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Emollients

Emollients and moisturisers

What are emollients and moisturisers?

Emollients soften skin and moisturisers add moisture. They are used to correct dryness and scaling of the skin, fine lines and wrinkles and mild irritant contact dermatitis.

What are the causes of dry, scaly skin?

Dry, scaly skin may be due to:

  • Dry air e.g. low winter humidity
  • Exposure to the wind
  • Over-washing
  • Reduction in production of natural moisturisers (sebum) in old age
  • Diuretic medications
  • Underactive thyroid gland
  • Inherited factors
  • A skin condition such as atopic dermatitis (eczema),psoriasis or ichthyosis
  • Any combination of these

How does dry skin arise?

Dry skin results from lack of water in the stratum corneum, the outer, compacted layer of non-living cells that covers the entire body like a layer of cling film. When it becomes dehydrated this layer loses its flexibility and becomes cracked and scaly. The stratum corneum contains natural water-holding substances that retain water seeping up from the deeper layers of the skin. Water is also retained in the stratum corneum by a surface film of natural oil (sebum) and broken-down skin cells, which slows down evaporation (trans-epidermal water loss or TEWL.)

Causes of dehydration of the skin

Water loss from the skin is increased by dry winter air, either outside on cold, frosty mornings, or inside in centrally-heated homes or offices. Wind also increases evaporation from the skin. Increasing age means the skin holds less water, particularly over the age of 50. People on diuretics for hypertension (high blood pressure) or heart failure, and those with underactive thyroid glands also have drier skins.

Another important factor in encouraging water loss from the skin is over bathing. Washing with hot water and soap washes off the surface layer of natural oil, which goes down the plug hole. Unless the oil is replaced with either an oil or an emollient applied to the skin after washing, water loss from the skin increases and an hour or so after bathing the skin is drier than it otherwise would have been. Detergents and solvents similarly encourage dehydration of the skin by removing the surface oil film.

How does scaly skin arise?

Scaly skin arises from visible detachment of cells from the surface of the stratum corneum. In normal skin this process is invisible because the scale consists of individual cells. In scaly skin the cells have difficulty in detaching from each other and come off in little ‘rafts’ which are easily visible. This occurs in dry skin from any cause but also in eczema, psoriasis and ichthyosis where the skin cells are imperfectly formed and don't detach properly.

Treatment of dry skin

To correct a dry skin tendency from any cause reduce contact with soap and water and apply a moisturiser or emollient.

Reduce bathing

  • Reduce washing to every second day, or less often, although the body folds may be sponged daily if desired.
  • Baths or showers should be kept as brief as possible.
  • Water should be lukewarm.
  • Minimise the use of soap. Use a mild soap or better still, a detergent-based cleanser. Cleansers that have the same pH as the skin (5.5) may be advantageous.
  • Reduce the need for bathing by keeping as clean as possible both at home and at work.

Moisturisers and emollients

The terms ‘moisturiser’ (to add moisture) and ‘emollient‘ (to soften) are interchangeable as they describe different effects of these agents on the skin. Basically they have two actions:

  • Occlusives, which provide a layer of oil on the surface of the skin to slow water loss and thus increase the moisture content of the stratum corneum.
  • Humectants, which are substances introduced into the stratum corneum to increase its water holding capacity.

Some moisturisers contain both occlusives and humectants.

Occlusive moisturisers

Occlusive emollients consist of oils of non-human origin, either in pure form or mixed with varying amounts of water through the action of an emulsifier to form a lotion or cream. A large variety are available, reflecting that there is no '‘right’ moisturiser for all patients: the most suitable one often having to be found by trial and error.

  • Bath oil deposits a thin layer of oil on the skin upon rising from the water.
  • Lotions are more occlusive than oils. These are best applied immediately after bathing, to retain the water in the skin, and at other times as necessary.
  • Creams are more occlusive again. Thicker barrier creams containing dimeticone are particularly useful for those withhand dermatitis.
  • Ointments are the most occlusive, and include pure oil preparations such as equal parts of white soft and liquid paraffin or petroleum jelly.

The choice of occlusive emollient depends upon the area of the body and the degree of dryness and scaling of the skin.

  • Lotions are used for the scalp and other hairy areas and for mild dryness on the face, trunk and limbs.
  • Creams are used when more emollience is required on these latter areas.
  • Ointments are prescribed for drier, thicker, more scaly areas, but many patients find them too greasy.

Aqueous cream is a good all-round moderate-strength moisturiser that suits many patients because it is non-greasy, cheap and available in bulk without prescription. Because it contains an emulsifier, aqueous cream can mix with sweat and it can be washed off. Aqueous cream can be made greasier to suit individual preferences by adding white soft paraffin.

250g (or ml) is a minimum quantity for an occlusive emollient and often 500g or 1Kg is needed: liberal and regular usage is to be encouraged. How frequently it is applied depends on how dry the skin is: very dry skin may benefit from a greasy emollient every couple of hours, but a light moisturiser may only be needed on slightly dry skin at night.

Humectants

Humectants, agents adding water to the stratum corneum, include:

  • Glycerine
  • Urea
  • Alpha hydroxy acids such as lactic acid or glycolic acid. At higher concentrations these also have a descaling or keratolytic action by thinning the stratum corneum: they are often known as peeling agents.

Urea and lactic acid preparations often sting if applied to broken (scratched or cracked) skin. Humectant / keratolytics are particularly important in management of the ichthyoses (inherited or acquired scaly disorders of the skin).

Adverse Reactions to emollients

  • Irritant reactions - A common irritant reaction to occlusive emollients is ‘overheating’, resulting in a burning sensation. Some people experience stinging reactions from certain moisturisers, sometimes from most. This is particularly common in those with a tendency to atopic dermatitis or with rosacea. Stinging is often an irritant reaction to some component of the cream or lotion base rather than a true allergy. If irritation is only transient it may be decided to continue the preparation. However if the stinging is more troublesome, trial and error will generally find an alternative preparation which can be tolerated.
  • Allergy - True allergy to moisturisers and emollients is rare. Suspected contact allergy can be investigated by patch testing. But even if a patient's allergens are identified, their presence in commercial preparations can be difficult to ascertain and it often comes back to trial and error.
  • Folliculitis - Over-occlusive emollients can result in blocked hair follicles and painful pustules (folliculitis) or boils.
  • Facial rashes - Over use of facial moisturisers, especially if they are occlusive, can aggravate acne or cause an unsightly rash, perioral dermatitis.

Dear Friends
 
Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified DermatologistMy goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results and the best dermatologist. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
Dr. Rothfeld
 

  
 
 

 Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist. 
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips.  
.

During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

 

Sun Protection

 

Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures to avoid overexposure.

 

Although many people enjoy the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types:

  • UVC rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
  • UVB rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
  • UVA rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and can penetrate windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight, there are five basic defenses that you should keep in mind when you go outdoors:

  • Avoid peak hours of sunlight
  • Sunscreen
  • Clothing
  • Sunglasses
  • Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

  • 0 to 2 = Minimal
  • 3 to 4 = Low
  • 5 to 6 = Moderate
  • 7 to 9 = High
  • 10 or more = Very high

The UV Index can be found on our Website or in local papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right sunscreen. (See the Sunscreens handout for more information.)

Sun protection actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens. 
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

Common sunscreen ingredients that  provide protection from UVB rays:

  • Cinnamates
  • Octocrylene
  • PABA (para-aminobenzoic acid)
  • Padimate O and Padimate A (Octyl Dimethyl PABA)
  • Salicylates

Common sunscreen ingredients that  provide protection from UVA rays:

  • Avobenzone (Parsol 1789)
  • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

  • Zinc oxide
  • Titanium dioxide
  • Iron oxide

Although past formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously and reapply frequently at least every two hours.


The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.


No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun's rays.

Clothing

Clothing can provide excellent protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection from UV rays. When selecting clothes for sun protection, consider the following:

  • Cover your head, shoulders, arms, legs, and feet.
  • Use a hat that is broad-brimmed (brim should be at least four inches wide).
  • Wear fabrics that are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
  • Wear darker-colored clothes that absorb more UV rays.
  • Wear clothing made from nylon or Dacron because it is more protective than cotton.
  • Avoid remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
  • Wash clothing with chemical absorbers to increase their protectiveness.
  • Some clothing comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

  • Good protection: UPF = 15 to 24
  • Very good protection: UPF = 25 to 39
  • Excellent protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

Summary

  • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
  • Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
  • Use a sunblock on your lips.
  • Wear a broad-brimmed hat when outdoors.
  • Wear sunglasses.
  • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
  • Stay in the shade when possible.
  • Avoid reflective surfaces, such as water or snow.
  • Avoid sunbathing.
  • Don't be fooled by cloudy days since damaging rays can penetrate clouds.

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