitizer outside of patients' rooms," he assures us about frequent use. "So I use hand sanitizer regularly, but personally, the way I perceive it is that because I care so much about my microbiome and strengthening it, I don't worry about that little sanitizer fundamentally changing my path on that."
What can you look for in a hand cream that will tend to your microbiome? "Use a moisturizer on your hands with real, traditional fats. These moisturizers can foster the development of good bacteria," says Shanahan. "This is going to be the vegetables and the seed oils. In fact, in tropical climates they would ferment coconut oil in the sun for a certain defined amount of time and then use it as a skin lotion for their body, which tells me that they were fostering some healthy bacteria in there."
You should also consider products that contain pre-, pro-, and postbiotics to help encourage a healthy balance of bacteria.
Don't neglect your gut microbiome either.
But, of course, the skin is not just a product of what it comes into contact with; it starts internally. Enter: the gut-skin axis. The gut-skin axis is a fascinating area of study that is ripe for growth. (One that we pay special attention to here at mbg.) One of the more well-understood connections is the role of inflammation. When your gut lining is permeable (read: damaged), it leaks into the rest of the body, causing inflammation. This inflammation is seen all over but perhaps most noticeably in your skin. In fact, this is why certain foods can cause breakouts, eczema flare-ups7, or even just general things like puffiness or redness.
But another fascinating, and certainly interwoven, link is the relationship between your gut microflora and your skin microflora8. They don't have the same makeup, no, but they do live together and influence each other as part of an intricate ecological community. While it's an area that we don't fully understand quite yet, all the available research suggests that if you have strong gut microflora, it can be highly beneficial for your skin barrier function. So if you want to help your skin microbiome, it's worth considering your gut microbiome as well. One way to help manage your gut flora is through oral probiotics.*
If you are concerned about over-sanitization right now, you're not alone. It's on many people's minds, including top doctors and wellness experts. There is, of course, much we don't know. However, there are also reasonable, easy solutions to help your skin microbiome thrive.
Alexandra Engler is the beauty director at mindbodygreen and host of the beauty podcast Clean Beauty School. Previously, she's held beauty roles at Harper's Bazaar, Marie Claire, SELF, and Cosmopolitan; her byline has appeared in Esquire, Sports Illustrated, and Allure.com. In her current role, she covers all the latest trends in the clean and natural beauty space, as well as lifestyle topics, such as travel. She received her journalism degree from Marquette University, graduating first in the department. She lives in Brooklyn, New York.