Happy Vs Flourishing episode 6 is with Dr George Moncrieff an expert in Dermatology. Past Chair of the Dermatology Council for England. In this episode he explains the many reasons we should avoid soap and the problems it creates by washing our bodies with soaps.
He has over 30 years experience of Primary Care is a past trainer in General Practice and an undergraduate tutor at Oxford University and The Royal Free Hospital in Hampstead, London.
More information on this topic:
‘What I am careful to do, is to avoid using soaps and detergents, shower gels, and shampoos. I don’t use shampoo, I use a conditioner,”
[00:05:34] Detergents remove grease, disrupt skin’s pH, cause dryness, and trigger eczema.
[00:10:15] Washing habits can harm skin, be cautious.
[00:12:15] Different types of soaps have different effects. Harsh original soaps are damaging and have a high pH. Synthetic detergents are gentler. Some soaps and shampoos contain harmful chemicals. The scalp doesn’t need to be washed. Too much shampoo can dry out the skin.
[00:17:48] Skin absorption of vitamin D is important. Vitamin D has many functions in the skin, including the production of antibiotics. Adequate levels of vitamin D control the production of natural antimicrobial peptides. Vitamin D is a modified molecule that acts like a hormone and controls various functions in the body. Deficiency in vitamin D increases the risk of COVID.
[00:23:13] Surface is antiseptic, kills bacteria. Our skin has billions of bacteria. Our microbiome is important for our health. Eczema sufferers have abnormal skin barrier.
[00:25:37] Skin barrier damage increases virus penetration. Eczema exposes to dangerous herpes virus. Inflammation deactivates antimicrobial peptides. Coronavirus lacks skin receptors for invasion. Broken skin allows virus harbouring in cracks. Detergents kill virus with minimal exposure.
[00:30:45] Washing is important for pH and bacteria.
[00:32:40] Washing habits affect skin health and microbiome.
[00:37:53] Moisturisers are emollients that soften and protect skin.
[00:41:05] Harmful creams: aqueous, ointment, tub; paraffin is dangerous.
[00:44:17] “Choose emollients that patients like and use.”
[00:49:42] Book recommendation: “Beyond Soap” by Sandy Scott.
[00:52:23] Improving communication in business and personal lives.
Quote from George:
Quote from me: ‘Your eczema will never settle unless you stop using detergents’ or ‘Soap is a four-letter word in my household’
Book recommendation from George:
Beyond Soap by Dr Sandy Skotnicki ISBN 978-0-7352-3360-7
Happy Vs Flourishing links:
Tony Winyard [00:00:00]: Happiness versus flourishing episode 6. In this week's episode, we talk about showers, washing, and soap, and why those things shouldn't go together.
Tony Winyard [00:00:18]: Welcome to the podcast where we aim to give you ideas how you can improve your life in small ways with different experts talking every week on, subjects that help to improve your life in some way or other. And this week is Doctor George Moncrief 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'd know who suffer in some ways. and we'll 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 to show some more people, subscribe and get to get to hear the show on a regular basis. Hope you do enjoy it, and here's this week's episode.
Tony Winyard [00:01:15]: Welcome to another edition of Happiness Versus Flourishing. And my guest today is Doctor George Moncrief. How are you, George?
Dr George Moncrieff [00:01:22]: I'm very well. Thank you. Thanks for inviting me.
Tony Winyard [00:01:25]: Well, and and thank you for coming on because this is quite an important topic. And it doesn't this it doesn't get the
Dr George Moncrieff [00:01:34]: publicity or the, you know, the the exposure that it should do. I couldn't agree with you more. I think really is a message that we do need to get out and try and let more people know that subtle changes in their I could make enormous differences to how they feel and in particular into the health of their skin.
Tony Winyard [00:01:53]: I mean, I've I've read a few articles and I, and I saw, you know, you were interviewed on, was it this this morning, was it?
Dr George Moncrieff [00:02:01]: Yes. I have been on them a couple of times. Yes.
Tony Winyard [00:02:04]: Yeah. And it was, it was fascinating watching that. So for the, for the people who maybe haven't read the show notes and aren't aware of what we're talking about, so You're a firm advocate in the belief that we don't need to be using soap when when we shower on it.
Dr George Moncrieff [00:02:20]: Well, more than that, we need to avoid soap as much as we can. there's one caveat I have to say currently in that, we do need to use soap and detergent to kill the coronavirus. And so or what I said on, this morning, and then I got some rather strange social media comment was that I hadn't watched for 20 years. That was a year ago when I said that And I got some rather extraordinary look from Holly, I think. but, yeah, I I I do wash. I wash every day, but I make a point of avoiding soaps and detergents because they are remarkably unnatural and remarkably damaging to your skin. Uh-huh. But of course, now we've got coronavirus to worry about. And, yeah, we do need to use soap to kill the coronavirus. So you can modify the way in which you wash and get the best of all wells, but, we shouldn't be putting the detergents on our skin that we have been doing for the last 40, 50 years.
Tony Winyard [00:03:21]: Well, before we sort of dig deeper into that, I mean, how did you sort of discover this? Is it something that many doctors know about? I mean, how did you first get into this?
Dr George Moncrieff [00:03:31]: I think many doctors are conscious that detergent damage is given, but not I don't think necessarily the message has got through to the extent that, I believe it matters and and they should understand the the the problem arises really because if you look at our ancestors, they didn't wash. If you go back a 100, 150 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 what he wasn't soap in those days, but he only washed in a bath four times a year. And years ago, people just didn't wash. And our skin has never had an opportunity to evolve to cope with the 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 if you just look at the number of children, with eczema after the 2nd World War, when very few people were washing on a daily basis, it it was a an unusual habit, and people would perhaps wash once a week in the family bath in front of a spa or or whatever. It wasn't a a regular experience. Back then, 70 years ago, Only about 1 in 20 children had eczema. And we have seen that those numbers have increased relentlessly till now 1 in 4 or 1 in 5 children have eczema. and that's 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 [00:05:28]: And why is it that risk causes, how does it cause eczema?
Dr George Moncrieff [00:05:34]: 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 the skin has a couple layers. The the deeper down you have the dermis. And then above that, you have the thinner more delicate surface called the epidermis. Now the top left of the epidermis is where you have a 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 you don't dehydrate and also prevent bacteria, other bugs getting in and also allergens getting in. So detergents are designed to remove grease. And between the the cells and the very top layer of your skin, the critical the corneocytes, You have a fatty membrane, almost like a sort of a layer between them rather like cement and a brick wall. And This is made up of cholesterol and waxy materials called ceramides and all sorts of other fatty materials that sort of sit between the cells, sealing it between between those cells. And the turtles will rip that out. It's called the lipid lamellar byle. because these fat these fats often have very long non polar chains, which don't like water. And then they have little pearl and nodules at the end. and so they naturally orientate themselves into a bilayer where the the non polar chain ends point inwards. and then the polar ends point out was facing water. So forming this bilayer, so it's called a lipid lamellar bilayer. The only thing that detergents do is they, raise the pH of the skin. They render the skin alkaline. no 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. It's there for a really good reason. The asset mantle controls the activity of the body's natural enzymes, chemicals that break down the bonds that hold these skin cells together. So if you raise the pH from its normal acid mantle with PA of about 5.5 with a detergent, you can raise it up to about a PA of 8, which is a 1000 fold more alkaline than a PA of 5 point 5 and or or nearly a 1000. And that's activates. It doubles the activity of these enzymes. So they start breaking down the bones 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 information switches off the body's natural processes for producing that lipid lamellar bilayer. and for producing the acids that you need on the surface. And also the body's natural chemicals, there's a called natural moisturizing factors, that are within the cell and hold moisture there. So the whole process breaks down bacteria get in and that that triggers abnormal immune reactions that drive eczema.
Tony Winyard [00:08:44]: Right. And so if the people Well, I'm I'm wondering, you know, so you were mentioning this statistics for the number of people who get an ex eczema, but I'm guessing from what you were saying that even if people who don't have eczema are suffering, but they have they think they're fine.
Dr George Moncrieff [00:09:02]: Yeah. I'm I'm 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 heartache actually on the video because it's video consultations. I'm just seeing loads and loads of people who who just had no idea the the the reason why their skin is dry and itchy is because they're washing 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 lost people even without eczema are going around with dry itchy skin and have no idea. It's washing their skin that's causing the problem. And then the skin feels synthetic. It feels uncomfortable. call it another sensitive, and and they they don't and then the the night is spent scratching rather than sleeping.
Tony Winyard [00:09:59]: Well, I'm just wondering when you were just saying about those, patients that and you mentioned it about that it's the soap that's causing the eczema. What what are the kind of reactions you get from people when you say things like that? one of the first questions I asked somebody with dry skin or eczema is tell me, how do you wash?
Dr George Moncrieff [00:10:15]: And they all often look quite astonished by the question as if what what business is out 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, cleanliness is next to godliness. I think I'm clean. I I I wash every day, but I don't but detergents near my skin unless I want to get rid of the coronavirus. So, I I and I what I want to know is how do 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 alkali. So if you're in that water for more than 10 or 15 minutes, that will start to do harm. If you're in it for less than that, it's 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 back interior on its own. And you can wash most things off with water. and then what I want to know is are you using a shar 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 and the junction between the top left of skin epidermis and the deeper layer 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 tolerate when you're a teenager with with spots and greasy skin suddenly becomes something that dries out very quickly. It becomes very dry and itchy and unpleasant.
Tony Winyard [00:12:02]: And so you mentioned just then about are they, when they're washing their hair, there's the shampoo, drip down onto the skin. So Is there something is shampoo stronger than normal soap? What is it about shampoo then?
Dr George Moncrieff [00:12:15]: I don't know. I'm not sure it's necessarily stronger, And there are different sorts of soaps that the rich soaps were originally discovered properly in about the mid 19th century. prior to that, we didn't have much access to soap. And of course, soaps are designed to enable fat the fats on my skin to be mixed with water and then to be lifted off. So these harsh original soaps, which you often get in some simple soaps and and and and soap bars are particularly damaging. It can have a very high pH indeed. You then have the, synthetic detergents. sometimes called syndets, synthetic detergents, which are a much gentler. and then you can have combi bars or comb bars, which would cover combination of a half soap and and, a more synthetic gentler soap, which isn't quite so alkaline. So there are different sorts of soaps and things. but many, these agents like chargels and, shampoos contain chemicals that enable the soothing agent to lift off the fats even better, things like sodium, loral sulfate. which is present in in lots and lots of soaps and charge outs. And that is, 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. So 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. It's an emollient soap substitute. or a multiplying ointment, which is a thicker greasy ointment from which, a quick cream is made by mixing with water. so things that contain sodium chloral sulfate, which is a a soaping agent is, the the malsified enables fats to mix with water. are particularly damaging to the skin. But, no, I I don't like to, shampoo. Basically, you need to wash your hair. Otherwise, it'll smell I think it's very reasonable, but ideally wash your hair, but why are you washing your scalp? 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 and then just cause these eczema down there, which I see all the time.
Tony Winyard [00:15:05]: And so what about the you mentioned about shampoo. What about, hair conditioner?
Dr George Moncrieff [00:15:10]: Yeah. I don't mind hair condition. Actually, I use that's what I tend to use. I attend for the last 20 years, I've if you've ever seen a photograph of me, I haven't gotten yet, 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. Products haven't got much hair, but I 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 onto my body.
Tony Winyard [00:15:42]: So the condition is okay for the hair, but that's still -- Yeah. -- not
Dr George Moncrieff [00:15:47]: not advisable for the to the skin. It's basically anything that forms a foam will be lifting off the oil and will be relatively alkaline and causing damage.
Tony Winyard [00:15:59]: Mhmm. And and isn't it as well? 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 the with the COVID stuff.
Dr George Moncrieff [00:16:13]: That's interesting. I didn't know that soaps interfere with Bismond D I need to look that up, but I am certainly aware of how incredibly important Visman 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 there's little doubt that, vitamin d deficiency is 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 and 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 I think children certainly with bad eczema, and when you give them vitamin d and you correct the vitamin d deficiency, Suddenly, their eczema becomes much easier to control. It can often be all that they need to get their eczema back under control. But we lose we lose 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 [00:17:40]: And I just remember that the I was reading an article, and it it it said that soaks interfere with vitamin D absorption apparently.
Dr George Moncrieff [00:17:48]: Really? Absorption from the skin. I presume so. Yeah. Doesn't doesn't greatly surprise me. Vifmindy has a lot of important functions in the skin, amongst its functions. And did you know that in the deeper layers of the epidermis in what's called the stratum spinosum? and I'm I'm talking about a layer of the skin that in some parts of the body is a tenth the stick 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, you know, good 4, 5 millimeters, but that these are all the epidermis. And in the deeper layers of that from the stratum spinosum, you you are actually reducing over 1800 net antibiotics, chemicals like the defensins and catheterociden, and these are bodies natural antimicrobial peptides, And the production of those is controlled by the adequate levels of Bismond E. Bismond E is a remarkable molecule, and I I I've never seen a contrary to what I was taught at medical school about that there's a risk that you can become vitamin d intoxicated. I have never encountered that I think it can happen, but it's remarkable, yeah, likely. So almost takes as much vitamin d as you can get off the shelf. it's my current view. And the the vitamin D molecule actually isn't like corticosteroid is an elaboration of of a cholesterol molecule The body makes cholesterol, and that is modified to turn into steroids. both the sex steroids like testosterone, progesterone, estrogen, but also the the steroids that we call steroids, the body naturally needs and and uses to signal things and control inflammation in the body and control many other functions like salt and 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 it actually controls a large number of 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 is I've become vitamin D deficient.
Tony Winyard [00:20:15]: And you just reminded me, I I 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 the epidermis and the, you know, the layer of skin. And within that, I don't know if it was the epidermis or the dermis, is our
Dr George Moncrieff [00:20:37]: Milanocytes. The little the melanocytes, are your melanin producing cells, and they rest on the basement membrane. which is what the epidermis sits on as well. So the the the sitting in the basal layer of the epidermis, the melanocytes, But these remarkable cells, which migrate to the skin quite late in the in the life of an embryo, and and a bit later still. they have very long finger like processes that extend up into the higher layers of the epidermis initially communicate with virtually every cell in the epidermis. So they have these little finger 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 melanosomes. And then the epidemocytes actually suck that into the melanocytes suck it into their own cell, structure, the cytoplasm. And then they release these little packets of melanin in these melanosomes 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? That's so clever. So that that's the melanocytes. And and your melanocytes produce different sorts of Melanin's. There's brown umelanin, there's black umelanin. that's our ancestors migrated to latitudes where the sunlight was weaker somewhere between
Tony Winyard [00:22:21]: 15 200000
Dr George Moncrieff [00:22:22]: years ago, we have evolved to make a deliberately weaker melanin called fear melanin, which is pink and therefore gets 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 up too much by having dark skin. It's very, very interesting concept. I I could go on about that in a lot more detail, but that's not the purpose of today's talk.
Tony Winyard [00:23:03]: It's fascinating. Yeah. And, and there was, there's something else that, again, in any article I read about this soap effects on microbiome?
Dr George Moncrieff [00:23:13]: Yeah. It does. surface is powerfully antiseptic, so it will kill bacteria. And We have about a 1,000,000 bacteria living on our skin in, in every centimeter of our skin a million the total number of bacteria on the healthy person's skin is is 10 to the 9. There's 10 but 9 naughts after it. So 1,000,000,000,000 and 1,000,000,000. In fact, in your body, if I include the bacteria in your gut, there are ten times more bacteria in your body, bacterial cells, and there are cells of you, Toni. it's a 10 to 1 ratio of bacteria to you as far as cells are concerned. Fortunately, these cells have have got tiny. So they're any way about 4 or 5 kilograms at most. but you we're all going around with this huge bacterial load, and it's incredibly important. We only really begin to realize how important our micro biome is both in the gut and on the skin. But -- Yeah. -- so we'll 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 skin is abnormal. all their skin has a higher pH. And they have much they're much more likely to be colonized with bad bacteria, things like staph aureus, which causes oils and causes eczema flares. People without eczema, it's only about 1 in 10 or 1 in 5, are carrying a staff, a bad staff. that staph aureus is bad bacteria. And we normally have a between
Tony Winyard [00:24:53]: 205100
Dr George Moncrieff [00:24:55]: different types of bacteria on our skin. And we have different patterns and balances of these bacteria in different parts of our body, whether it's your armpit or your foot or your or your nose or your side of your nose or your head. And that diversity is lost in eczema, and 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 they actually preserve and build up that skin barrier I mentioned at the beginning.
Tony Winyard [00:25:26]: And you said that makes it more open to being attacked by bad bacteria. So would that include things like viruses?
Dr George Moncrieff [00:25:37]: I think if if the skin barrier is is damaged, then viruses do have a better chance of getting in. and and the notable one is the herpes virus in eczema, which can cause a really, really frightening and dangerous acute rash called eczemaherpeticum. that that actually also is if the skin becomes inflamed, you switch off as antimicrobial peptides I mentioned earlier. And they're the things you actually need to prevent exomeherpeticum 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 laid the patient vulnerable to exemapeticon. 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 ACE 2 receptor. And fortunately, there are very, very few ACE receptors or ACE 2 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. Those receptors are 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 harbor viruses in the cracks in your skin. And if your face also is sore, you're going to have your face 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 gonna be less inclined to wash your skin with things because you know that that makes it even more sore. But the the the coronavirus has the same lipid lamellae envelope, the envelope of the coronavirus, is also a lipid lamellae by envelope, and the spike proteins are attached to the to the outside of that. And so detergents have to say are really good at ripping out our own lipid lamellae by envelope between the cells. rapidly break down the coronavirus lipid lamellae by envelope and kill it. So very minimal exposure to detergents will kill the coronavirus.
Tony Winyard [00:27:59]: Right. And so hence why, we always been told to wash our hands all the time, and so
Dr George Moncrieff [00:28:06]: I used to say, well, sanitizing is is if you're up and about, it can be more convenient, but, you've gotta use 90% alcohol to have any benefits at that level the alcohol is pretty damaging to the skin barrier too. The ideal is is is, and for years, I said wash with an emollient, but I wouldn't want to do that nowadays because Desimersen will coat that lipid lamellar by envelope of the coronavirus and just protect it. So I've had to amend my ways, and I'm 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 ripping 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 then having killed the virus and then washed the emollient. Any simple emollient doesn't matter what you use. that will mix with water nicely and will restore some of that fatty layer, but most importantly, it will restore the pH and then you rinse that off prior hands, and then I think you should then put on another emollient afterwards. And by doing it that way, you can prevent all the all 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 [00:29:31]: Would that just damage the hand in, or would that would that spread to anywhere else if you were just using it on your hands?
Dr George Moncrieff [00:29:37]: Oh, if you're just using it on your hands, it'll probably only damage the hands. But if that were to let in cause a break, you know, then more vulnerable to developing a contact allergic dermatitis. We're talking here about sort of contact irritant dermatitis from the the irritant effect of the detergent causing a localized dermatitis. 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 become allergic to can cause quite marked reactions and dermatitis elsewhere. mostly on the face where the skin barrier is thinnest and weakest.
Tony Winyard [00:30:18]: I mean, a couple of questions I can imagine many people thinking at the moment, you know, because we're all been brain conditioned, I guess, to, to, you know, think that using soap is something we obviously have to do. so the three questions that come to mind, and I'm guessing you probably receive far more than these 3 that I'm going to ask are, why don't you smell terrible? Why don't you look dirty and Why don't you get sick, maybe?
Dr George Moncrieff [00:30:45]: Right. Well, I I hope I don't smell. I I but I do wash. I wash every day. but I wash within a 1,000,000. And so I am regreasing 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 to be to stay on the skin, which is what you want. And it's actually very good at killing. It's antiseptic for those bad bacteria, things like staph. So that pH is incredibly important for a whole host of reasons which is why the bodies evolve to have it. but I I I do wash and I wash very thoroughly and I wash with an emollient and it's lovely feeling when you, in the shower and you're washing with it. You do need to be careful. I will render you and the shower tray or the bath extremely slippery. So you gotta be very careful. And, of course, putting at a moment, which will then go down into the drains. It can clog up the drains and probably clog up the sewers. So I do boiling water down once a week or but put soda crystals down the char tray, but not not not onto my skin, of course, to try 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 about per month and you couldn't wash. You'd be amazed how wonderful your skin would look and how wonderful your hair would look. Initially, we get a bit greasy and then calm down. And as the skin microbiome begins to recover and this and the whole grease gland activity just balances back out again. it'll end up looking wonderful. And and it it doesn't, interestingly, it doesn't smell because your microbiome becomes the normal healthy microbiome. is bad bacteria that tend to produce offensive smells.
Tony Winyard [00:32:32]: And and isn't it, I've I've heard the body odor is more about what we eat rather than you know, what's on my skin?
Dr George Moncrieff [00:32:40]: I think that has a big part to play this as well. Yes. So that comes out in your sweat and your and and and and turn me into your armpits and things like that. And certainly, if I've had, anything with garlic, you know that things like eating your sweat can smell a bit of garlicy. Yep. So you start as a big part to play, but I think it's a lot to do with the bad bacteria. And, just maintaining a healthy microbiome is is how this 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 of mankind who've been on the planet 2 and a half 1000000 years. So it no. Our our ancestors just didn't wash, and our skin was if you were meant to be washing like we are today, we would have fish scales. the skin the skin cannot cope with this demand. And and it's very, very abnormal, way of of treating our skin. And and this is why our skin is responding. It it's coupled with other things like, houses nowadays are wonderfully dry. We have dry carpet, dry walls. and we have central heating, and we have air conditioning. and a scheme was not intended to be in that dry environment. It it is 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 don't intend to live as long as I've lived. So as you get older, as I've mentioned earlier, your skin does become drier. Your whole skin barrier becomes weaker, and our access is rarely lived beyond 70 or 80. And, once you get over 50, 60 already, you're you're moving into a time in your life when your skin is more vulnerable. And the same activities that you could skincare Torres as a young person are no longer possible to to live with. And so therefore, what should people
Tony Winyard [00:34:34]: of 60, 70, 80, what what should they be doing to help this skin?
Dr George Moncrieff [00:34:41]: Well, acknowledge that the skin barrier is weaker. do they need to wash every day? I think washing twice a week might be all that your skin needs. you need to clean, you know, the the important air is it needs cleaning, like, your bottom and and in the groin and armpits and things, but the rest of it, does it need cleaning? even shaving, for example, I shave with a mammalian I don't shave the shaving foam, or soap at all. I I I use a a a razor through and emollient, and it's perfectly acceptable. Just glides through beautifully and gives a really nice close cut. you should be getting rid of the the the soaps jar gels completely, I think, and you should be washing with and the merlin to your choice, but be have a maybe have a shower mean, the chart rates 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're getting 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 to for skin cancer. The most important risk practice was skin cancer. the number of models you've been born with, or you can develop in 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, yep, therefore, sunlight does matter, but it also brings lots of advantages. And so we need to be sensible about sunlight and just not burn, but otherwise, it's doing you quite a lot of good.
Tony Winyard [00:36:29]: And doesn't, sun protection, that's on cranes. they're harmful to the skin, aren't they?
Dr George Moncrieff [00:36:35]: Well, there are worries there. both the chemicals that are used as chemical filters like the Ava Benzene there are concerns that they are 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 the the the the the mineral physical reflectance that films reflect light, things like titanium dioxide and zinc oxide. and there are some theoretical concerns about those. So I have my reservations, to be honest, about Sun Block. 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 and wearing a hat and protecting yourself with a with that sort of barrier. I'm not more in 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 [00:37:46]: We've talked about the the damage that soap can do it skin. So is that the same for moisturizers?
Dr George Moncrieff [00:37:53]: No. Not at all. No. Moisturizers, I think, is another word as far as I'm concerned, for emollient and and it just means nice and soft. so both of these, I think, are, there are things like Avino and, E45 and DIPpro Basin, double bass, and oylate under the loads and loads available and the acronym range which are fabulous. and these are all moisturizers or emollients because they they don't degrease the skin. They will regrease it and they also preserve the the surface pH. because some of them are much, much more sophisticated. Some of them contain humectants, which are mimicking the body's own natural moisturizing factors. In the in the skin barrier, we produce a really important very large molecule called filagrin which stands for filament aggregating protein. It it changes the shapes of the cells as as they mature to the surface amongst other things But then fernagron breaks down into a large number of very, very small molecules, which are all natural moisturizing as they all draw moisture water to them and they hold that moisture in the cell to things like amino acids, but, other things like your rear, you, and your acanic acid, sodium, prod link, carboxylic acid. there are a load of very small molecules that are all acids which is partly how you produce that acid mantle from the breakdown products of PhilAGrin. And the and so some emollients contain humectants like glycerol or urea, or sodium throttling carboxylate, which draw that moisture into the cell and hold it that So the cell is full of water and and pushed up tightly against its neighbors separated only by that wonderful lipid LaMela by there. and so sealing the skin and preventing bacteria, pathogens, allergens, things getting in. And then they contain other clever things as well, like colloidal oat or Bittamin B3 Nicotinamide is an amazing molecule that we're discovering has remarkable properties in the skin. augmenting the production of the lipid lamellae bodies that produce a lipid lamellae envelope, but also anti inflammatory properties, rendering skin less itchy less inflamed and controlling quite a few functions. So some contain nicotinamide or nicotinic acid. Sorry, niacinamide. Others have hairspraying them, Poppydone, polyvinylporadolone, and that just forms a 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 and extending the time that that's a moisturizer emollient to protect the skin from drying out. So lots of things are added to the more sophisticated emollients to enable these sorts of additional properties and benefits.
Tony Winyard [00:40:53]: So how would, I mean, the average person who doesn't know much about this? What are there? Are there any harmful moisturizers or Is it most moisturizers okay?
Dr George Moncrieff [00:41:05]: The harmful ones are aqueous cream because that contains sodium Laurel sulfate. and that should not get anywhere near anyone's skin ever. And a mask fine ointment, which has 3% an acreage screen has 1% sodium and oral sulfate. the mask weight, which has 3%. So I'd avoid those 2 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. And you're then putting bad bacteria straight on to broken damaged skin and people can start getting problems with the infection. So if you it it should it should really come either. The the ideally in a in a pump dispenser where you press the pump down and and and it squeezes out, or failing that in a 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 in redone, they don't recharge very quickly. They take about 20 seconds to recharge. So patients don't enough on or They just don't empty the bottle. So things like a Vener, which is a wonderful emulators. I think one of my favorite emolents, 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, a aqueous cream in multiplying ointment and possibly creams that come in a tub. ointment 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 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 put on your skin, you then get to bed with some pajamas on and you wear those pajamas all night, and then you wash those pajamas. A panorama, I think there's no there's a there's a BBC program 2 years ago demonstrated that those pajamas, even after they've been through a washing cycle and a washing machine, are still significantly more flammable than pajamas that haven't even been exposed to it. So detergents are, I'm sorry, the the merleons that contain paraffin can virtually all of them do. The only one I know that doesn't is acronym colloidal oat. but all the rest contain paraffin and paraffin can be dangerous.
Tony Winyard [00:44:08]: And are there any that you would recommend?
Dr George Moncrieff [00:44:12]: Yes. I'm allowed to.
Tony Winyard [00:44:14]: Yeah. Of course.
Dr George Moncrieff [00:44:17]: So the emollients that I recommend, well, at the end of the day, the emollients that the patient likes is the most is the best emollient because that way you can be confident that they will use it. there's no point in saying this is the best emollients 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, in include most of the Aprodigm range. The Aprodigm 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 of leic acid, but they've they've taken it out now. so the apiderm range I think, are excellent. An acronym colloidal is probably my favorite. I really like Avina, 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 Lipicar Barm, AP plus made by La Roche Posay, that's a really lovely emollient for eczema. and amongst other things, it contains the nicotinamide. the niacinamide that this would be 3, 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 lipicar balms is another nice one. Cetroben is is good. It's got a high concentration of glycerol, it's a humectant, I like or Latam, it's got Poppydone in it, and it's not very expensive or Latam cream. The double bass and, both the ordinary double bass and double bass day leave are particularly nice ones. The day leave has some providone as well. There's a newest one called Addex, which I think is very nice. It's, double bass plus some nick niacinamide or nicotinic acid. I'm sorry. Niacinamide, which is a very nice anti inflammatory emollient. So that's another nice one. I could go on for about an hour if you wanted. very nice, but that's very expensive. Honeywell ointments are good, but it mixes with water very easily. as the most ointments are too greasy, and they went mixed with water hydraulics is beautifully water.
Tony Winyard [00:46:42]: earlier on, you you talked about the temperature of water. So I'm wondering how much of a difference it makes where hot warm or cold?
Dr George Moncrieff [00:46:50]: No one wants to be in cold water for 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 a bit more than tepid. A warm is sharp, but not hot. It needs to be comfortably warm, and it should only really be in it for about 5:5 to 7 minutes at most. ideally. but I think that the hotter the water, the more likely, and and because hot water can become quite itching. It can make skin quite sore on achieve. You're in it for too long, particularly when you get out.
Tony Winyard [00:47:27]: And there's there's cold water. I mean, apart from the fact that it's not comfortable for most people, but is cold water fine for this skin?
Dr George Moncrieff [00:47:36]: Yeah, I think so. And there are some cold induced skin problems where people can get hives from cold rarely. And it it does cut down the blood supply to the skin. So and you needed the blood supply to nourish the skin and and help it to produce skin barrier and produce grease and everything else. So it's it's cold for a very long period of time that can make make the skin weaker. And because in in cold weather you 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 [00:48:17]: One of the reasons I asked that is because you you you talked before about being, in water too long. So thinking about people that say swim in the sea and and so on?
Dr George Moncrieff [00:48:27]: Well, if you notice, they generally cover the views. If you go across a channel. They cover themselves in large or equivalent, don't they, before they do it, to act as a barrier, to protect the skin, and also to make them more slippery through the water. Yeah. I I I I don't think it's ideal for the skin. I, obviously, in salty water things are better than in in freshwater for a long period of time. but I I think if you're in a wet suit and in the sea doing things, I don't think it does do any great harm or even in the lake, does any harm for any period of time. Obviously, the kit becomes waterlogged and you can get it, things like athlete's foot in that macerated skin, but I'm not aware of any particular problem for being in cold water for a long time specifically.
Tony Winyard [00:49:13]: George, if people want to find out more about you, where would be the place to go to. About me.
Dr George Moncrieff [00:49:22]: I suppose Google come up with a few things there.
Tony Winyard [00:49:26]: Yeah.
Dr George Moncrieff [00:49:28]: I don't think you want to find out about me. I -- k. It's a nice spot.
Tony Winyard [00:49:36]: And and do you have, do you is there any book that you often recommend to people?
Dr George Moncrieff [00:49:42]: do you know, you asked me that earlier, and I I realized that I I don't specifically direct people to a particular book, but there is a a book I think is at absolutely brilliant. I've got it just here. where is it? It's called Beyond soap. Yeah. I a lovely dermatologist from I think she's from Toronto called Sandy Scott, Scott Niki, and she's she's I she's researched the subject in such detail. It's it's it's a very, very readable book and she she sent it to me because she discovered that I equally hate soap. and she is a dermatologist working in the world of contact dermatitis, particularly just sees just endless patients coming through with their skin that's being damaged by their lifestyle. And so she goes into some detail about how to just just look after skin and and let it recover and return to its normal state. Just just leaving it alone.
Tony Winyard [00:50:51]: Well, and, well, I'll put that a link to that booking in the show notes. And do you have any, any, any quotes that you like, George?
Dr George Moncrieff [00:51:02]: I I I can't think of any particular quotes that I've heard other people saying, but, what I regularly say, I think people have heard people quoting me saying is that your your eczema will never get better if you don't stop the soaps and detergents. I think I said just a simple message to remember. If you don't stop the soaps and detergents, you cannot expect your skin to see settled. Your export will however much I put powerful treatments onto your skin that'll give you vitamin d or do anything else, it will still be a problem.
Tony Winyard [00:51:30]: Well, I think that's a perfect quote to end on. So George, I really appreciate your time and, and the, the knowledge that you shared with us. And hopefully, a few people will all take action on some of the things that you said. hope more than a few. I hope that the whole of society will start realizing that, we need to change our,
Dr George Moncrieff [00:51:48]: washing habits because we We are are just seeing troops of people coming through to me with the consequences of our modern lifestyle, and it and it just wrecked their lives that they the skin is dry and uncomfortable and itchy, it feels sensitive, and they're much more vulnerable to other things, like concrete dermatitis.
Tony Winyard [00:52:08]: Well, hopefully, that people will start to take an action, and, and this message will get out to more people with, with a bit of math. So -- Thank you for what you're doing there. I really think that's Thank you, George. And,
Dr George Moncrieff [00:52:19]: yeah. All the payments. Bye bye.
Tony Winyard [00:52:23]: Next week is episode 7 with Ben Affia, and we learn about the importance of communication and how we can improve our communication in many different areas in in our business lives, in our personal lives, and the the massive difference it can make and he gives some really good examples of just how big a problem poor communication could be. So that's next week's episode episode 7 Ben Affia. If you did enjoy this week's show with Doctor George Moncreek, please do share it with anyone who you feel would get some benefit from it. Anyone you know with eczema, why not leave a review for us, subscribe? And I hope you have a great week.
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