Most of us have likely experienced it at some point over the past months while making efforts to keep our hands sanitized: Tight feeling, dry, itchy hands that turn hand hygiene into an unpleasant if not painful experience. Learn more about how hand sanitization practices can cause irritation or dryness and what we can do to prevent the symptoms.
Our skin is our first line of defense against external intrusion from infection, chemical substances and potentially harmful radiation. It helps us sense our surrounding with the help of receptors and innervation and is involved in the regulation of body functions like temperature and the endocrine system. To optimally fulfil its physiological functions, the skin needs to have an intact structure including the subcutis, the dermis and the epidermis with its outermost layer, the stratum corneum (Latin for horny layer).
The stratum corneum as the top part of the epidermis is the key structure for maintaining skin hydration and providing the physical protection function for our skin. This barrier also continuously renews itself by a process called desquamation. Desquamation is the final stage in the lifecycle of the main skin cell type in the epidermis. It includes their maturation and change from keratinocytes (in the cell layers close to the dermis) to mature corneocytes in the upper layers of the epidermis and the stratum corneum.
Here, corneocytes help provide the barrier function in combination with surrounding lipids that they are embedded in. This structure is comparable to a wall constructed of bricks (corneocytes) and held together by mortar (lipids). Stratum corneum lipids are produced by younger keratinocytes during their maturation and fill up the space between the flat shaped corneocytes.
Corneocytes also contain NMF (Natural Moisturising Factor) made from small, water soluble molecules like amino acids, urea, glycerol and multiple acids which can absorb and hold on to water. They are the skin´s own humectants.
The thickness of the Epidermis varies in different areas of the body. It is for example thicker under the soles of our feet and inside the palms of our hands thanks to one specific part -the stratum lucidum.
The science behind dry skin
When the skin is healthy and functioning well, the stratum corneum helps prevent water from evaporating from the deeper layers of the skin (called TEWL or Trans Epidermal Water Loss).
For this, the brick and mortar structure made from corneocytes and skin lipids needs to be intact, so all mechanisms that deliver these structures (keratinocyte maturation, NMF and lipid synthesis) need to be functioning normally.
When these mechanisms are disturbed, or the structures providing the barrier function are removed or out of balance, the skin barrier can be impaired in its function to prevent TEWL and skin can become dry.
Causes for dry skin
Let´s start with another question: What actually is dry skin? Dry skin symptoms can include skin that feels and looks tight or rough including flakiness, scaling or peeling which can lead to an ashy appearance, itching, dehydration lines and in severe cases even cracked skin and bleeding.
Dry hands can occur naturally because of skin conditions that are linked to an imbalance of the natural mechanisms that generate the skin barrier like for example atopic dermatitis (eczema) or psoriasis. But dry skin can also be produced when our hands are exposed to harsh environmental factors that affect the order and integrity of our skin barrier or increase trans epidermal water loss, which in turn itself can throw the entire process of skin barrier maintenance and function off balance.
Environmental factors, habits and ingredients that can affect the moisture level of the skin
Depleting stratum corneum lipids by using detergents or surfactants that “wash” lipids out of the brick and mortar structure, over exfoliation that removes an excessive amount of corneocytes or an increased TEWL caused by some hand sanitizers can worsen existing dry skin conditions or contribute to causing dry skin on our hands.
While washing (lipid depletion) and towel-drying (exfoliation) our hands as well as the use of hand sanitizer (increased TEWL) are key, some ingredients, environmental factors and aspects of these routine gestures can be extra detrimental to the skin barrier. Being cautious of these factors and adapting to them can substantially help improve dry skin on the hands.
Living in a dry climate is a factor that we cannot do much about unless we decide to move. However, we can make choices about how we wash our hands.
Anionic surfactants
- Anionic surfactants like the ones found in traditional soap tend to be more stripping and disrupting when it comes to removing not only soil and grime but also skin lipids from our hands. Replacing cleansers that are solely based on anionic surfactants with products that rely on a combination of surfactants, are based on amphoteric technologies or are formulated with lipid replacing, moisturising or replenishing ingredients can make a big difference. Completely removing all cleanser residues by proper rinsing after washing is also a must.
Water temperature
- Using cold or moderately warm water as opposed to hot water provides a gentler wash.
Using rough towels or paper towels
- Drying the hands after washing can have an exfoliating effect which can contribute to disrupting the skin barrier by mechanically removing corneocytes. Using a soft towel and gently patting hands dry is another step that can help prevent dry hands.
Type of alcohol in hand sanitizer
- There also seems to be an impact from how alcohol- based hand sanitizers are formulated. While 70% isopropanol and min. 60% ethanol-based sanitizers are both suggested for effective hand sanitization, there seems to be less impact on the TEWL from using products formulated with ethanol.
Why are hands and faces treated differently in respect to skincare?
The skin on our hands is different in structure from our facial skin. Like we said earlier, the stratum corneum inside the palm of the hands is thicker compared to other parts of our body. Facial skin is thinner than skin across the rest of the body with the areas around the eyes and the lips being extra sensitive. The stratum corneum of the lips is so thin so that our lips are prone to be particularly dry if we don´t pay attention. The main other reason why we treat our hands differently than the skin in our face is that we use our hands as tools to sense and also manipulate our surrounding by touching different objects all the time. During this process we constantly contaminate our hands by loading the skin surface with soil, bacteria and other components from our environment and thus it makes sense to clean them often by washing them or using hand sanitizer in situations when washing is not possible.
Effective strategies to help moisturise dry hands
We can help prevent dry hands from happening by including small changes in our washing routines like moderate water temperatures, proper rinsing and gentle drying. Choosing cleansers formulated for sensitive or dry skin that are moisturising can make a big difference for the skin barrier.
The dose makes the poison, and the formulation makes the effect. A single ingredient by itself doesn´t do much without a good formulation to provide an effective context. Even ingredients that are not listed or mentioned below can be formulated into products that are gentle, and suitable for dry skin.
Cleansers
Secondary surfactants from the amphoteric group like Cocamidopropyl Betaine or nonionic surfactants like Coco-Glucoside can significantly lower the drying and irritational potential of anionic surfactants in a formulation.
The inclusion of humectants like Glycerin or Urea are beneficial even in a rinse-off formula.
Lipids like Jojoba Oil or Soybean Oil can contribute to the overall moisturising and replenishing effects of a cleanser.
Moisturisers
Using a moisturising hand cream regularly, most importantly after hand-washing but also as a treatment mask or overnight is an effective way to keep dry skin on the hands at bay. Hand moisturisers can utilize different technologies to keep the stratum corneum hydrated and the hands soft and smooth
Emollients like Shea Butter , Cholesterol and Caprylic/Capric Triglyceride help replenish the loss of lipids and can help curb the increased TEWL of dry skin. Ceramides can help strengthen the skin barrier by adding to the “mortar” substance giving cohesion to the stratum corneum.
Humectants
In addition to Glycerin or Urea, Lactic Acid which, like Urea is a part of the NMF can be beneficial in moisturizing hand formulations and balms.
Balancing ingredients like Allantoin or Oat Extract that help soothe symptoms like redness or itching can provide extra relief from the discomfort of dry skin.
Sanitizers
When hand washing is not an option and alcohol-based sanitizers are the alternative to be looking for, formulations based on ethanol rather than isopropanol seem to be the more gentle choice and a study recently published in the journal Dermatitis indicated that ethanol-based sanitizers that contain urea could have a beneficial effect on the skin barrier, too. Humectants like glycerin can provide additional hydration.
What are the effective technologies to address dry & cracking skin?
For very dry skin a hand cream with occluding ingredients to provide immediate barrier support is a first option to provide relief. Moisturizers with a high amount of occlusive lipids like Petrolatum or skin identical lipids like Cholesterol and free fatty acids such as Stearic Acid sometimes come in the form of ointments or salves, which are traditionally heavier and sometimes include waxes like Beeswax or Carnauba Wax to help optimize an occlusive effect.
Regular moisturization to help restore the balance of the barrier-generating processes including the keratinocyte maturation, NMF and lipid production is key.
Skin that is pathologically out of balance and severely dry to the extend where the skin is broken or cracked might need the supervision of a dermatologist. Severely dry skin should not be treated with cosmetics or at home remedies.
How about SPF for hands?
After discussing the difference between our hands and the rest of our body, let´s look at what the skin on our hands and the skin in our face actually have in common.
One often forgotten fact is that our hands are exposed to the sun and UV damage almost as much as the face is and should as a matter of fact receive the same attention as the face when it comes to sun protection. Using a hand cream with SPF daily isn´t only advisable, it also makes sense to be reapplied during the day if the hands are continuously exposed to the sun. A formulation with a good UVA absorption range makes sense even indoors if siting by a window or driving a car is a regular scenario. After all, UVA does penetrate glass as well.
Effective hand sanitization and hand care are possible at the same time
Can you keep your hands sanitized and cared for at the same time without developing angry, dry skin that unpleasantly complains every time you turn on the faucet? For some of us especially with pre-existing conditions this is going to be more difficult than for others with less sensitive skin and a more robust skin barrier but there are steps that can be taken:
Adapting how we wash and dry our hands: Moderate temperatures, gentle drying, barrier-gentle cleansers like
- Avene XeraCalm A.D Lipid-replenishing cleansing oil
- Cetaphil Restoraderm Soothing Wash
- Eucerin pH5 Handwash Oil
Or
Regular use of a moisturizer
- La Roche Posay Lipikar Xerand for hands
- AVEENO® Skin Relief Moisturising Hand Cream
- AmLactin® Ultra Smoothing Intensely Hydrating Cream
Or if you prefer balm:
And if adequate a formulation with SPF like
- Daily Hydration Hand Cream Broad Spectrum SPF 30
- Neutrogena Norwegian Formula Visibly Renew Elasti-Boost Hand Cream SPF 20
Conscious choices about hand sanitizers
And if the dryness gets out of hand the best thing to do is to consult with a dermatologist.
References
- Cosmetic Dermatology, Products and Procedures, Blackwell Publishing Ltd. 2010, pp 3, pp 95, pp 106, pp123, pp 130
- Journal of Drugs in Dermatology, September 2016, 1;15(9) p 1047-51.
- Journal of Investigative Dermatology, June 2005, 124, p 1099-110
- International Journal of Cosmetic Science, March 2017,39, p 366-372
- International Journal of Environmental Research and Public Health, May 2020, 17, pp 3326
- Cureus, April 2020, doi: 10.7759/cureus.7506
- Dermatitis, June 2020, doi: 10.1097/DER.0000000000000612
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