A new book, Beyond Soap, by dermatologist Sandy Skotnicki is forcing me to rethink some of my assumptions about personal cleanliness. Skotnicki, who specializes in skin irritation, argues that our culture’s obsession with hygiene is destroying our skin’s ability to do its job. She explains that by scrubbing and soaping up daily — or even more than once a day, as she sees with many of her patients — we’re inadvertently damaging the important outer layer of our body’s largest organ.
“I noticed over the years a growing number of people coming into my office with reactions to things and not knowing what to do,” Skotnicki said during our recent interview. “I got frustrated that patients don’t have the right information. This book tries to cut through the misconceptions.”
How the Beauty Industry Led Us Astray
Skotnicki felt compelled to write Beyond Soap in response to what seemed like “an epidemic” of skin reactions and a worrying lack of awareness about how to prevent and heal them. She believes most people don’t realize that they cause their own skin problems through product use and hygiene habits. Statistics seem to support her observations.
Rates of eczema and sensitive skin have more than tripled since the middle of the last century, with up to 40% of the population claiming their skin is sensitive—up to 91% in some countries.
In her book’s introduction, Skotnicki lays responsibility for this epidemic with “the modern beauty habits—including our overall obsession with grooming—that are supposed to be taking care of our skin in the first place!”
She likens the outer layer of our skin to a brick and mortar wall. Our skin cells are the bricks, and the mortar is made of lipids, fat molecules that we routinely remove when we lather up with soap. Soaping up as often as we do leads to gaps in this wall, whose job it is to protect us from irritants and pathogens. When we take out the lipid mortar, our skin’s ability to function as a barrier is compromised and we’re left open to irritants.
Rates of eczema and sensitive skin have more than tripled since the 1950s, with up to 40% of the population claiming their skin is sensitive—up to 91% in some countries.
To make matters worse, we unwittingly slather these irritants on our skin many times daily, since they’re lurking in our shampoos, lotions, makeup, and other beauty products. Beyond Soap details the ingredients used in common body products, many of which can cause reactions. Patients with rashes and other skin problems have found relief by doing what Skotnicki calls a “product elimination diet” to root out the irritants and allergens hiding in their personal care products. Since each product contains numerous ingredients, reducing how many you put on your body can help lower the likelihood of irritation. Shampoos contain particularly long lists of ingredients and are one of the first suspects Skotnicki investigates when she sees a patient with skin irritation.
Other suspects include products with terms like “mild,” “hypoallergenic,” and “unscented.” Since these terms are not regulated, they don’t tell consumers much about the ingredients or how their reactive skin might respond to them. Patients are often misled by these terms and don’t find relief until they try product elimination and switch to specific products she’s vetted.
Natural Doesn’t Mean Good For Skin
Most surprising to those of us who tend to prefer “natural” ingredients to synthetic ones are Skotnicki’s findings that many common plant-based ingredients can cause irritation or allergic reactions. “The organic movement is great for the earth, though not necessarily for the skin,” she says.
Lavender oil, tea tree oil, and even soothing calendula may spark reactions. She’s found that many patients suffering from skin reactions often assume it can’t be their “natural” skin care products, because they believe anything natural must be good for them. “They have a knee-jerk response that because something is natural it’s safer,” she explains. “Poison ivy is also natural. So’s arsenic.”
Once these patients have done a product elimination, they often find the source of their problem is an essential oil like frankincence or lavender, which contain linalool, a common component of many essential oils and one of the 26 allergenic substances that the European Union requires makers of personal care products to list on labels.
Also on the EU list? Compounds found in geranium, cinnamon, peppermint, and other essential oils used in numerous “natural” products. Most problematic, Skotnicki says, is when multiple oils are used in the same product, increasing the likelihood of an adverse reaction. She questions the logic behind including so many essential oils: “What’s the science behind all those oils put in a product? When you see thirty, it’s marketing.”
In trying to find solutions for patients suffering from debilitating skin conditions, Skotnicki counsels, “It’s not about good and bad. It’s not about synthetic and natural. It’s about less.” To help people navigate the bewildering array of beauty products in drugstore aisles, she maintains a list of products to help people find options least likely to aggravate sensitive or irritated skin. “The market is so big and we have so many choices,” that the average consumer has the cards stacked against them trying to find what supports healthy skin.
As Skotnicki learns about new products, she adds them to the list. For those preferring products without synthetic chemicals, she includes coconut and sunflower oil as moisturizers as well as some plant-based hair and body products.
Skotnicki advises all of us — even those of us not experiencing skin irritation — to wash less often and only where we’re really dirty, to keep our skin in optimum working order. Our arms and legs, she says, don’t generally need more than a rinse unless they’re actually dirty. She also suggests avoiding soap, which is very alkaline and strips skin of its protective lipid layer. She has a list of soap alternatives she suggests instead.
In a fascinating chapter on the history of humanity’s hygiene practices dating back to the first hominids, Skotnicki describes how the rise of marketing in the last seven decades has led Western culture to create a wholly unnatural ideal of cleanliness. Through much of human history a bath was a rare occurrence, and as recently as the early twentieth century, a weekly bath was considered more than adequate.
Marketing campaigns of the last many decades have taught us to feel grimy if we skip even a day’s bathing, so most of us are stripping our skin of oil as well as potentially helpful microbes every day. Dermatologists, Skotnicki says, have been trying to educate the public about washing less often for years, but they seem to be fighting a losing battle against powerful marketing campaigns and now-ingrained cultural norms. Beyond Soap sprung from her desire “to change mindsets about how we perceive cleanliness.”
Marketing campaigns have taught us to feel grimy if we skip even a day’s bathing, so most of us are stripping our skin of oil and helpful microbes every day.
And while she began her book with a focus on overwashing’s effects on our skin’s lipid layer and on skin irritation caused by product ingredients, she was soon drawn to emerging research on the human microbiome showing that soaping up eliminates microbes that help keep the skin’s ecology in balance. “As a society we have an epidemic of inflammatory conditions. Is there an association with how we’ve changed our microbiomes? Perhaps this is part of the reason eczema and asthma are increasing in prevalence.”
Of particular concern is how — and how often — we bathe our kids. Some parents believe a daily bath with a thorough, all-over soaping is a necessity, but dermatologists now think too much bathing may be part of the reason so many kids have skin problems and allergies.
“The first two years of life are most critical for developing a healthy microbiome,” Skotnicki says. She advises parents to be especially cautious with overwashing and product choices during this sensitive time for developing immune systems. She also thinks it wise to limit kids’ exposure to ingredients that may lead to allergies or irritation, including products with essential oils.
Skotnicki also notes that laundry detergent and fabric softeners are common sources of allergenic or irritating compounds. She recommends using unscented laundry products and skipping the scent-filled fabric softeners and dryer sheets. (Dryer balls can soften your laundry while also saving energy and resources.)
If you’re really trying to go for natural, Skotnicki says, the thing to do is leave your skin alone to do its job, which it did perfectly well for thousands of years before the advent of indoor plumbing and the personal care industry. “What could be more natural than leaving the skin of the body to care for itself?”
As someone who’s been watching research on the gut microbiome for years, this book pushed me to reexamine some of my personal cleansing habits. Am I washing too often? Are my natural soaps too harsh? Should I be concerned about the essential oils in so many of my products? How do I weigh my concerns about hormone disrupting chemicals and carcinogens against Skotnicki’s concerns about the harshness of soap?
If your skin isn’t having an obvious reaction, Skotnicki says, you don’t necessarily have to overhaul your skincare routine. “But what do you do when you have a problem?” She wants people to understand when irritation arises, it’s likely caused by their hygiene practices.
Additionally, “allergy comes with repeat exposure,” so backing off on essential oils could help head off a potential reaction in the future. “Each essential oil has a number of chemical compounds, and they can also be different depending on where they’re grown and when. Plus there’s no regulation,” Skotnicki says. With all these uncertainties, she believes cutting back on botanicals in products is a wise move.
I’ve never really questioned my soaps after checking their ingredient list — no synthetic chemicals and into the cart they go. But after reading Skotnicki’s take on what traditional soap does to skin, I may give one of the “syndet” or beauty bars she recommends a try. I’m also going to try the unscented versions of the products I already use, which I’ve vetted for chemicals of concern. Though they’re not giving me any problems (that I’m aware of), my lavender lotion, lavender shampoo, and lavender body soap could make me allergic to my beloved lavender over time. I aim to avert this tragic state of affairs!
I will also be seeking out unscented versions of my kids’ plant-based shampoo and soap for the same reason. And I will delight in the fact that their dislike of baths (and thus mine of giving them) made them healthfully dirtier than many of their peers for most of their young lives. Will this mean fewer allergies and sensitivities down the line? Perhaps. Healthier skin left to do the job it was designed for? Probably. Regardless, setting them up for a lifetime of saner, safer skincare is certainly a goal worth aiming for.