HVF006 – Dr George Moncrieff

Tony Winyard 0:00
Happiness versus flourishing episode six. In this week's episode, we talk about showers, washing and soap, and why those things shouldn't go together. Welcome to the podcast where we aim to give you ideas how you can improve your life in small ways. We have different experts talking every week on subjects that help to improve your life in some way or other. And this week is Dr. George Moncrieff, who talks about why we shouldn't be using soap and the damage that soap causes to our skin. So that's coming up very soon. If you do like this episode, please do share it, there's probably going to be lots of people you know, who suffer in some ways, and will definitely benefit from some of the things that George talks about in this episode. why not subscribe? leave a review for us. And that lets more people know about the show. So more people subscribing get to get to hear the show on a regular basis. Hope you do enjoy it, and is this week's episode.

Tony Winyard 1:15
Welcome to another edition of happiness versus flourishing. And my guest today is Dr. George Moncrieff. How are you, George?

Dr George Moncrieff 1:22
I'm very well. Thank you. Thanks for inviting me.

Tony Winyard 1:25
Thank you for coming on, because this is quite an important topic. And it doesn't get the publicity or the exposure it should.

Dr George Moncrieff 1:38
I couldn't agree with you more. I think it really is a message that we do need to get out and try and let more people know that subtle changes in their lifestyle could make enormous differences to how they feel, and in particular to the health of their skin.

Tony Winyard 1:54
I've read a few articles and I saw you were interviewed on "This morning", was it?

Dr George Moncrieff 2:01
Yes. I have been on there a couple of times. Yes.

Tony Winyard 2:05
It was fascinating watching that. So for the people who maybe haven't read the show notes and aren't aware of what we're talking about. You're a firm advocate in the belief that we don't need to be using soap when when we shower?

Dr George Moncrieff 2:20
Well, more than that we need to avoid it as much as we can. There's one caveat I have to say currently and that we do need to use soap and detergents to kill the Coronavirus and so on what I said on This Morning, and then I got some rather strange social media comments was that I hadn't washed for 20 years. That was a year ago when I said that. And I got a rather extraordinary look from Holly I think. But yeah, I do wash every day but I make a point of avoiding soaps and detergents because they are remarkably unnatural and remarkably damaging to your skin. But of course never previously had Coronavirus to worry about. And yeah, we do need to use soap to kill the Coronavirus so that you can modify the way in which you wash and get the best of all worlds. But we shouldn't be putting the detergents on our skin that we have been doing for the last 40, 50 years.

Tony Winyard 3:21
Before we dig deeper into that, how did you discover this? Is it something that many doctors know about?

Dr George Moncrieff 3:31
I think many doctors are conscious that detergents damage skin. I don't think necessarily the message has got through to the extent that I believe it matters and they should understand. The problem arises really because if you look at our ancestors, they didn't wash, we go back 100 hundred 50 years, they just didn't wash. I'm told that even Queen Elizabeth the first only washed with soap about four times a year. It wasn't safe in those days. And years ago people just didn't wash, our skin has never had an opportunity to evolve to cope with the washing and detergent demands that we put on it nowadays. It wasn't designed for that. And detergents do actually cause remarkable damage to the skin. And if you just look at the number of children with eczema. After the Second World War, when very few people were washing on a daily basis, it was an unusual habit and people would perhaps wash once a week in the family bath in front of a fire or whatever. It wasn't a regular experience. Back then 70 years ago, only about one in 20 children had eczema. And we have seen that those numbers have increased relentlessly till now one in four, or one in five children have eczema. And that's an epidemic level. And the thing that I think has changed most dramatically, there's been a number of changes during that time. But one of the most dramatic has been that everyone is now washing at least once a day, sometimes twice a day. And children from a very young age are exposed to a lot of detergents, bubble bath, soap shampoo. And this is causing untold damage to their skin.

Tony Winyard 5:31
How does it cause eczema?

Dr George Moncrieff 5:34
Well, detergents are designed to remove grease, that's what they're meant to do. Now the very, very top layer of your skin, the skin has a couple of layers, deeper down you have the dermis, and then above that you have the thinner, more delicate surface called the epidermis. The top layer of the epidermis is where you have what we call the skin barrier. And that's actually a remarkably sophisticated barrier. It's designed to prevent water escaping from your body. So you don't dehydrate and also to prevent bacteria, other bugs getting in and also allergens getting in. So detergents are designed to remove grease and between the cells and the very top layer of your skin, what are called the corneo sites, you have a fatty membrane almost like a sort of a layer between them rather like cement in a brick wall. And this is made up of cholesterol and waxy materials called ceramides. And all sorts of other fatty materials that sit between the cells sealing it between those cells. And detergents will rip that out. It's called the lipid lamellar bilayer because these fats often have very long nonpolar chains, which don't like water, and then they have little polar nodules at the end. And so they naturally orientate themselves into a bilayer where the the nonpolar chain ends point inwards. And the polar ends point outwards facing water. So forming this bilayer was called a limpid lamella bilayer. The other thing that detergents do is they raise the pH of the skin, they render the skin alkaline. Normally, the skin has a really important what's called acid mantle, it has an acid environment on the surface that isn't there by chance is there for a really good reason. That acid mantle controls the activity of the body's natural enzymes, chemicals that break down the bonds that hold the skin cells together. So if you raise the pH from its normal acid mantle with a pH of about 5.5, with a detergent, you can raise it up to about a pH of eight, which is 1000 fold more alkaline than a pH of 5.5 and or nearly 1000. And that activates it doubles the activity of these enzymes. So they start breaking down the bonds that hold the skin cells together. And that causes skin to lose moisture become dry, feel itchy, and then if you scratch it, it becomes inflamed. And then that inflammation switches off the body's natural processes for producing that lipid lamella bilayer. And for producing the acids that you need on the surface and also the body's natural chemicals that are called natural moisturising factors that are within the cell and hold moisture there. So the whole process breaks down, bacteria get in and that triggers abnormal immune reactions that drive eczema.

Tony Winyard 8:49
You mentioned in the statistics that a number of people who are getting eczema, but I'm guessing from what you were saying that even people who don't have eczema are suffering, but they think they're fine?

Dr George Moncrieff 9:02
Yeah, I'm a GP. But I've been working very significantly in the world of Dermatology now for over 20 years, and now almost exclusively in the world of skin disease. And so most of my working days spent talking to people with skin problems. And I just see people coming through the door or nowadays actually on the video because video consultations, I'm just seeing loads and loads of people who who just had no idea that the reason why their skin is dry and itchy is because they're washing with detergents on a daily basis. And what I say is Look, your eczema will never settle unless you stop these detergents. You're just not giving the skin a chance. But lots of people even without eczema are going around with dry, itchy skin and have no idea yhat is washing their skin that's causing the problem. And then the skin feel sensitive it feels uncomfortable. and sensitive and their night is spent scratching rather than sleeping.

Tony Winyard 10:00
When you were just saying about those patients that you mentioned to them that it's the soap that's causing the eczema. What kind of reaction do you get from people when you say things like that?

Dr George Moncrieff 10:09
Well, one of the first questions I ask somebody with dry skin or eczema is tell me, how do you wash? And they often look quite astonished by the question as if what business is that of yours? And what's wrong with washing? It's so ingrained in our culture now that we must wash and we must wash regularly and that cleanliness is next to godliness. I think I'm clean; I wash every day, but I don't put detergents near my skin unless I want to get rid of the Coronavirus. So what I want to know, is how do you wash? Are you having a shower? Or do you have a bath? How hot is it? How long are you in the water? Some waters, particularly hard water are quite strong alkaline. So if you're in the water for more than 10 or 15 minutes that will start to do harm. If you're in it for less than that its possibly hydrating the skin. So being in water for up to say 10 minutes is probably doing more good than harm. And water will do most of the washing. Water is very powerful at killing bacteria on its own. And you can wash most things off with water. And then, but I want to know, are you using a shower gel? Are you using soap are you producing a huge lather on your skin which is ripping into that skin barrier and damaging it. If you wash your hair with shampoo does that shampoo rinse down over your skin. Because as we get older, our grease glands get less active, our skin barrier becomes much much thinner. And the junction between the top layer of the skin the epidermis and the deeper level is much more fragile and it can tear more easily. And you can lose moisture much more quickly. So the washing habits that your skin could tolerate when you were a teenager with spots of greasy skin suddenly becomes something that dries out very quickly and becomes very dry and itchy and unpleasant.

Tony Winyard 12:03
You mentioned just then about when they're washing their hair, to not let the shampoo drip down onto the skin. Is shampoo stronger than normal soap?

Dr George Moncrieff 12:15
I don't know. I'm not sure it's necessarily stronger. There are different sorts of soaps. Soaps were discovered properly in about the mid 19th century prior to that we didn't have much access to soap of course, soaps are designed to enable fats, the fats on our skin to be mixed with water and then to be lifted off. These harsh original soaps, which often gets into simple soaps and soap bars are particularly damaging and can have a very high pH indeed. You then have the synthetic detergents, sometimes called syndet, synthetic detergents which have a much gentler and then you can have combi bars or combars, which is a combination of a half soap and a more synthetic, gentler soap which isn't quite so alkaline. So there are different sorts of soaps and things. But many of these agents like shower gels and shampoos contain chemicals that enable the soaping agent to lift off the fats even better things like sodium lauryl sulphate, which is present in lots and lots of soaps and shower gels. And that has been shown to be particularly damaging to the skin barrier. It really does break it down and it actually damages normal skin very quickly. And it's present in some emollients that people use. So things like aqueous cream, I think shouldn't go anywhere near the skin even as a soap substitute as an emollient soap substitute, or emulsifying ointments, which is a thicker, greasy ointment from which aqueous cream is made by mixing it with water to things that contain sodium lauryl sulphate, which is a soaping agent is the melt device enables fats to mix with water are particularly damaging to the skin. But I don't like that shampoos. Basically you need to wash your hair, otherwise it'll smell. I think that's very reasonable but ideally wash your hair. But why are you washing your scalp? The scalp doesn't have to be washed and people often have a dry itchy scalp. So if you've got nice long hair, wash the hair but try not to get too much shampoo onto the scalp and there's absolutely no need for that shampoo to go onto your body as well. At the very least lean well forward and rinse it off your body not onto your body because areas like your legs have very inactive grease glands. And if you let all that detergent wash past your legs as well as washing your legs and every bit of detergent that goes on your skin going past your legs. Your legs become dry and cracked and sore And then just causes eczema down there, which I see all the time.

Tony Winyard 15:06
You mentioned about shampoo. What about hair conditioner?

Dr George Moncrieff 15:10
Yeah, I don't mind hair conditioner Actually, that's what I tend to use. I tend, for the last 20 years... if you see a photograph of me, I haven't got any hair. But I've got a little bit and I only use conditioner, I put conditioner on a couple times a week. And I don't think conditioner does any harm at all. But I don't use much, partly because I haven't got much hair, but enough to cover perhaps a fingernail! And I make sure I rinse it thoroughly off, make sure I don't leave any behind my ears, and I rinse it off my body not on to my body.

Tony Winyard 15:42
So conditioner is okay for the hair. But that's not advisable for the skin?

Dr George Moncrieff 15:50
It's basically anything that forms a foam will be lifting off the oil and will be relatively alkaline and causing damage.

Tony Winyard 16:01
I heard that using soap can also be damaging for vitamin D, which is something that's really important for us, especially in this whole climate with COVID.

Dr George Moncrieff 16:14
Interesting, I didn't know that soaps interfere with vitamin D, I need to look that up. But I am certainly aware of how incredibly important vitamin D is for our general health and also in particular for our skin health. And I actually take vitamin D all year round. But even higher doses in the winter. there's little doubt that vitamin D deficiency... actually interestingly, if I see a child with severe eczema, they invariably have very low levels of vitamin D. And so part of my consultation is talking to them about the importance of taking vitamin D supplements, I'm not so keen for little children to get themselves out in the sun. Because I'm concerned about sun exposure. As far as skin cancer in later life, particularly in children under 11. But in adults, you've got the option of going out and getting a bit of natural sunlight; just don't burn. But I think children certainly who have had eczema... And when you give them vitamin D, and you correct their vitamin D deficiency, suddenly their eczema becomes much easier to control, it can often be all that they need to get theie eczema back under control. But we use light therapy to treat a number of skin conditions including eczema. And I'm sure that's partly through the manufacturer of vitamin D in the skin.

Tony Winyard 17:41
The article said that soaps interfere with vitamin D absorption, apparently,

Dr George Moncrieff 17:48
Really? Absorption from the skin.

Tony Winyard 17:51
I presume so yeah.

Dr George Moncrieff 17:53
Doesn't greatly surprise me. Vitamin D has a lot of important functions in the skin amongst its functions. And did you know that in the deeper layers of the epidermis, what's called the stratum spinosum. And I'm talking about a layer of the skin that in some parts of the body is a 10th as thick as a piece of paper. It's astonishing, isn't it? And then other parts of the body like your heel or your scalp, it can be a good four or five millimetres. But these are all the epidermis. And in the deeper layers of that from the stratum spinosum you are actually producing over 1800 natural antibiotics. Chemicals like the defensins and cathelicidin. And these are bodies natural antimicrobial peptides. And the production of those is controlled by adequate levels of vitamin D. Vitamin D is a remarkable molecule and I I've never seen... contrary to what I was taught in medical school, but there's a risk that you can become vitamin D intoxicated, I have never encountered that. I think it can happen but it's remarkably unlikely. So almost take as much bisman D as you can get off the shelf is my current view. And the vitamin D molecule actually, like steroids is an elaboration of a cholesterol molecule. The body makes cholesterol and that is modified to turn into steroids. Both the sex steroids like testosterone, progesterone oestrogen, but also the steroids that we call steroids the body naturally needs and uses to signal things and control inflammation in the body and control many other functions like salt and blood pressure, salt levels of blood pressure, but vitamin D is a further subtle modification of that same molecule. So just in the way that steroids go around the body and have remarkable effects. So vitamin D goes around the body and acts a bit like a hormone. It actually controls a large number of functions of the body from Cancer surveillance through to immune regulation. And we now know that vitamin D deficiency also puts you at much greater risk as you're hinting of COVID. So another good reason not to become vitamin D deficient.

Tony Winyard 20:15
You just reminded me I read a book about a year or so ago by Bill Bryson About The Body. And he mentioned, I can't remember the exact quote, but it was something about you mentioned about how thin the epidermis and the layer of skin. And within that I don't know if it was the epidermis, or the dermis is our...

Dr George Moncrieff 20:37
Melanocytes? are your melanin producing cells, and they rest on the basement membrane, which is what the epidermis sits on as well. So they're sitting in the bazel layer of the epidermis, the melanocytes, but these remarkable cells, which migrate to the skin quite late in the life of an embryo. And a bit later, still, they have very long finger like processes that extend up into the higher layers of the epidermis, and interestingly communicate with virtually every cell in the epidermis. So they had these little things like processes that wriggle between the cells and go up and then join them. And then there's epidermal cells. Along those arms, are little packets of melanin called Mulana zones. And then the epidemic sites actually suck that into the mulanazones and suck it into their own cell, structure the cytoplasm. And then they released these little packets of melanin in these mulana zones into their cytoplasm, but then incredibly concentrated like an umbrella on the outer surface of the nucleus of their cell. So it just has a little cap sitting on the outer surface of the nucleus, in the cytoplasm, just like an umbrella, and thereby protect the nucleus from the DNA damage from irradiation. Isn't that astonishing? They are so clever. So that's the melanacytes and melanocytes produce different sorts of melanins. There's brown eumelanin, there's Black eumelanin. But as our ancestors migrated to latitudes where the sunlight was weaker, somewhere between 50 and 200,000 years ago, we have evolved to make a deliberately weaker melanin called pheomelanin, which is pink, and therefore gives us our white skin. And I think we did that because the evolutionary advantage of letting more sunlight through drove the need to have a weaker melanin. In other words, evolution tells us that sunlight matters and sunlight is good. And when the sunlight is weaker, you don't want to filter out too much by having dark skin. Now, it's very, very interesting concept. I could go on about that a lot more detail. But that's not the purpose of today's talk.

Tony Winyard 23:03
It's fascinating. Yeah. And there was there's something else now, again, in in any article I read about this soap affects our microbiome.

Dr George Moncrieff 23:13
Yeah, it does. Soap is powerfully antiseptic, so it will kill bacteria. And we have about a million bacteria living on our skin, in every centimetre of our skin, a million. The total number of bacteria on a healthy person's skin is 10 to the nine that's 10, with nine noughts after it (10,000,000,000). So billions, billions and billions. In fact, in your body, if I included the bacteria in your gut, there are 10 times more bacteria in your body bacterial cells, and there are cells of you Tony, its a 10 to one ratio of bacteria to you, as far as cells are concerned. Fortunately, the cells are tiny, so they only weight about four or five kilogrammes at most, but we're all going around with this huge bacterial load and it's incredibly important. We're only really beginning to realise how important our micro biome is, both in the gut and on the skin. But soap will kill that bacteria and leave the door open then for bad bacteria to get onto the skin and in eczema about 90% of people with eczema have an abnormal skin barrier all over not just where they're exhibiting eczema, but all their skins abnormal. All their skin has a higher pH and they're much more likely to be colonised with bad bacteria things like Staphylococcus, which causes boils and causes eczema flares. People without eczema, only about one in 10 or one in five, are carrying a bad staph. Their Staphylococcus is bad bacteria and we normally have between 200 and 500 different types of bacteria on our skin and we have different patterns and balances of the bacteria in different parts of our body, whether it's your armpit or your foot or your nose or your side of the nose or your hair and that diversity is lost in eczema and detergents will definitely destroy those bacteria. But we need those bacteria we have evolved to live with them, they are doing a lot of good they actually preserve and build up that skin barrier I mentioned at the beginning.

Tony Winyard 25:26
And you said that makes them more open to being attacked by bad bacteria. So would that include things like viruses?

Dr George Moncrieff 25:37
I think if the skin barrier is damaged, then viruses do have a better chance of getting in. And the notable one is the herpes virus in eczema, which can cause a really really frightening and dangerous acute rash called eczema herpeticum. That actually also is if the skin becomes inflamed, you switch off those antimicrobial peptides I mentioned earlier, and they're the things you actually need to prevent eczema herpeticum from getting a foothold. So the skin barrier is broken and it's inflamed, you actually switch off the antimicrobial peptides amongst other things and lay the patient vulnerable to eczema herpeticum. But as far as Coronavirus is concerned, I wonder whether you're moving on to thinking about that. The Coronavirus needs access to our skin via a particular receptor called the angiotensin converting enzyme 2 receptor or ACE2 receptor. And fortunately, there are very, very few Ace receptors or ACE2 receptors in the skin in the epidermis. So even if the skin is broken, you're not likely to get invasion of that particular virus because you haven't got the receptors for it. There's receptors in our respiratory tract in our nose and our lungs. Also in our blood vessels, kidney, heart brain, but not particularly in the skin. Because if your skin is broken, you can probably harbour viruses in the cracks in your skin. And if your face also is sore, you're going to have your hand going up to your face even more often. And therefore you can carry the virus up there more easily because you've got larger amounts of it and of course if your skin is sore and broken, you're going to be less inclined to wash your skin with things because you know that that makes it even more sore. But the Corona virus has the same lipid lamella envelope the envelope of the Coronavirus is also a lipid lamella by envelope and the spike proteins are attached to the to the outside of that. And so detergent are really good at ripping out our own lipid lamella by envelope between the cells rapidly break down the coronavirus lipid lamella by envelope and kill it. So very minimal exposure to detergents will kill the coronavirus.

Tony Winyard 28:00
And so hence why we've been told to wash our hands all the time.

Dr George Moncrieff 28:08
If you're out and about, it can be more convenient. But its gonna have to have 90% alcohol to have any benefits and at that level the alcohol is pretty damaging to the skin barrier too. The ideal is... and for years I said wash with an emollient, but I wouldn't want to do that nowadays because that's emollient would coat that lipid lamella by envelope of the coronavirus and just protect it. So I've had to amend my ways and I had to bring soap into our house which is really quite difficult for me. And I now do wash my hands carefully and thoroughly with soap. Acknowledging that I'm causing untold damage, and I'm probably killing all my natural microbiome and rendering it alkaline and whipping up my normal fatty layers and removing a little bit of sweat, which is really nice and acid and really good for the skin. But then I rinse that off thoroughly. And I then having killed the virus and then wash with an emollient any simple emollient, it doesn't matter what you use. That will mix with water nicely and will restore some of that fatty layer. But most importantly, will restore the pH and then you rinse that off dry hands and then I think you should then put on another emollient afterwards. And by doing it that way, you can prevent all that terrible hand dermatitis that people are seeing from over washing their hands, just with detergents and then rinsing them drying them and heading off.

Tony Winyard 29:29
And would that just damage the hand area or would it spread to anywhere else if you were just using it on your hands?

Dr George Moncrieff 29:37
Oh, I think you've just used it on your hands. It would probably only damage the hands but if that were to let in or cause a break, you're then more vulnerable to developing a contact allergic dermatitis. We're talking here about full contact irritant dermatitis from the irritant effects the detergent causing a localised dermatitis. But if you've got the skin barrier broken, then you are opening the door for more trouble including contact allergic dermatitis, and once you've got that, then trivial exposure to that thing you've become allergic to can cause quite marked reactions and dermatitis elsewhere, notably on the face of the skin barrier is thinnest and weakest.

Tony Winyard 30:18
A couple of questions I can imagine many people thinking at the moment. Because we've all been conditioned, I guess to to think that using soap is something we obviously have to do. So the three questions that come to mind, I'm guessing you probably received far more than these three I'm going to ask are: Why don't you smell terrible? Why don't you look dirty? Why don't you get sick?

Dr George Moncrieff 30:42
Right! Well, I hope I don't smell, but I do wash I wash every day. But I wash with an emollient, so I am re-greasing my skin and not degreasing it, I'm maintaining that Ph. and that pH, by the way, also enables the adhesion of healthy bacteria. And it helps them to stay on the skin, which is what you want. And it's actually very good at killing, its anti septic for those bad bacteria, things like staph. So that pH is incredibly important for a whole host of reasons, which is why the bodies evolved to have it. I do wash and I wash very thoroughly. And I wash with an emollient and it's a lovely feeling when you're in the shower and you're washing with it, you do need to be careful, it will render you and the shower tray or the bath extremely slippery. So you've got to be very careful. And because putting an emollient, which will then go down into the drains, it can clog up the drains and probably clog up the sewers. So I do pour boiling water down once a week or put soda crystals down the shower tray but not onto my skin and make sure it doesn't get blocked. Why don't I smell because I'm clean and actually interesting. You know, if you stop, you went camping somewhere. You went off camping for a month, or went on a boat for a month and you couldn't wash. You'd be amazed how wonderful your skin would look and how wonderful your hair would look. Initially it would get a bit greasy, and then it'd calm down. And as the skin microbiome begins to recover, and the whole grease gland activity just balances back out again. It'll end up looking wonderful. And interestingly it doesn't smell because your microbiome becomes the normal healthy microbiome. Its bad bacteria that tend to produce offensive smells.

Tony Winyard 32:34
I've heard that body odour is more about what we eat rather than what's on our skin?

Dr George Moncrieff 32:40
I think that has a big part to play in this as well. Yes. And it comes out in your sweat in your and certainly into your armpits. And thing's like that, and certainly if I've had anything with garlic, you know that things like even your sweat can sweat a bit garlicky? Yeah. So yes, that has a big part to play. But I think it's a lot to do with the bad bacteria. And just maintaining a healthy microbiome... this era of washing, which is predominantly in the last 50 years. But it's only really at all in the last 150 years is a fraction of a second in the lifetime of mankind, we've been on the planet three and a half million years. So our ancestors just didn't wash and our skin was meant to be washing like we are today we would have fish scales. The skin cannot cope with this demand. And it's very, very abnormal way of treating our skin and this is why our skin is responding... its coupled with other things like houses nowadays are wonderfully dry. We have dry carpets, dry walls. And we have central heating and we have air conditioning. And our skin was not intended to be in that dry environment. It is really very abnormal. It's no surprise to me that we are responding by having all this dermatitis, and dry skin problems. Also we were never intended to live as long as I've lived. So as you get older, as I mentioned earlier, your skin does become dry your whole skin barrier becomes weaker. And our ancestors rarely lived beyond 70 or 80. And so once you get over 50, 60 already, you're moving into a time in your life when your skin is more vulnerable and the same activities that your skin could tolerate as a young person are no longer possible to live with.

Tony Winyard 34:32
And so therefore what should people of, 60, 70, 80 What should they be doing to help their skin?

Dr George Moncrieff 34:41
Well, if knowledge that the skin barrier is weaker, do they need to wash every day? And I think washing twice a week might be all that your skin needs. You need to clean the important areas that need cleaning like your bottom and in the groin and armpits and things but the rest of it does it need cleaning? Even Shaving, for example, I shave with an emollient, I don't shave with shaving foam, or soap at all, I can use a razor through an emollient and it's perfectly acceptable. It just glides through beautifully and I get a really nice close cut. You should be getting rid of the soaps and shower gels completely, I think and you should be washing with an emollient of your choice, but maybe have something in the shower so you don't fall over or something in the bath so you can get out safely. I don't want people to slip around and break their hips and things. Make sure you get plenty of vitamin D and getting a sensible amount of sunlight on your skin. Never burn. And whilst sunlight is unquestionably the single most important modifiable risk factor for skin cancer, the most important risk factors for skin cancer are the number of moles you've been born with or you develop in your teenage years typically, your family history, whether you've had a skin cancer before, and whether your immune suppressed, those are the the biggest things that drive whether you get skin cancer or not. You can't modify those so easily. So yeah, therefore sunlight does matter. But it also brings a lot of advantages. And so we need to be sensible about sunlight and just not burn but otherwise it's doing us quite a lot of good

Tony Winyard 36:29
and sun protection, some creams, they're harmful to the skin aren't they?

Dr George Moncrieff 36:35
Well there are worries there. Both the chemicals that are used as chemical filters... the EVA benzene. There are concerns that if you put them on the skin, they're absorbed and they hang around for not just hours, but days in the body, and they may have an impact on fertility. And then there are the mineral, physical reflectance that reflect light, things like titanium dioxide and zinc oxide. There are some theoretical concerns about those. So I have my reservations to be honest about sunblock. It does enable us to go out in the sun and not burn which is obviously the most important thing. But so does wearing thin cotton clothing and wearing a hat and protecting yourself with that sort of barrier. I'm a lot more keen on keeping in the shade if the sun's very hot or putting a hat on or putting a shirt on. Then just wearing your trunks and relying on sunblock.

Tony Winyard 37:46
We talked about the damage that soap can do to the skin. So is that the same for moisturisers?

Dr George Moncrieff 37:53
No not at all. Moisturisers i think is another word as far as I'm concerned for emollients and emollients just means nice and soft. So, both of these I think are, they're things like Aveeno and E45 and Diprobase and Doublebase and Oilatum there are loads and loads available and the Aproderm range are fabulous. And these are all moisturisers or emollients because they they don't degrease the skin they will re-grease it and they also preserve the surface pH and of course some of them are much much more sophisticated. Some of them contain humectants which are mimicking the body's own natural moisturising factors. In the skin barrier we produce a really important very large molecule called filaggrin, which stands for filament aggregating protein, it changes the shapes of the cells as they mature to the surface amongst other things. But then filaggrin breaks down into a large number of very, very small molecules, which are all natural moisturising factors. They all draw moisture, water to them, and they hold that moisture in the cell. So things like amino acids. But other things like Urea and urocanic acid, sodium pyrrolidone carboxylic acid, there are a lot of very small molecules that are all acids, which is how partly how you produce that acid mantle from the breakdown products of filaggrin. And so some emollients contain humectants, like glycerol or urea, or sodium pyrrolidone carboxylate which draw that moisture into the cell and hold it there. So the cell is full of water and pushed up tightly against its neighbours separated only by that wonderful lipid lamellar bilayer, and so sealing the skin and preventing bacterial pathogens, allergens and things getting in. And they contain other clever things as well like colloidal oat or vitamin b3 nicotinamide is an amazing molecule that we are discovering, has remarkable properties in the skin, augmenting the production of the lipid lamellar bodies that produce the lipid lamellar envelope, but also anti inflammatory properties renting the skin less itchy and less inflamed and controlling quite a few functions. So some contain niacin, amide. Others have hairspray in them povidone, polyvinyl peratallada and that just forms a very fine membrane you can't even see it on the surface of the skin and that just prevents water from escaping from the skin and extending the time that that moisturiser or emollient protects the skin from drying out. So lots of things that are added to the more sophisticated emollients to enable these sorts of additional properties and benefits.

Tony Winyard 40:53
So for the average person who doesn't know much about this Are there any harmful moisturisers? Or are most moisturisers Okay?

Dr George Moncrieff 41:05
The harmful ones are aqueous cream, because that contains sodium lauryl sulphate. And that should not go anywhere near anyones skin ever. And an emulsifying ointment which has 3%... aqueous cream has 1%, sodium lauryl sulphate. Emulsifying which has 3%. So I'd avoid those two completely. Then as a general rule, I'm not keen on creams that come only in a tub. Creams are quite thin, and there's no reason why they shouldn't have a pump to pump it out. If you've got it in a tub, the temptation is to put your fingers in that tub to get it out. And within a week that can then become infected with bad bacteria, you're then putting bad bacteria straight onto broken, damaged skin. And you can start getting problems with infection. So it should really come either ideally in a pump dispenser where you press the pump down and it squeezes out. Or, failing that in a quality tube. But the tubes often then suck air back in and then need high concentrations of preservatives to prevent the bacteria that come in with the air from contaminating it. So nothing beats having a quality pump. But some unfortunately don't use quality pumps. Either like... they don't recharge very quickly, they take about 20 seconds to recharge. So patients don't put enough on, or they just don't empty the bottle. So things like Avino, which is a wonderful emollient, I think one of my favourite emollients, but it's very wasteful because over a quarter is left in when you finished and when you can no longer pump any more out of it. So that's very extravagant. So harmful; aqueous cream, emulsifying ointment and possibly creams that come in a tub. ointments are so thick they all have to come in tubs. And so I just urge patients there to be sure to just take it out with a spoon which they can clean and dry in between. The other thing to be aware of is that virtually all emollients contain paraffin. And paraffin of course is flammable. And even if you've put it on your skin you then get to bed with some pyjamas on and you wear those pyjamas all night and then you wash those pyjamas; a panorama... a BBC programme about two years ago demonstrated that those pyjamas even after they'd been through a washing cycle in a washing machine are still significantly more flammable than pyjamas that haven't even been exposed to it. So emollients that contain paraffin; virtually all of them do. The only one I know that doesn't is Aproderm colloidal oat. But all the rest contain paraffin, paraffin could be dangerous.

Tony Winyard 44:08
And are there any that you would recommend?

Dr George Moncrieff 44:12
Yes, I'm allowed to? The emollients that I recommend? Well, at the end of the day, the emollient that the patient likes is the best emollient because that way you can be confident that they will use it. There's no point me saying this is the best emollient and they can't stand the feel of it and therefore don't use it. It doesn't work. So that's the most important thing. So I think patients should have a choice of emollient. But the emollients that if I was on a desert island I'd like to have with me include most of the Aproderm range, the Aproderm range by Fontus Health, I think are now excellent. They used to contain olive oil, and olive oil actually is bad for your skin. It's got too much oleic acid but they've taken it out now. So the Aproderm range, I think are excellent and Aproderm colloidal is probably my favourite. I really like Avino but I'm concerned about the pump as I've mentioned. But there's so many others. There are some that you can't prescribe things like Lipikar AP+ M Replenishing Balm made by LaRoche-Posay that's a really lovely emollient for eczema, and amongst other things, it contains the nicotinamide, the niacinamide the vitamin B3. But it also contains a bacteria, a healthy bacteria, which will help to restore the normal microbiome along with Selenium in the water that they use to make it. So lipikar balms another nice one, Septabene is good. It's got a high concentration of glycerol an humectant I like Oilatum its got poppy don in it and it's not very expensive. Oilatum cream, The Doublebase and both the ordinary Doublebase and Doublebase Dayleve are particularly nice ones the Dayleve has some Bovadone(?) as well. There's a new one called Adex which I think is very nice. It's Doublebase plus some nicotinamide, the niacinamide acid which is very nice anti inflammatory emollient. So that's another nice one. I could go on for about an hour if you wanted!?

Dr George Moncrieff 46:29
...very nice but that's very expensive. Hydromol ointment is a good ointment, it mixes with water very easily. Most ointments are too greasy and they won't mix with water but Hydromol is beautiful with water.

Tony Winyard 46:43
You talked about the temperature of water so I'm wondering how much of a difference it makes whether it's hot, warm or cold?

Dr George Moncrieff 46:50
No one wants to be in cold water very long. Hot water obviously will melt the body's natural oils off the skin more quickly. So generally someone's got a problem with their skin I suggest that they have a... bit more than tepid, a warmish, but not too hot, needs to be comfortably warm. And they should only really be in it for about five to seven minutes at most ideally. But I think that the hotter the water the more likely... and because hot water can become quite itching it can be quite sore and itchy if you're in it for too long. Particularly when you get out

Tony Winyard 47:28
Does cold water, apart from the fact that it's not comfortable for most people, but is cold water fine for the skin?

Dr George Moncrieff 47:36
Yeah, I think so. There are some cold induced skin problems people can get hives from cold rarely and it does cut down the blood supply to the skin. And you need a good blood supply to nourish the skin and to help it to produce the skin barrier and produce grease and everything else. So if it's cold for a long period of time that can make make the skin weaker, because in cold weather the air tends to be drier still, so cold weather can be bad, but cold water no i don't think that that particularly does any harm compared to just tepid water.

Tony Winyard 48:17
One of the reasons I asked that is because you talked before about being in water too long and I was thinking about people that say swim in the sea and so on?

Dr George Moncrieff 48:28
If they swim across the channel they cover themselves in lard or equivalent don't they? Before they do it to act a barrier to protect the skin and also to make them more slippery through the water? Yeah, I don't think it's ideal for the skin. Obviously, in salty water things are better than in freshwater for a long period of time. But I think if you're in a wet suit and in the sea doing things I don't think it does you any great harm or even in a lake does any harm for any period of time. Obviously if the skin becomes waterlogged. And you can get things like athlete's foot in that lacerated skin. But I'm not aware of any particular problem for being in cold water for a long time. Specifically,

Tony Winyard 49:13
If people want to find out more about you, where would be the best place to go?

Dr George Moncrieff 49:22
I suppose Google may come up with a few things, I don't think you would want to find out about me!

Tony Winyard 49:38
Is there any book that you often recommend to people?

Dr George Moncrieff 49:42
You know, you asked me that earlier and I don't specifically direct people to a particular book, but there is a book I think is absolutely brilliant. It's called Beyond Soap, by a lovely dermatologist from I think she's from Toronto, called Sandy Scott Niki. And she's researched the subject in such detail is it's a very, very readable book. And she sent it to me because she discovered that I equally hate soap. And she said, dermatologists working in the world of contact dermatitis particularly just sees just endless patients coming through with their skin that's been damaged by their lifestyle.

Dr George Moncrieff 50:38
And so she goes into some detail about how to just just look after skin and let it recover and return to its normal state, just leaving it alone.

Tony Winyard 50:52
I'll put that a link to that book in the show notes. And do you have any quotes that you like George?

Dr George Moncrieff 50:59
I can't think of any particular quotes that I've heard other people saying, but what I regularly say I think you'll have heard people quoting me saying is that "Your eczema will never get better if you don't stop the soaps and detergents". I think thats a simple message to remember if you don't stop with the soaps and detergents you cannot expect the skin to settle. Your eczema will... however much I put powerful treatments onto your skin or give you vitamin D or do anything else, it will still be a problem.

Tony Winyard 51:30
Well, I think that's a perfect quote to end on. So George, I really appreciate your time and the the knowledge that you've shared with us, and hopefully a few people will take action on some of the things that you said,

Dr George Moncrieff 51:42
I hope more than a few. I hope that the whole society will start realising that we need to change our washing habits. We are just seeing troops of people coming through to me with the consequences of our modern lifestyle and it has wrecked their lives that their skin is dry and uncomfortable and itchy it feels sensitive and they're much more vulnerable things.

Tony Winyard 52:08
Well, hopefully people will start taking action and this message will get out to more people.

Dr George Moncrieff 52:13
Well thank you for what you're doing. I really think that's excellent.

Tony Winyard 52:17
Thank you, George. Yeah. All right. Next week is Episode Seven with Ben Afia. And we learn about the importance of communication, and how we can improve our communication in many different areas in our business lives, in our personal lives, and the massive difference it can make, and he gives some really good examples of just how big a problem poor communication can be. So that's next week, episode seven with Ben Afia. If you did enjoy this week's show with Dr George Moncrieff, please do share it with anyone who you feel would get some benefit from it, especially if you know anyone with eczema. Why not leave a review for us Subscribe and I hope you have a great week.